Determination of specific symptoms of non-differentiated displasia of connecting tissue in patients with postoperative ventral hernia with the substantiation of the vibor of the optimum method of operational intervention and prosthetic type

Abstract

The aim of the work: to develop tactical prerequisites and improve the results of surgical treatment of patients with postoperative ventral hernia based on the determination of clinical signs of undifferentiated connective tissue dysplasia with the subsequent choice of a pathogenetically substantiated method of surgical intervention and choice of alogransplant.

Materials and Methods. The results of surgical treatment of 106 patients operated on postoperative ventral hernia with implan­tation of lungs and heavy polypropylene mesh under conditions of existing connective tissue dysplasia were analyzed. The phe­notypic signs of connective tissue dysplasia were studied according to the international scale M. J. Glesby (1994). To assess the state of metabolism, the content of hydroxyproline in the blood serum was studied. Normative values of biochemical parameters were obtained by examining 20 practically healthy persons (control), which were compared by age and sex with the examined 106 patients for postoperative ventral hernia. The content of blood serum cryoglobulins was determined by the method of N.A. Kon­stantinova and A.Yu. Kirsanov (1989). For morphological investigation for the purpose of determining nonspecific connective tis­sue dysplasia, during operative intervention, fragments of the aponeurosis of the white abdominal line near the hernia were taken. In 5 patients who re-operated with another pathology of the abdominal organs, with their consent, guided by the norms of medical bio­ethics, fragments of the anterior abdominal wall with an implanted heavy and easy mesh were taken for further morphological study.

Results and Discussion. Dynamics of growth of the collagenolytic activity of the level of glycosaminoglycans and free hydroxyproline showed a direct correlation with the severity of nonspecific connective tissue dysplasia. Thus, for a mild degree, the serum hydroxy­proline level was (54.3 ± 1.1) μmol / l, the average degree (69.7 ± 1.8) μmol / l. And a severe degree (92.5 ± 1.4) μmol / l, which is almost 8 times higher than the norm. The corresponding dynamics to growth, depending on the degree of nonspecific connective tissue dysplasia, was also observed in the determination of glycosaminoglycans and cryoglobulin. Thus, in patients of the control group and in patients with isolated hernia, glycosaminoglycan indices practically did not differ and amounted to (39.25 ± 0.9) μmol / L in urine and (41.3 ± 1.1) μmol / l in urine, respectively. In the group of patients with medium and severe form of connective tissue dysplasia, they increased 2–2.5 times (101.9 ± 1.3) umol / l in urine. A similar increase in cryoglobulin indices was observed in comparison groups with increasing severity of connective tissue dysplasia. So, in the norm the cryoglobulin indices were (40.3 ± 1.2) cu, at an average severity of NDST (234.8 ± 2.5) cu, and for a severe (312.3 ± 2.4) ) Cu, which is almost six times higher than the norm. Morphological studies showed prioritites when using a light large-sized polypropylene omega-2 mesh that manifested itself in the absence of perivascular edema, the formation of loose granulation tissue around the fibers, a moderate amount of fibroblasts, and a large number of collagen fibers infiltrated by lympho- and histiocytes.