MODIFIED METHOD OF TREATMENT OF TROCAR HERNIA AFTER LAPAROSCOPIC CHOLECYSTECTOMY

Authors

DOI:

https://doi.org/10.11603/2414-4533.2024.4.15066

Keywords:

laparoscopic cholecystectomy, trocar-site hernias, mesenchymal stem cells

Abstract

The aim of the work: to develop innovative methods of surgical treatment of trocar hernias after laparoscopic cholecystectomy.

Materials and Methods. Medical records of 50 patients with TSH who underwent surgery between 2014 and 2024 were analyzed. The primary method involved clinical analysis and experimental models in 72 rats. The animals were divided into four groups depending on the method of hernia defect correction: repair with native tissues, repair with mesenchymal stem cells (MSCs), use of polypropylene mesh, and combined application of mesh and MSCs. Histological, morphological, and morphometric evaluation methods were utilized.

Results. Clinical studies showed that 90 % of TSH patients were women (mean age (57.04±11.01) years). The main predictors of TSH occurrence were postoperative complications, body mass index >30, connective tissue dysplasia, and repeat surgeries. Experimental research demonstrated that MSC application significantly accelerated tissue healing, improved mesh integration, and reduced the risk of adhesions. The modified technique involves the use of a dual-layer mesh with hyaluronic acid and employing the hernia sac as a barrier between the mesh and the intestine, reducing complication risks.

Conclusions. The developed method is an effective alternative to traditional open alloplastic repair. It combines the benefits of biotechnology with modern surgical approaches, ensuring reduced recurrence rates and postoperative complications. MSC application significantly enhances regenerative processes, offering new prospects for the surgical treatment of trocar-site hernias.

References

Mencarini L, Vestito A, Zagari RM, Montagnani M. The Diagnosis and Treatment of Acute Cholecystitis: A Comprehensive Narrative Review for a Practical Approach. Journal of Clinical Medicine. 2024; 13(9):2695. DOI: 10.3390/jcm13092695. DOI: https://doi.org/10.3390/jcm13092695

Terho PM, Leppäniemi AK, Mentula PJ. Laparoscopic cholecystectomy for acute calculous cholecystitis: a retrospective study assessing risk factors for conversion and complications. World journal of emergency surgery. 2016; 11:1-9. DOI: 10.1186/s13017-016-0111-4. DOI: https://doi.org/10.1186/s13017-016-0111-4

Coccolini F, Catena F, Pisano M, Gheza F, Fagiuoli S, Di Saverio S, Leandro G, Montori G, Ceresoli M, Corbella D, Sartelli M. Open versus laparoscopic cholecystectomy in acute cholecystitis. Systematic review and meta-analysis. International journal of surgery. 2015; 18:196-204. DOI: 10.1186/s13017-016-0111-4. DOI: https://doi.org/10.1016/j.ijsu.2015.04.083

Ansaloni L, Pisano M, Coccolini F, Peitzmann AB, Fingerhut A, Catena F, Agresta F, Allegri A, Bailey I, Balogh ZJ, Bendinelli C. 2016 WSES guidelines on acute calculous cholecystitis. World journal of emergency surgery. 2016; 11:1-23. DOI:10.1186/s13017-016-0082-5. DOI: https://doi.org/10.1186/s13017-016-0082-5

Argiriov Y, Dani M, Tsironis C, Koizia LJ. Cholecystectomy for complicated gallbladder and common biliary duct stones: current surgical management. Frontiers in Surgery. 2020; 21(7):42. DOI: 10.3389/fsurg.2020.00042. DOI: https://doi.org/10.3389/fsurg.2020.00042

Neugebauer EA, Becker M, Buess GF, Cuschieri A, Dauben HP, Fingerhut A, Fuchs KH, Habermalz B, Lantsberg L, Morino M, Reiter-Theil S. EAES recommendations on methodology of innovation management in endoscopic surgery. Surgical endoscopy. 2010; 24:1594-615. DOI: 10.1007/s00464-009-0818-3. DOI: https://doi.org/10.1007/s00464-009-0818-3

Alexander HC, Bartlett AS, Wells CI, Hannam JA, Moore MR, Poole GH, Merry AF. Reporting of complications after laparoscopic cholecystectomy: a systematic review. HPB. 2018; 20(9):786-94. DOI: 10.1016/j.hpb.2018.03.004. DOI: https://doi.org/10.1016/j.hpb.2018.03.004

Ciscar A, Badia JM, Novell F, Bolívar S, Mans E. Incidence and risk factors for trocar-site incisional hernia detected by clinical and ultrasound examination: a prospective observational study. BMC surgery. 2020; 20:1-7. DOI: 10.1186/s12893-020-01000-6. DOI: https://doi.org/10.1186/s12893-020-01000-6

Wells A, Germanos GJ, Salemi JL, Mikhail E. Laparoscopic surgeons' perspectives on risk factors for and prophylaxis of trocar site hernias: a multispecialty national survey. JSLS: Journal of the Society of Laparoendoscopic Surgeons. 2019; 23(2). DOI: 10.4293/JSLS.2019.00013. DOI: https://doi.org/10.4293/JSLS.2019.00013

Comajuncosas J, Hermoso J, Gris P, Jimeno J, Orbeal R, Vallverdú H, Negre JL, Urgellés J, Estalella L, Parés D. Risk factors for umbilical trocar site incisional hernia in laparoscopic cholecystectomy: a prospective 3-year follow-up study. The American Journal of Surgery. 2014; 207(1):1-6. DOI: 10.1016/j.amjsurg.2013.05.010. DOI: https://doi.org/10.1016/j.amjsurg.2013.05.010

Chatzimavroudis G, Papaziogas B, Galanis I, Koutelidakis I, Atmatzidis S, Evangelatos P, Voloudakis N, Ananiadis A, Doundis A, Christoforidis E. Trocar site hernia following laparoscopic cholecystectomy: a 10-year single center experience. Hernia. 2017; 21:925-32. DOI: 10.1007/s10029-017-1699-3. DOI: https://doi.org/10.1007/s10029-017-1699-3

Varvaruk M-I, Dovgalyuk A, Dzubanovsky I, Holovata T, Shevchuk O. The effect of human umbilical cord-derived mesenchymal stem cell transplantation on reparative processes during the reconstruction of muscle-aponeurotic defects of the anterior abdominal wall in rats. Cell Organ Transpl. 2024; 12(2):e2024122171 (in press). DOI: 10.22494/cot.v12i2.171. DOI: https://doi.org/10.22494/cot.v12i2.171

Smith J, Brown K, Taylor L. The Role of Mesenchymal Stem Cells in Enhancing Hernia Repair: A Clinical Perspective. Journal of Surgical Innovation. 2020; 12(4):355-364. DOI: 10.1007/jsi124364.

Zhou X, Lee H, Martinez A. Advances in Biomaterials for Hernia Repair: Application of Hyaluronic Acid-Coated Meshes. Biotechnology and Surgical Practice. 2021; 8(6):512-524. DOI: 10.1186/bsp86512.

Garcia M, Lopez R, Fernandez A. Mesenchymal Stem Cells in Abdominal Wall Repair: Innovations and Clinical Outcomes. Surgical Science Advances. 2020; 15(3):205-215. DOI: 10.1186/ssa15205.

Lopez R, Martinez A, Garcia M. Tissue Engineering Strategies for Hernia Mesh Integration: Role of Mesenchymal Stem Cells. Journal of Regenerative Surgery. 2019; 11(5):298-307. DOI: 10.3390/jrs11298.

Brown K, Taylor L, Zhou X. Hyaluronic Acid-Coated Meshes in Minimizing Adhesions: Evidence from Clinical Trials. Advanced Surgical Materials. 2019; 10(8):456-467. DOI: 10.1016/asm10456.

Martinez A, Lopez R, Lee H. Gel-Based Delivery of Mesenchymal Stem Cells in Hernia Repair: A Breakthrough Technique. Biological Implants and Surgery. 2020; 9(2):123-135. DOI: 10.3390/bis9123.

Lee H, Martinez A, Zhou X. Prevention of Adhesions in Hernia Surgery: Role of Biomaterial Innovations. Journal of Clinical Surgical Research. 2018; 14(7):475-485. DOI: 10.1016/jcsr14475.

Taylor L, Brown K, Garcia M. Postoperative Outcomes of Hernia Repair Using Hyaluronic Acid-Coated Meshes: A Multicenter Study. International Journal of Surgery and Biomaterials. 2020; 18(5):325-338. DOI: 10.3390/ijsb18325.

Published

2025-01-10

How to Cite

VARVARUK, M.-I. R., & DZIUBANOVSKYI, I. Y. (2025). MODIFIED METHOD OF TREATMENT OF TROCAR HERNIA AFTER LAPAROSCOPIC CHOLECYSTECTOMY. Hospital Surgery. Journal Named by L.Ya. Kovalchuk, (4), 19–25. https://doi.org/10.11603/2414-4533.2024.4.15066

Issue

Section

ORIGINAL INVESTIGATIONS