COMPARATIVE MORPHOMETRIC ASSESSMENT OF REGENERATION PROCESSES OF THE ANTERIOR ABDOMINAL WALL TISSUES AFTER IMPLANTATION OF VARIOUS TYPES OF POLYPROPYLENE MESHES IN THE EXPERIMENT
DOI:
https://doi.org/10.11603/1811-2471.2018.v0.i4.9562Keywords:
implantation, polypropylene mesh, artery morphometry, media thickness, Kernogan indexAbstract
The widespread introduction of modern alloplastic materials into the surgical practice has significantly improved the results of surgical treatment of patients with ventral and postoperative ventral hernia. However, the implantation of synthetic material in the tissue of the anterior abdominal wall is accompanied by different local reactions, especially when using "heavy" meshes, which often leads to the development of complications. Analysis of the results determines the relevance of this study.
The aim of the study – to conduct a morphometric assessment of changes in the arteries of the muscular aponeurotic layer after implantation of "heavy" and "light" polypropylene meshes and "light" in combination with a PRF membrane.
Materials and Methods. Morphometric analysis of the arteries of the musculo-aponeurotic layer after the implantation of "heavy", "light" polypropylene meshes and "light" in combination with the PRF membrane in a light-optical study of microscopic preparations. The experiments were performed on 18 mature male pigs of the Vietnamese breed, which were divided into 6 groups.
Results and its Discussion. The measurements in the group of intact animals showed that the outer diameter of the arteries of small caliber is (35.80±0.24) μm, the internal diameter is (12.60±0.15) μm, the thickness of the media is (10.50±0.09 ) μm, the Kernogan index (the ratio of the lumen area to the entire area of the vessel) is equal to (12.40±0.12) %. The height of the endotheliocytes of these vessels reached (6.20±0.03) μm, the diameter of their nuclei – (2.98±0.02) μm. Nuclear-cytoplasmic relations in the studied cells were – (0.230±0.003). On the 28th day of the experiment under conditions of implantation of a light mesh, the thickness of the media vessels is equal to (10.90±0.12) μm. This morphometric parameter was 3.8 % higher than the same control and statistically significantly (p <0.05) control and was statistically significantly (p <0.05) different from it. During the implantation of the “light” mesh in combination with the PRF membrane, changes in the relative volume of damaged endothelial cells in the arteries of small caliber were noted. In the group 1 of observations, the indicated morphometric parameter is (2.40±0.03) %, and in the group 4 (2.60±0.09) %. Morphometric parameters of small-caliber arteries during the implantation of a “heavy” mesh showed an increase in the backward diameter of these vessels by only 0.22 %, and the internal diameter was almost unchanged and equal to (12.70±0.18) μm. The thickness of the media arteries of small caliber of the anterior abdominal wall was increased and reached (10.92±0.15) μm. The given morphometric parameter was statistically significantly (p <0.05) different from the similar control (10.50±0.09) μm. The revealed difference between the given morphometric parameters was equal to 4.0 %.
Conclusions. Morphometric measurements of small-caliber arteries established implantation of a “light” mesh compared to a “heavy” in the vitality period of the experiment led to pronounced re-modeling of the vessels under study, which was confirmed by relative volumes of damaged endothelial cells, which is (4.10±0.05) % and (4.90±0.05) %. The use of a light mesh with a PRF membrane for implantation resulted in the least pronounced structural reorganization of the arteries.
References
Avtandilov, G.G. (2002). Morfometriya v patologii [Morphometry in pathology]. Moscow: Meditsina [in Russian].
Bondarev, R.V., & Chibisov, A.L. (2008). Strukturnaya osnova klinicheskogo prognozirovaniya reperativnykh protsessov v posleoperatsionnom periode u patsiyentov s posleoperatsionnymi gryzhami peredney bryushnoy stenki [Structural basis of the clinical prediction of the regenerative processes in the postoperative period in patients with postoperative hernias of the anterior abdominal wall]. Khirurhiia Ukrainy – Surgery of Ukraine, 2 (26), 83-85 [in Russian].
Dziubanovskyi, I.Ya., & Piatnochka, V.I. (2009). Ranovi uskladnennia pislia alohernioplastyky pisliaoperatsiinoi hryzhi cherevnoi stinky [Early complications after alohernioplasty of the postoperative hernia of the abdominal wall]. Klinichna khirurhiia – Clinical Surgery, 11/12, 33-34 [in Ukrainian].
Lupaltsov, V.I., Yahniuk, A.I., Dekhtiaruk, I.A., & Voroshchuk, R.S. (2010). Profilaktyka ranovykh hniinykh uskladnen pisliaoperatsiinykh hryzh cherevnoi stinky [Prevention of wound purulent complications of postoperative hernia of the abdominal wall]. Klinichna khirurhiia – Clinical Surgery, 1, 58 [in Ukrainian].
Pishak, V.P., Vysotska, V.H., & Mahalias, V.M. (2006). Laboratorni tvaryny v medyko-biolohichnykh eksperymentakh: metod. posib. [Laboratory animals in medical and biological experiments: method. manual]. Chernivtsi: Meduniversytet [in Ukrainian].
Feleshtynskyi, Ya.P., Vatamaniuk, V.F., Svyrydovskyi, S.A., & Dubenets, V.O. (2009). Eksplantatsiia sitok pry uskladenniakh alohernioplastyky, pokazannia ta profilaktyka [Exteriorization of meshes with complications of alohernioplasty, indications and prophylaxis]. Lvivskyi medychnyi chasopys – Lviv Medical Journal, 15, 2, 61-64 [in Ukrainian].
Chetverikov, S.H., Vododiuk, V.Yu., & Chekhlov, M.V. (2008). Problemni pytannia alloplastyky ventralnykh hryzh [Problematic questions of alloplasty of ventral hernias]. Khirurhiia Ukrainy – Surgery of Ukraine, 2 (26), (Dodatok), 81-83 [in Ukrainian].
Beets, G.L., Go, P.M., & Mameren, H. van (1996). Foreign body reactions to monofilament and braided polypropylene mesh used as preperitoneal implants in pigs. Eur. J. Surg., 162 (10), 823-825.
Shivashankar, V.Y., Johns, D.A., & Vidyanath, S., & Sam, S. (2013). Combination of platelet rich fibrin, hydroxyapatite and PRF membrane in the management of large inflammatory periapical lesion. J. Conserv. Dent., 16 (3), 261-264.
Chung, L.G., Tse, H., & O’Dwyer, P.J. (2014). Outcome of patients with chronic mesh infection following abdominal wall hernia repair. Hernia, 18 (5), 701-704.
Matyja, A., Solecki, R., & Heitzman, J. (2004). Local reaction to polypropylene mesh – histopatological findings. Hernia Recurrences. Praga.
Offner, F.A., & Schumpelich, V. (Eds.). (2004). Meshes: benefits and risks. Berlin.
Choukroun, J., Diss, A., & Simonpieri, A. (2006). Platelet-rich fibrin (PRF): A second-generation platelet concentrate. Part IV: Clinical effects on tissue healing. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod., 101 (3), 56-60.
Rosen, M.J. (2012). Evaluation of surgical outcomes of retro-rectus versus intraperitoneal reinforcement with bio-prosthetic mesh in the repair of contaminated ventral hernias. Hernia, 16 (1), 152-156.
Schumpelick, V., & Nygus, L. (2003). Meshes: benefits аnd risks. Springer-Verlag: Berlin.
Thorat, M., Pradeep, A.R., & Pallavi, B. (2011). Clinical effect of autologous platelet-rich fibrin in the treatment of intra-bony defects: A controlled clinical trial. J. Clin. Periodontol., 38 (10), 925-932. doi: 10.1111/j.1600-051X. 2011.01760.x.
