RU2792283C1 - Method for modeling ventral hernia - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: tube with a rubber balloon fixed to it at one end and a pear for pumping air with a pressure gauge at the other end is introduced through a mini-access into the abdominal cavity of a pig or a corpse. The second stage consists in making a layer-by-layer incision of the anterior abdominal wall to the peritoneum. At the third stage, a device for measuring the tissue tension is attached to the edges of the dissected aponeurosis of the white line of the abdomen. Air is pumped into the balloon and intra-abdominal hypertension is created with a divergence of the edges of the aponeurosis.

EFFECT: method reduces trauma, allows to adjust the tension of the tissues and intra-abdominal pressure.

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Description

The invention relates to medicine, namely to experimental surgery, and can be used to develop, improve methods for the treatment and prevention of ventral hernias.

Ventral hernia is a common surgical disease. The treatment of this pathology, especially in large and giant ventral hernias, is often complicated by intra-abdominal hypertension with the development of compartment syndrome. Residual increased tension of stitched tissues leads to a recurrence of the disease. Moreover, the above complications are interrelated. Relevant is the development of methods for modeling ventral hernias with given parameters of intra-abdominal pressure and tissue tension in animals and in cadaver studies.

The most well-known method of modeling a ventral hernia is the creation of a defect in the anterior abdominal wall by partial excision of the musculoaponeurotic complex, followed by suturing of the skin and subcutaneous fat. Within a month, a hernial protrusion is formed in animals in the projection of the defect (Koveshnikov A.P. The use of a nylon mesh to close abdominal wall defects in the experiment. Health of Tajikistan, 1960 No. 6, p. 58-61; Netyaga A.A. et al. Method for modeling ventral hernia Patent 2002102282/14 dated January 31, 2005).

The main disadvantages of the methods are: trauma, violation of the anatomical integrity of the anterior abdominal wall, the duration of the formation of a hernia, the inability to regulate tissue tension and intra-abdominal pressure.

The technical result of the invention: the creation of an acute model of ventral hernia in animals and in cadaver studies with controlled intra-abdominal pressure and tension of sutured tissues.

The problem is solved in the following way. First, through a mini-access in the anterior abdominal wall of a pig or a corpse, a tube with a rubber balloon sealed at the end is inserted into the abdominal cavity. A pear for pumping air with a pressure gauge is attached to the other end of the tube (Fedoseev A.V. et al. Method for creating intra-abdominal hypertension in the experiment. Patent No. 2021118133 dated March 24, 2022). . 1). At the third stage, the paws of a special device for measuring tissue tension are attached to the edges of the dissected aponeurosis of the white line of the abdomen (Fedoseev A.V. et al. RF Patent No. 187472 of 03/06/19) (Fig. 2).

A hernia model in an acute experiment is created by pumping air into a balloon and creating intra-abdominal hypertension. At the same time, there is a divergence of the edges of the aponeurosis, which mimics a hernial defect of the anterior abdominal wall with tissue tension (Fig. 3).

Brief description of the drawings

Fig. 1. Simulation of intra-abdominal hypertension in an animal

Fig. 2. Measurement of tissue tension in intra-abdominal hypertension in an animal

Fig. 3 Separation plasty according to Nowitzki

Fig. 4. Measurement of the tension of the edges of the laparotomic wound (cadaver study)

Case Study #1

Pig No. 1 after introduction into the abdominal cavity through a mini-access in the left iliac region of the balloon on the tube of the device for creating intra-abdominal hypertension, a dissection of the skin, subcutaneous tissue, aponeurosis of the white line of the abdomen from the xiphoid process to the pubic joint was performed. On the edges of the dissected aponeurosis in the middle third of the white line, the paws of the device for measuring tissue tension are fixed. The initial tension of the edges of the aponeurosis was 1.7 N. By inflating up to 40 mm Hg. Art. Intra-abdominal hypertension was modeled with air into the balloon with a bulb connected to a manometer. In this case, there was a divergence of the edges of the aponeurosis up to 5 cm with an imitation of a hernial defect (hernia) with tissue tension. The starting point was the tension of the edges of the aponeurosis in 3.7 N. When the initial parameter of tissue tension was reached, the tube was blocked. The animal underwent separation plasty of the anterior abdominal wall according to Ramirez. At the same time, the tension of the edges of the aponeurosis decreased to 2 N.

The ventral hernia modeling method was used on 10 pigs. Experiments on animals were carried out in the vivarium of the Central Scientific Research Laboratory of the Federal State Budget Educational Institution of Higher Education of the Ryazan State Medical University of the Ministry of Health of Russia. Operations and all manipulations with animals were carried out using general anesthesia, regulated by Appendix No. 8 (“Rules for the Humane Treatment of Laboratory Animals”) of the “Sanitary Rules for the Arrangement, Equipment and Maintenance of Experimental Biological Cells (Vivariums)” (No. 1045-73), as well as by Order No. 724 of 1984 of the Ministry of Higher Education of the USSR "Rules for carrying out work with experimental animals." The studies were carried out in accordance with the Declaration of Helsinki of the World Medical Association on the humane treatment of laboratory animals (2000), the directive of the European Community (86/609 EU) and the Rules of Laboratory Practice in the Russian Federation (Order of the Ministry of Health of the Russian Federation No. 267 dated 06/19/2003) . In all animals, by correcting increased intra-abdominal pressure, the same tissue tension was created.

Five animals underwent separation plasty of the anterior abdominal wall according to Ramirez, followed by measurement of the residual tension of the aponeurosis and intra-abdominal pressure. The remaining five animals underwent posterior separation plastic according to Nowitzki with the measurement of residual tissue tension and intra-abdominal pressure (Fig. 3). The conducted research allowed to determine the most effective method of separation plastics.

Case Study #2

The corpse of a 72-year-old woman who died from acute myocardial infarction, after being introduced into the abdominal cavity through a mini-access in the left iliac region of the balloon on the tube of the device for creating intra-abdominal hypertension, the skin, subcutaneous tissue, aponeurosis of the white line of the abdomen from the xiphoid process to the pubic symphysis were dissected. On the edges of the dissected aponeurosis in the middle third of the white line, the paws of the device for measuring tissue tension are fixed. The initial tension of the edges of the aponeurosis was 1.7 N. By pumping air into the balloon with a bulb connected to a manometer, an imitation of intra-abdominal hypertension up to 40 mm Hg was performed. Art. In this case, there was a divergence of the edges of the aponeurosis up to 8 cm with an imitation of a hernial defect (hernia) with tissue tension. The starting point was the tension of the edges of the aponeurosis of 4.7 N. When the initial parameter of tissue tension was reached, the tube was blocked. Next, separation plasty of the anterior abdominal wall according to Ramirez was performed. At the same time, the tension of the edges of the aponeurosis decreased to 2.7 N.

A similar procedure was carried out on five corpses of both sexes aged 65 to 78 years in the pathoanatomical department of the Kolomna Central District Hospital. The cause of death in all patients was cardiovascular disease. The inclusion criterion was the absence of surgical interventions on the anterior abdominal wall, no more than 24 hours from the moment of death, and the informed consent of relatives to conduct the study. After layer-by-layer dissection of tissues to the peritoneum along the midline of the abdomen from the xiphoid process to the pubic joint, intra-abdominal hypertension was modeled with a divergence (imitation of a hernial defect) and tension of the edges of the aponeurosis of 4.7 N. subsequent measurement of the residual tension of the aponeurosis and intra-abdominal pressure.

Claims (1)

A method for modeling a ventral hernia, including introducing a tube into the abdominal cavity through a mini-access into the abdominal cavity with a rubber balloon fixed to it at one end and a pear for pumping air with a pressure gauge at the other end, the second step is to make a layer-by-layer incision of the anterior abdominal wall to the peritoneum, at the third step a device for measuring tissue tension is attached to the edges of the dissected aponeurosis of the white line of the abdomen, then air is pumped into the balloon and intra-abdominal hypertension is created with a divergence of the edges of the aponeurosis.

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