MORPHOLOGICAL RESPONSE TO IMPLANTATION OF A POLYPROPYLENE MESH WITH A PRF MEMBRANE IN PATIENTS WITH POSTOPERATIVE VENTRAL HERNIA AND UNDIFFERENTIATED CONNECTIVE TISSUE DYSPLASIA
Background. Current herniology promotes the widespread usage of mesh implants in the primary treatment and, especially, in the for postoperative ventral hernias.
Objective. The aim of the research was to study the morphological response of the tissues of muscular aponeurotic layer to implantation of a polypropylene mesh with using PRF membrane-enriched platelets in the patients with postoperative ventral hernia and concomitant undifferentiated dysplasia of connective tissues.
Methods. The research involved 98 patients with postoperative ventral hernia, who underwent retro-muscular alogernioplasty by the Sublay technique of implantation of ‘light’ meshes, and a ‘light’ polypropylene mesh (PPM) in combination with a platelet-rich fibrin (PRF) membrane. The patients were divided into experimental groups according to the presence of undifferentiated connective tissue dysplasia syndrome.
Results. Microscopic studies carried out after the implantation of a polypropylene mesh with a PRF membrane has proved that structural changes in connective tissues are like those of a polypropylene mesh, but they are less significant. There was a leukocyte infiltration near the mesh material, but its area was small. The enlargement and blood filling of the vessels of microcirculatory channel was a manifestation of the increased vascularization of this area.
Conclusions. The usage of a polypropylene mesh in combination with a PRF membrane in the surgical treatment of postoperative ventral hernias reduces inflammatory changes in the tissues significantly and increases the activation of fibroblasts and signs of collagen fibers around the mesh material that is relevant especially for the patients with connective tissue pathology.
Liang MK, Holihan JL, Itani K, Alawadi ZM, Gonzalez JR, Askenasy EP, Ballecer C, Chong HS, Goldblatt MI, Greenberg JA, Harvin JA. Ventral hernia management. Annals of surgery. 2017 Jan 1; 265(1):80 9.
Eriksson A, Rosenberg J, Bisgaard T. Surgical treatment for giant incisional hernia: a qualitative systematic review. Hernia. 2014 Feb 1;18(1):31-8.
Kingsnorth A. Operation hernia. Hernia, Abstract book, 5th international hernia congress the world hernia celebration. New York, USA. 2012. 16(1). 73 р.
Winsnes A, Haapamäki MM, Gunnarsson U, Strigård K. Surgical outcome of mesh and suture repair in primary umbilical hernia: postoperative complications and recurrence. Hernia. 2016 Aug 1;20(4):509-16.
Fedoseev AV, Chekushin AA. Undifferentiated connective tissue dysplasia how one of possible mechanism of external hernias formation. IP Pavlov Russian Medical Biological Herald. 2010;18(3):125-130. [In Russian].
Miron RJ, Fujioka-Kobayashi M, Bishara M, Zhang Y, Hernandez M, Choukroun J. Platelet-rich fibrin and soft tissue wound healing: a systematic review. Tissue Engineering Part B: Reviews. 2017 Feb 1;23(1):83-99.
Kobayashi E, Flückiger L, Fujioka-Kobayashi M, Sawada K, Sculean A, Schaller B, Miron RJ. Comparative release of growth factors from PRP, PRF, and advanced-PRF. Clinical oral investigations. 2016 Dec 1;20(9):2353-60.
Goschinskij VB, Prodan AM, Pjatnichka OZ. Morphological, clinical and biochemical parallels of connective tissue dysfunction in patients with varicose veins of the lower limbs. Scientific Bulletin of Uzhhorod University. Series Medicine. 2014;49(1):59-64. [In Ukrainian].
Heniford BT, Ross SW, Wormer BA, Walters AL, Lincourt AE, Colavita PD, Kercher KW, Augenstein VA. Preperitoneal ventral hernia repair: a decade long prospective observational study with analysis of 1023 patient outcomes. Annals of Surgery. 2018 Aug.
Piatnochka V. Determination of specific symptoms of non-differentiated dysplasia of connective tissue in patients with postoperative ventral hernia with the substantiation of the optimum method of operational intervention and prosthetic type. Hospital Surgery. 2017 Jul;(2):43-9. [In Ukrainian].
Piatnochka VI. Morphometric characteristics of changes in the anterior abdominal wall muscles after implantation of polypropylene meshes of different types in experiment. Journal of Education, Health and Sport. 2018; 8(5):325-34.
Dziubanovskyy IYa, Piatnochka VI. Complications after alohernioplastics of postoperative ventral hernia: solutions. Ukrainian Journal of Surgery. 2017;(5):79-82. [In Ukrainian].
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