Morpho-functional assessment of different methods of separation of the abdominal wall at increasing abdominal cavity

Abstract

The aim of the study was to investigate the effect of different methods of anterior abdominal wall separation on the increasion of the abdominal cavity volume (ACV) for the prevention of compartment sindrome. The effect of Novitsky posterior separation (Transversus Abdominis Release – TAR), Ramirez anterior separation and Ramirez anterior separation with the mobilization of posterior wall rectus sheath (R+MPRS) on increase ACV was studied. The study was conducted on autopsy materials of 30 non-fixed corpses. In the first part of investigation the results of Novitsky operation have been studied (n=10), in the second part – of Ramirez operation (n=10) and in the third part – R+MPRS (n=10). The ACV have been determined before and after surgery and the degree of it’s increasion after each operation have been counted. In Ramiraz's separation the average of ACV before the operation was 3.2±0.2 L, after the operation – 4.06±0.2 L with an average increasion in volume of 27.8±2.6%. In Novitsky operation the average of ACV before the operation was 3.1±0.1 L, after the operation – 3.9±0.1 L, with an average increasion of 24.2±1.7%. In Ramiraz + MPRS the average of ACV before the operation was 3.1±0.08 L, after the operation – 4.7±0.22 L with an average increasion of 49.8±4.6%. The study revealed different effects of the three types seperation of the abdominal wall on increasion the ACV. The operation of Ramiraz+ MPRS has the greatest effect on the increasion the ACV (49.8±4.6). The results were successfully used in the choice of the type of operation in 8 patients with large ventral hernias.