Topographic-Anatomic Justification of Various Methods Reducing Tissue Tension at Prosthetic Incisional Hernia Repair by «Sublay»

Abstract

Purpose. To develop a new relaxing incision on the anterior wall of rectus sheath and to compare its efficiency with the classical counterparts in the experiment. Materials and methods. We measured tension nodal seam with the help of a spring dynamometer on 24 cadavers. This seam was overlaid on the inner edge of the rectus abdominis in the region of the umbilical ring before and after relaxing incision. The objects of study were divided into four groups randomly. We studied the proposed wavelike relaxing incision in the first group and classical methods in other groups. Results.  Maximum relaxation nodal seam (56%) was observed when using a wavelike relaxing incision of anterior wall of  rectus sheath . Vertical relaxing incision of aponeurosis of the external oblique abdominal muscles along the lateral edge of the rectus abdominis (by O. M. Ramirez) was close in efficiency to the proposed method. It is possible to reduce tension of the nodal seam at 48%. Relaxing effect arc-shaped relaxing incision of anterior wall of rectus sheath by V.I. Belokonev was 39%. Vertical relaxing incision in a staggered pattern by U.Z. Zagirov showed minimal relaxing effect – 25%. Conclusion. Wavelike relaxing incision of anterior wall of rectus sheath which was proposed allows reducing tissue tension in hernioplasty compared to the classical methods.