Abstract

Background. Despite the improvement of surgical techniques, prevention and treatment of parastomal hernias (PH) remain a priority task of abdominal surgery due to the high frequency of their occurrence (up to 30%). The development of PH is determined not only by the mechanical factor, but also by degenerative changes of the aponeurosis, which causes a high predisposition to relapses and justifies the expediency of using deep alloplasty. Aim: to study of morphological features of musculoaponeurotic edges of hernia defects in parastomal hernias, justification of the location and fixation of the mesh implant.
Materials and methods. A morphological study of musculoaponeurotic edges was performed in three groups of patients. The main study group (Group I) consisted of 22 patients with parastomal hernias who underwent elective surgical treatment with resection of the abdominal wall area, which included the edges of the hernia ring. Comparison group 1 (Group II) consisted of 26 patients with ventral hernias who underwent elective hernioplasty. Comparison group 2 (Group III) was formed by 23 patients with midline postoperative wounds without a hernia defect who underwent surgery for other reasons (laparotomy or revision of the abdominal cavity). A comprehensive pathomorphological study was performed at the Department of Clinical Pathology and Forensic Medicine of the Shupyk NHU of Ukraine. Morphological studies were conducted by staining with hematoxylin and eosin, picrofuchsin according to van Gieson and according to Azan trichrome.
Results. In patients of Group I, pronounced destruction and dystrophy of the musculoaponeurotic complex with edema, fiber separation of collagen and active inflammation (microabscesses, granulomas around ligatures) were revealed, which indicates defective local reparation. In Group II, moderate atrophic changes and thinning of collagen fibers were recorded with preserved integrity of deep layers, which corresponds to a chronic adaptive-remodeling process with minimal inflammation. Histoarchitectonics of tissues in Group III remained unchanged; detected solitary densifications of connective tissue were of a purely physiological age-related nature. Conclusions. Placement of the mesh implant in deep layers is pathogenetically more expedient, as it ensures reliable fixation to stable anatomical structures, while superficial placement of the implant is associated with a high risk of reactive inflammation, seromas and infectious complications. The use of a modified posterior technique of separation of anatomical components and placement of the mesh implant in deep layers of the anterior abdominal wall demonstrates long-term effectiveness, which is confirmed by the absence of relapses in the period up to 12 months of observation