scholarly journals MORPHOLOGICAL RESPONSE TO IMPLANTATION OF A POLYPROPYLENE MESH WITH A PRF MEMBRANE IN PATIENTS WITH POSTOPERATIVE VENTRAL HERNIA AND UNDIFFERENTIATED CONNECTIVE TISSUE DYSPLASIA

2019 ◽  
Vol 4 (2) ◽  
pp. 31-35
Author(s):  
V. I. Piatnochka ◽  
A. M. Prodan
Keyword(s):  
Connective Tissue ◽  
Ventral Hernia ◽  
Polypropylene Mesh ◽  
Structural Changes ◽  
Connective Tissues ◽  
Morphological Response ◽  
Sublay Technique ◽  
Mesh Material ◽  
Connective Tissue Dysplasia ◽  
Ventral Hernias

Background. Current herniology promotes the widespread usage of mesh implants in the primary treatment and, especially, in the for postoperative ventral hernias. Objective. The aim of the research was to study the morphological response of the tissues of muscular aponeurotic layer to implantation of a polypropylene mesh with using PRF membrane-enriched platelets in the patients with postoperative ventral hernia and concomitant undifferentiated dysplasia of connective tissues. Methods. The research involved 98 patients with postoperative ventral hernia, who underwent retro-muscular alogernioplasty by the Sublay technique of implantation of ‘light’ meshes, and a ‘light’ polypropylene mesh (PPM) in combination with a platelet-rich fibrin (PRF) membrane. The patients were divided into experimental groups according to the presence of undifferentiated connective tissue dysplasia syndrome. Results. Microscopic studies carried out after the implantation of a polypropylene mesh with a PRF membrane has proved that structural changes in connective tissues are like those of a polypropylene mesh, but they are less significant. There was a leukocyte infiltration near the mesh material, but its area was small. The enlargement and blood filling of the vessels of microcirculatory channel was a manifestation of the increased vascularization of this area. Conclusions. The usage of a polypropylene mesh in combination with a PRF membrane in the surgical treatment of postoperative ventral hernias reduces inflammatory changes in the tissues significantly and increases the activation of fibroblasts and signs of collagen fibers around the mesh material that is relevant especially for the patients with connective tissue pathology.

Preventative repair of postoperative ventral hernia considering the markers of connective tissue dysplasia

2019 ◽  
pp. 12
Author(s):  
V. A. Lazarenko ◽  
S. V. Ivanov ◽  
I. S. Ivanov ◽  
A. V. Tsukanov ◽  
G. N. Goryainova ◽  
...  
Keyword(s):  
Connective Tissue ◽  
Ventral Hernia ◽  
Connective Tissue Dysplasia

Use of Polypropylene Mesh in the Management of a Contaminated Large Ventral Hernia: A Contraindication or a Solution?

2013 ◽  
Vol 79 (12) ◽  
pp. 1298-1303 ◽  
Author(s):  
Fei Yang
Keyword(s):  
Ventral Hernia ◽  
Polypropylene Mesh ◽  
Perioperative Management ◽  
Abdominal Cavity ◽  
Mesh Size ◽  
Bladder Injury ◽  
Wound Debridement ◽  
Large Ventral Hernia ◽  
Hernia Size ◽  
Ventral Hernias

Management of contaminated large ventral hernias is still a challenge as a result of massive loss of muscular and fascial tissues in the abdominal wall, traditional contraindication to use of a prosthesis, and complicated perioperative management. This study aimed to provide a solution for this challenging dilemma using monofilament polypropylene mesh (Marlex; Bard) in the Sublay-Bridge fashion. Twenty-three consecutive patients with contaminated large ventral hernias from 2009 to 2011 were identified. Preoperatively, source of contamination at the surgical site was managed through oral antibiotics, wound débridement, and dressing change; the hernia content was reduced into the abdominal cavity gradually and an abdominal binder was applied. Marlex meshes in the Sublay-Bridge fashion were used in these patients. Demographic and perioperative data were collected. Fourteen males and nine females were included with a mean age of 52.5 ± 10.5 years and a mean body mass index of 25.2 ± 6.1 kg/m2. Twelve patients underwent ostomy takedown, which was the most common indication. Mean hernia size was 120.5 ± 18.5 cm2 and a mean mesh size was 380.0 ± 80.5 cm2. The mean operative time was 125.5 ± 35.5 minutes and the hospital stay was 10.0 ± 3.5 days. Twenty-three patients had a mean follow-up period of 12.5 ± 6.5 months. An iatrogenic bladder injury occurred because of severe prevesical adhesion attributed to previous prosthesis repair. There was no presentation of abdominal compartment syndrome. Four patients developed surgical site infection and managed with conservative therapy without mesh removal. Three patients had seromas and underwent aspiration guided by B-ultrasound. Three patients reported chronic foreign body sensation. No recurrence was followed up. Repair of contaminated large ventral hernia using a Marlex mesh in the Sublay-Bridge fashion is safe and efficient management. Perioperative management and operative technology play important roles in dealing with this problem.

scholarly journals ANALYSIS OF IMMEDIATE AND LONG-TERM RESULTS OF SUBLAY AND TAPP TECHNIQUES IN THE TREATMENT OF VENTRAL HERNIAS

2021 ◽  
pp. 42-46
Author(s):  
V. S. Dubchenko
Keyword(s):  
Ventral Hernia ◽  
State Institution ◽  
The State ◽  
Long Term Results ◽  
Ministry Of Health ◽  
Transabdominal Preperitoneal ◽  
Sublay Technique ◽  
Significant Difference ◽  
Ventral Hernias

The accumulated clinical experience has proven that the “sublay” technique allows to achieve greater functional activity of the anterior abdominal wall and is the method of choice in the treatment of ventral hernia. The use of self-adhesive nets during laparoscopic transabdominal preperitoneal plasty (TAPP- Transabdominal Preperitoneal Plastic) in the treatment of small and medium ventral hernia is safe and effective, with low values of postoperative pain syndrome and rapid functional recovery after surgery, without increasing the recurrence in the short term. The aim – was to analyze the immediate and long-term results of “sublay” and TAPP techniques in the treatment of ventral hernias of lower and median localization. The author noted that the search for technical methods aimed to reduce the intra-abdominal pressure in this hernioplasty technique was relevant and practically significant. Material and Methods. The work was performed on the basis of the surgical department of the State Institution “Specialized Multi-Purpose Hospital №1 of Ministry of Health of Ukraine”, Department of General Surgery of the State Institution “Dnipro State Medical University of Ministry of Health of Ukraine”. Results. Comparison of immediate and long-term results of peritoneal-prosthetic-aponeurosis thickness studies showed a statistically significant difference (p < 0.001) using different techniques. When analyzing the separated results, reliable differences (p <0.001) depending on the gender of patients were recorded. Thus, in males, when using the “sublay” technique the peritoneal-prosthetic-aponeurosis thickness was greater by 1.15 mm (by 42.43 %) in comparison with the Tapptechnique, and in females, by 1.16 mm (by 42.09 %), respectively. Conclusions. The analysis of the immediate and long-term results of the “sublay” and TAPP techniques in the treatment of ventral hernias of lower and median localization showed that the “sublay” technique was characterized by traumatic surgical intervention, shift of the prosthesis to one side, as a consequence of its deformation. When using this technique, peritoneum-prosthetic-aponeurosis thickness values were significantly higher  –  by 13.16 % and 42.40 % in the early and distant postoperative periods, respectively. Also, when using the Tapp technique in the distant period the thickness was significantly reduced (p <0,0001) by 49,47 % in comparison with the immediate results.

scholarly journals INCREASING SAFETY OF SURGICAL INTERVENTIONS IN PATIENTS WITH VENTRAL AND INCISIONAL HERNIA UNDER COMORBIDITY CONDITIONS WHEN PERFORMING DIFFERENT TYPES OF OPEN HERNIOPLASTY

2020 ◽  
pp. 135-139
Author(s):  
V. I. Piatnochka ◽  
I. Ya. Dziubanovskyi ◽  
A. M. Prodan
Keyword(s):  
Surgical Treatment ◽  
Postoperative Complications ◽  
Abdominal Wall ◽  
Ventral Hernia ◽  
Polypropylene Mesh ◽  
Immunosuppressive Agents ◽  
Technical Improvement ◽  
Surgical Interventions ◽  
Duration Of Surgery ◽  
Ventral Hernias

Abstract. In the period from 2001 to 2017, 1419 patients with ventral and postoperative ventral hernia were operated on. The unsatisfactory results of the surgical treatment of this pathology were due to a number of disadvantages: the choice of an inadequate method of hernioplasty in a specific clinical situation, an incomplete revision of the muscle-aponeurotic layer of the anterior abdominal wall, especially in patients with postoperative veterinary hernias, concomitant syndrome of undifferentiated connective tissue dysplasia and obesity, and weak points, the wrong choice of the type of mesh implant (“light” or “heavy” polypropylene mesh) and its size, the choice of an inappropriate type of suture material, as well as the high invasiveness of surgical intervention. Based on the given causes of complications in the operated patients with a high risk of their development, we have made a technical improvement of the existing methods of hernioplasty and development of new ones, which significantly reduced the number of postoperative complications and increased the safety of performing surgical interventions in patients with ventral and postoperative ventral hernia. Purpose. Based on the results of the analysis of surgical treatment of patients with comorbid conditions for primary and incisional ventral hernias to develop technical prerequisites for improving the safety of surgical interventions in this category of patients. Methods. Іn the period from 2001 to 2017, an in-depth comprehensive clinical-instrumental and laboratory examination of 1419 patients with primary ventral hernia (PVH) and postoperative ventral hernia (PVH) was conducted. The patients were divided into groups according to the periods of surgical treatment of patients. For this purpose, two periods were formed: from 2001 to 2009 and from 2010 to 2017. At the first period, 597 (42.07%) patients were examined and operated on. These patients formed a comparison group. The main group corresponding to patients who were treated in the period from 2010 to 2017 was 822 (57.93%) people. Results. Developed techniques for performing retromuscular allogernioplasty, which were based on controlled visualization of suturing when fixing polypropylene mesh to the posterior leaf of the vagina of the rectus muscle, allowed us to reliably and safely place and secure the implant in the retromuscular space, significantly reduce the trauma and duration of surgery. Kind of treatment using the mesh allograft with a liposomal complex with included antibacterial and immunosuppressive agents during the operation on the "onlay" method significantly reduced the number of local infectious complications. The location of the PRF membrane over the polypropylene mesh during retromuscular allogernioplasty improved neoangiogenesis at the mesh implantation site, increased fibroblast activity and the formation of collagen fibers around the mesh material, which provided maximum integration of the "light" abdominal wall with polypropylene tissue. Conclusion. These features of the dynamics of the used methods of surgical interventions and types of polypropylene nets with an individualized approach to each patient were reflected in a significant reduction in the number of both early local and general late postoperative complications, which improved the effectiveness of surgical treatment of patients with primary postoperative ventral hernias.

scholarly journals ENDOTOXIN AS ADJUVATOR TO THE TRANSPLANTATION OF A MOUSE MAMMARY TUMOR

1968 ◽  
Vol 128 (6) ◽  
pp. 1363-1383 ◽  
Author(s):  
James Stuart Henderson
Keyword(s):  
Connective Tissue ◽  
Tumor Cells ◽  
Mammary Tumor ◽  
Structural Changes ◽  
Connective Tissues ◽  
Local Type ◽  
Mouse Mammary Tumor ◽  
Series Of Experiments ◽  
Increased Susceptibility

The mouse mammary tumor MT 296 was used in a further series of experiments on the implantation of tumor, plated out in vivo, from suspensions of individual cells. Lipopolysaccharide from S. typhosa was shown to exert an adjuvator influence. But this adjuvator, an endotoxin, had no direct effect on the suspended tumor cells, unlike the liver preparations previously reported. Lipopolysaccharide from S. typhosa was shown to act on the host. It made the host's connective tissue expanses more susceptible to successful implantation by the tumor cells. It did this only if present at the time these connective tissue expanses were split. The increased susceptibility, caused by splitting the connective tissue expanses in the presence of lipopolysaccharide, declined quickly after 24 hr. The structural changes wrought upon the connective tissues by splitting them in the presence of lipopolysaccharide are described. They show kinship to a Schwartzman reaction of the local type. Their possible role in the adjuvator effect on the plating of single cell suspensions of this tumor is discussed.

GENETIC ASPECTS OF CERVICAL INSUFFICIENCY PROBLEM

2021 ◽  
Vol 77 (1) ◽  
pp. 17-20
Author(s):  
M.S. Selikhova ◽  
◽  
T.I. Kostenko ◽  
S.A. Karapetyan ◽  
◽  
...  
Keyword(s):  
Connective Tissue ◽  
Structural Changes ◽  
Cervical Insufficiency ◽  
Second Trimester ◽  
Cervical Tissue ◽  
Third Trimester ◽  
Morphological Studies ◽  
Key Factor ◽  
Connective Tissue Dysplasia ◽  
Genetically Determined

Cervical insufficiency is the main cause of miscarriage in the second trimester of pregnancy (up to 40 %), and in the third trimester occurs in a one third of women with preterm birth. Diagnosis of this pathology is based on the identification of structural changes in the cervix, which determines the impossibility of predicting this pathology before pregnancy. Current morphological studies have shown that connective tissue predominates in the cervix, represented mainly by collagen, which provides up to 85 % of the weight of the cervical tissue, elastin and proteoglycans. A key factor in the development of CI is currently considered a defect in collagen synthesis and the development of cervical incompetence is considered as a manifestation of undifferentiated connective tissue dysplasia. The results of recent studies show that cervical insufficiency is a genetically determined condition and polymorphisms in genes related to the metabolism of connective tissue can play a role in the development of CI.

scholarly journals PECULIARITIES OF MORPHOLOGICAL CHANGES OF TISSUES AFTER HERNOPLASTIC DURING RECURRENCE OF POSTOPERATIVE VENTRAL HERNIAS

2019 ◽  
Vol 18 (4) ◽  
pp. 100-106
Author(s):  
V. I. Pyatnochka ◽  
I. Ya. Dzyubanovsky ◽  
A. M. Prodan ◽  
T. V. Datsko
Keyword(s):  
Postoperative Complications ◽  
Connective Tissue ◽  
Abdominal Wall ◽  
Ventral Hernia ◽  
Anterior Abdominal Wall ◽  
Morphological Changes ◽  
Surrounding Tissue ◽  
Elastic Fibers ◽  
Immune Inflammation ◽  
Ventral Hernias

Considering the results of surgical treatment of postoperative ventral hernias, a significant number of relapses, comprising 4.3-46 %, should be noted, and for large and giant postoperative ventral hernias reaches 80 %. The lack of clear criteria for assessing the local response of the tissues of the anterior abdominal wall to the implantation of various types of mesh implants and the associated early wound postoperative complications and relapses prompts further study of the morphological features of the anterior abdominal wall tissue responses in patients with primary and postoperative ventral hernias. Aim of the study: to establish morphological patterns of the restructuring of the tissues of the anterior abdominal wall in patients with recurrent ventral hernia. Material and methods. An in-depth comprehensive clinical, instrumental and laboratory examination of 1419 patients with primary and postoperative ventral hernia was performed. There were 250 patients with recurrent ventral hernia (17.62 %). Results and conclusions. The use of a “light mesh” in patients with recurrent postoperative ventral hernia in the presence of concomitant NDCT appears to be significantly less lymphohistiocytic and leukocyte infiltration for the surrounding tissue, and reduces the likelihood of postoperative complications. Morphological changes in the tissue of the anterior abdominal wall with NDCT strongly indicate a disorder of its architectonics. It is clinically reflected in the formation of postoperative and recurrent hernias. Separate muscle fibers lose cross striation. In the muscular aponeurotic component without signs of connective tissue dysplasia, the application of various types of nets leads to the formation of elastic and collagen fibers, with minor changes in their architectonics and minimal cell infiltration of the immune inflammation of the extracellular matrix. Disintegration, destructive-dystrophic changes in the architectonics of the connective tissue were observed in patients with signs of NDCT in relapses. When using the “heavy” mesh, significant disorientation, collagenolysis, reduced synthesis of all types of collagens, the phenomenon of thickening of elastic fibers and elastolysis were observed. Inflammatory infiltration, triggered by immune inflammation cells, increased mucoid and fibrinoid edema, which led to homogenization, local lysis, and focal tissue destruction.

Banded Structures in the Connective Tissue of Meningioma

1976 ◽  
Vol 34 ◽  
pp. 234-235
Author(s):  
C. N. Sun ◽  
H. J. White
Keyword(s):  
Connective Tissue ◽  
Osmium Tetroxide ◽  
Uranyl Acetate ◽  
Collagen Fibrils ◽  
Lead Citrate ◽  
Connective Tissues ◽  
Native Collagen ◽  
Routine Procedures

Previously, we have reported on extracellular cross-striated banded structures in human connective tissues of a variety of organs (1). Since then, more material has been examined and other techniques applied. Recently, we studied a fibrocytic meningioma of the falx. After the specimen was fixed in 4% buffered glutaraldehyde and post-fixed in 1% buffered osmium tetroxide, other routine procedures were followed for embedding in Epon 812. Sections were stained with uranyl acetate and lead citrate. There were numerous cross striated banded structures in aggregated bundle forms found in the connecfive tissue of the tumor. The banded material has a periodicity of about 450 Å and where it assumes a filamentous arrangement, appears to be about 800 Å in diameter. In comparison with the vicinal native collagen fibrils, the banded material Is sometimes about twice the diameter of native collagen.

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