MORPHOLOGICAL JUSTIFICATION OF RETROMUSCULAR ALLOPLASTY IN DIASTASIS OF RECTUS ABDOMINAL MUSCLES

Abstract

Background. Diastasis of the rectus abdominis muscles weakens the white line and contributes to the occurrence of defects with the formation of white line hernias and umbilical hernias. In our opinion, the study of the morphological features of the anterior and posterior aponeurotic walls of the rectus abdominis will make it possible to justify alloplasty, which will increase the effectiveness of surgical treatment of diastasis of the rectus abdominis. Aim: Justification of retromuscular alloplasty of diastasis recti abdominis by studying the morphological features of the anterior and posterior aponeurotic walls of the sheath of the rectus muscle Materials and methods. A comprehensive pathomorphological study of the anterior and posterior aponeurotic walls of the rectus abdominis muscles was conducted in 34 patients (the main group) with diastasis recti who underwent surgical treatment. The comparison group consisted of 32 patients with gallstone disease without diastasis recti who underwent laparoscopic cholecystectomy. The obtained material was examined using histological, histochemical, immunohistochemical, morphometric, statistic methods. Results. In a comparative analysis of the morphological indicators of the front sheet of the sheath of the rectus abdominis muscle with the corresponding indicators of the back sheet in the main group of patients with diastasis of the rectus abdominis, the specific volume of the vascular-fibrous component was more important, the specific volume of adipose tissue and the specific volume the volume of the cavities was less important. The obtained pathomorphological data emphasizes that the front sheet of the sheath of the rectus abdominis muscle in diastasis is mechanically stronger compared to the back sheet. The posterior aponeurotic sheet of the vagina of the rectus muscle in case of diastasis is more prone to ruptures, which is evidenced by the greater value of the specific volume of the cavities in the posterior sheet. Conclusions. Morphological changes of the aponeurotic leaves of the sheath of the rectus abdominis in patients of the main group with diastasis of the rectus muscles in comparison with the comparison group without diastasis differ significantly in the detected changes, the results of the morphological study of the anterior and posterior aponeurotic walls of the rectus muscle in their diastasis indicate the fact that the back walls are thinner, branched , with a decrease in the vascular-fibrous component compared to the front ones, which justifies the strengthening of the back aponeurotic walls by means of retromuscular alloplasty during the surgical treatment of diastasis.