MORPHOMETRIC FEATURES OF CHANGES IN THE MUSCLES OF THE ANTERIOR ABDOMINAL WALL AFTER IMPLANTATION OF THE CAPROMESH MESH COMBINED WITH PRP IN THE EXPERIMENT

Abstract

Summary. Despite the use of meshes and other improvements, currently popular methods of surgical treatment of diastasis recti of the abdominal muscles and umbilical hernia have certain disadvantages and risks, especially in the group of patients with morbid obesity. The priority surgical intervention for diastasis and umbilical hernia under the conditions of morbid obesity is the performance of E-Milos video assisted operation. However, this type of procedure does not involve suture or stapled fixation of the mesh in the retromuscular space, which can lead to a number of complications. The analysis of the obtained results determines the relevance of this study.
 Purpose. Carry out a quantitative morphometric assessment of the changes in the arteriomuscular-aponeurotic layer and muscles of the abdominal wall under the conditions of the E-Milos operation using meshes based on e-caprolactone treated with PRP (plasma enriched with growth factors) in the experiment.
 Materials and Methods. The morphometric study involved the analysis of the muscles of the anterior abdominal wall after the implantation of the Capromesh based on e-caprolactone treated with PRP into the retromuscular space under the light-optical examination of micronutrients. Experiments were conducted on 16 sexually mature male Vietnamese pigs, which were divided into 4 groups.
 Results. Measurements made in a group of intact animals showed that the outer diameter of small-caliber arteries was equal to (35.40±0.39) μm,, the inner diameter was (16.95±0.15) μm, the media thickness was (6.36±0 .06) μm, the Kernohan index (the ratio of the area of the lumen to the entire area of the vessel) was (22.90±0.18) %. The height of the endotheliocytes of these vessels reached (6.12±0.06) μm, the diameter of their nuclei – (3.12±0.03) μm. The nuclear-cytoplasmic ratio in the studied cells was equal to (0.260±0.003).
 The thickness of the media of small caliber arteries on day 7 of the experiment increased from (6.38±0.06) μm to (6.60±0.06) μm, i.e. by 3.4 % (р<0.05), and adventitia thickness – by 24.7 % (р<0.001). Thus, the Wogenvoort index increased from (436.20±4.20) % to (513.90±4.50) %, i.e. by 77.7 %. It is also worth noting that the given morphometric indicators were statistically significantly (p<0.001) different from each other.
 On day 14 of the experiment, the relative volume of damaged endothelial cells was (4.20±0.03) %. This morphometric parameter exceeded the similar control by 1.8 times (p<0.001). The morphometric parameters of the small-caliber arteries of the soft tissues of the anterior abdominal wall of male Vietnamese pigs on day 21 of the experiment did not differ significantly from similar quantitative morphological indicators of the control observations.
 Conclusions. On day 14 of the experiment, the structural rearrangement of small-caliber arteries did not significantly differ from similar vessels of control observations. The relative volume of damaged endothelial cells was equal to (4.20±0.03) %. The morphometric parameters of the small-caliber arteries of the soft tissues of the anterior abdominal wall of male Vietnamese pigs on day 21 of the experiment did not differ significantly from similar quantitative morphological indicators of the control observations.
 On day 21 of the experiment, the nuclear-cytoplasmic ratio in the studied muscle structures was equal to (0.055±0.002), and the given morphometric parameter did not differ from the similar control, which indicated the preservation and stability of cellular structural homeostasis.