PECULIARITIES OF MORPHOLOGICAL CHANGES OF TISSUES AFTER HERNOPLASTIC DURING RECURRENCE OF POSTOPERATIVE VENTRAL HERNIAS

Abstract

Considering the results of surgical treatment of postoperative ventral hernias, a significant number of relapses, comprising 4.3-46 %, should be noted, and for large and giant postoperative ventral hernias reaches 80 %. The lack of clear criteria for assessing the local response of the tissues of the anterior abdominal wall to the implantation of various types of mesh implants and the associated early wound postoperative complications and relapses prompts further study of the morphological features of the anterior abdominal wall tissue responses in patients with primary and postoperative ventral hernias. Aim of the study: to establish morphological patterns of the restructuring of the tissues of the anterior abdominal wall in patients with recurrent ventral hernia. Material and methods. An in-depth comprehensive clinical, instrumental and laboratory examination of 1419 patients with primary and postoperative ventral hernia was performed. There were 250 patients with recurrent ventral hernia (17.62 %). Results and conclusions. The use of a “light mesh” in patients with recurrent postoperative ventral hernia in the presence of concomitant NDCT appears to be significantly less lymphohistiocytic and leukocyte infiltration for the surrounding tissue, and reduces the likelihood of postoperative complications. Morphological changes in the tissue of the anterior abdominal wall with NDCT strongly indicate a disorder of its architectonics. It is clinically reflected in the formation of postoperative and recurrent hernias. Separate muscle fibers lose cross striation. In the muscular aponeurotic component without signs of connective tissue dysplasia, the application of various types of nets leads to the formation of elastic and collagen fibers, with minor changes in their architectonics and minimal cell infiltration of the immune inflammation of the extracellular matrix. Disintegration, destructive-dystrophic changes in the architectonics of the connective tissue were observed in patients with signs of NDCT in relapses. When using the “heavy” mesh, significant disorientation, collagenolysis, reduced synthesis of all types of collagens, the phenomenon of thickening of elastic fibers and elastolysis were observed. Inflammatory infiltration, triggered by immune inflammation cells, increased mucoid and fibrinoid edema, which led to homogenization, local lysis, and focal tissue destruction.