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Background: Posterior component separation with transversus abdominis release (TAR) is considered to be the optimal technique for large incisional ventral hernia repair. Endoscopic TAR (eTAR) that gets all the benefits of minimally invasive surgery (MIS) gives a possibility to enhance results of the treatment. The aim of our study was to make the comparison between open and endoscopic TAR procedures with an emphasis on frequency and severity of postoperative complications in comparable groups., Materials and Methods: All patients had midline incisional hernia and underwent either open (open TAR group) or endoscopic (eTAR group) Rives-Stoppa repair in combination with bilateral transversus abdominis release in Moscow City Hospital №1 from January 2018 to December 2022. A propensity score matching (PSM) was used to make groups comparable. Postoperative complications were classified according to Clavien-Dindo Classification, and Comprehensive complication index was calculated., Results: We performed 133 open and endoscopic TAR separation for midline incisional hernia. After PSM analysis 51 patients were matched to each group. Overall surgical morbidity in the open TAR group (56.9%) was statistically significantly higher than in the eTAR group (29.4%) (p = 0.009). There were more severe complications (Clavien IIIa-V) in the open TAR group (11.8% vs. 0%, p = 0.027). Length of hospital stay after surgery was shorter in eTAR group (p < 0.001). The Comprehensive complication index in the open TAR group was significantly higher than in eTAR group, 8.7 (0-20.9) vs. 0 (0-8.7) (p = 0.011)., Conclusion: Based on the data from our study, the entire MIS procedure including endoscopic TAR is a safe and optimal technique for surgery of midline incisional ventral hernia, requiring TAR separation in terms of reducing the rate of postoperative complications, their severity and hospital length of stay, compared to open TAR procedure., (© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Background: Transabdominal preperitoneal (TAPP) inguinal hernia repair requires the surgeon to have good manual skills in laparoscopic surgery, as well as an understanding of the laparoscopic features of the groin anatomy. This is why TAPP is considered a more difficult surgical procedure compared to open techniques. Realistic training model for TAPP inguinal hernia repair would enhance surgeons' skills before they enter in the operation room. Our aim was to create a realistic, inexpensive, and easily reproducible model for laparoscopic TAPP inguinal hernia repair and to assess its effectiveness., Methods: The applied TAPP inguinal hernia repair training simulator consists of a laparoscopic box and an inguinal region model placed in it. The model of the groin area is made of the porcine stomach and assembling materials. Uniaxial tensile and T-peel tests were performed to compare the mechanical properties of the porcine stomach and the human cadaver peritoneum. Thirty eight surgeons performed TAPP inguinal hernia repair using this model. Their opinions were scored on a five-point Likert scale., Results: Close elastic modules of the porcine and human tissues (13.5 ± 4.2 kPa vs. 15.8 ± 6.7 kPa, p = 0.531) gave to trainees a realistic tissue feel and instrument usage. All participants strongly agreed that model was highly useful for TAPP inguinal hernia repair training. They also put the following points: the model as a whole 5 (3-5), simulation of anatomy 5 (3-5), simulation of dissection and mobilization 5 (3-5), and simulation of intracorporeal suture 5 (4-5)., Conclusions: We successfully created a model for TAPP inguinal hernia repair training. The model is made of inexpensive synthetic and biological materials similar to the human tissue. The model is easy to reproduce and can be used in the training programs of surgical residents.

The aim of this study was to compare the efficacy of different methods of sutureless fixation of lightweight meshes made of different polymers for repair of experimental hernias. Two lateral hernia defects were modeled in male rats and covered with polyester and polypropylene prostheses. The meshes were fixed with Histacryl glue (group 1), or self-gripping meshes were used (group 2), or the meshes were implanted without fixation (group 3). On day 5 after surgery, mesh position and efficiency of fixation were evaluated. It was found that fixation is necessary for all light surgical meshes. Polyester meshes demonstrated better adhesive properties than polypropylene meshes. The most pronounced differences in the adhesive properties were found for self-gripping prosthesis, while in the groups with glue fixation, the differences were less pronounced.

Purpose: We aimed to compare the effectiveness of experimental middle hernia defect repair in regard to the transverse and longitudinal positioning of anisotropic lightweight surgical mesh., Methods: The mechanical properties of fascial layers and surgical mesh DynaMesh(®)-PP Light were determined in two perpendicular directions under uniaxial tension. In 12 male Wistar rats, middle hernia defect was repaired by the sublay technique. In six animals, the mesh was positioned across (DLH group) and in the other six along (DLV group) the midline. At 6 months after implantation, mesh deformation, structural rearrangement, and repaired abdominal wall biomechanics were evaluated. Histological sections were stained with van Giesen and Mallory's trichrome., Results: The anisotropic mechanical properties of the mesh and fascial layers coincided in the DLH group, but did not correspond to each other in the DLV group. In the DLV group, meshes were stretched in width by 11.4% and reduced in length by 12.7%. In all animals, the lower edge of the mesh was shifted to a defect area with margin hernia formation in two rats. Constant shear stress caused disproportional connective tissue formation. Repaired abdominal wall lost its natural elasticity. In the DLH group, the mesh deformation was minimal. Formed connective tissue was tightly associated with the anterior layer and did not differ from it in composition. The mechanical properties of repaired abdominal wall were close to those of the anterior layer., Conclusions: In prosthetic hernia repair, the mechanical properties of surgical mesh should correspond with those of the fascia being repaired. A mismatch of mechanical properties may result in implant deformation, abdominal wall biomechanics impairment, and recurrent herniation at the edges of the meshes.

Standard and light surgical meshes with identical knitted structure: Parietene Standard/Parietene Light and Premilene/Optilene were chosen for hernioplasty in 20 rats. Six months after surgery, the complications were primarily related to inflammation in groups with implanted standard meshes and with prosthesis deformation in groups with light meshes. The character of complications was determined by characteristics of knitting structure and mechanical proprieties of surgical meshes.

Mechanical testing of light mesh endoprosthesis Ultrapro for tension and bending resistance showed strong anisotropy of the material along and across the loop columns. Ultrapro endoprosthesis was placed parallel and perpendicularly to the midline during plastic repair of a hernial defect in rats. Six months after surgery, the development of hernias and violation of endoprosthesis structure were observed in the group with longitudinal orientation of the endoprosthesis. Transverse orientation of the endoprosthesis led to fortification of the defect site. However, the meshes were in some cases misshapen and formed folds across the loop columns, because of insufficient bending rigidity and elasticity of the material.

Mechanical testing of light mesh endoprosthesis Ultrapro for stretching and bending resistance showed strong anisotropy of the material along and across the loop columns. Ultrapro endoprosthesis was placed parallel and perpendicularly to the midline during plastic repair of a hernial defect in rats. Six months after surgery, the development of hernias and violation of endoprosthesis structure were observed in the group with longitudinal orientation of the endoprosthesis. Transverse orientation of the endoprosthesis led to fortification of the defect site. However, the meshes were in some cases misshapen and formed folds across the loop columns, because of insufficient bending rigidity and elasticity of the material.

Three types of light mesh endoprostheses with different jersey structure were implanted into the anterior abdominal walls of 18 rabbits. Changes in the geometrical size and mechanical properties of the prostheses detected 3 months after implantation largely depended on the jersey structure and distribution of mature connective tissue in the structure of the material.

Endoprostheses made from knitted fabric of 3 loop types were used for hernioplasty in rats. Biocompatibility of implanted textile constructions was evaluated after 6 months. The intensity of inflammatory reaction and types of complications in animals depended on the loop type and method of finishing of the mesh endoprosthesis tissue.

Background: Hiatal mesh implantation in the operative treatment of gastroesophageal reflux disease has become an increasing therapy option. Besides clinical results little is known about histological changes in the esophageal wall., Methods: Two different meshes [polypropylene (PP), Prolene; polypropylene-polyglecaprone 25 composite (PP-PG), Ultrapro] were placed on the diaphragm circular the esophagus of 20 female rabbits. After three months a swallow with iodine water-soluble contrast medium for functional analysis was performed. After the animals were sacrificed, histopathological evaluation of the foreign-body reaction, the localization of the mesh relating to the esophageal wall was analyzed., Results: Sixteen rabbits survived the complete observation period of three months. After three months distinctive mesh shrinkage was observed in all animals and meshes had lost up to 50% of their original size before implantation. We found a delayed passage of the fluid into the stomach in all operated animals. There was a significant increased diameter of the outer ring of granulomas in the PP group (76.5 +/- 8.0) compared to the PP-PG group (64 +/- 8.5; p = 0.002). However, we found a mesh migration into the esophageal wall in six out of seven animals (PP) and five out of nine animals (PP-PG), respectively., Conclusion: Experimental data suggest that more knowledge is necessary to assess the optimal size, structure, and position of prosthetic materials for mesh hiatoplasty. The indication for mesh implantation in the hiatal region should be carried out very carefully.

Full-thickness skin wounds (460 mm(2)) in rats were associated with increased blood chemiluminescence and neutrophil infiltration of the wound tissue and surrounding skin (recorded by myeloperoxidase activity). Activities of glutathione peroxidase and glutathione S-transferase in the skin and wound tissue increased on days 4 and 8. A correlation was revealed between activities of these enzymes and myeloperoxidase activity. Activities of myeloperoxidase and catalase increased in patient's skin excised during plastic surgeries of more than 2.5 h duration.

Background: Formation of recurrent inguinal and incisional hernia shows an underlying defect in the wound healing process. Even following mesh repair an altered collagen formation and insufficient mesh integration has been found as main reason for recurrences. Therefore the development of bioactive mesh materials to achieve a local modification of the scar formation to improve patients outcome is advisable., Methods: Thirty-six male Wistar rats were used within this study. A Mersilene (R) mesh sample was implanted after midline skin incision and subcutaneous preparation. Before implantation mesh samples were incubated for 30 minutes with either one of the following agents: doxycycline, TGF-beta 3, zinc-hydrogeneaspartate, ascorbic acid, hyaluronic acid. Incubation with a physiologic 0.9 % NaCl solution served as control. Seven and 90 days after mesh implantation 3 animals from each group (n = 6) were sacrificed for morphological observations. Collagen quantity and quality was analyzed measuring the collagen/protein as well as the collagen type I/III ratio., Results: Following an implantation interval of 90 days supplementation with doxycycline (39.3 +/- 7.0 microg/mg) and hyaluronic acid (34.4 +/- 5.8 microg/mg) were found to have a significantly increased collagen/protein ratio compared to implantation of the pure Mersilene (R) mesh samples (28.3 +/- 1.9 microg/mg). Furthermore, an overall increase of the collagen type I/III ratio was found in all groups indicating scar maturation over time. However, no significant differences were found after 7 and 90 days of implantation comparing collagen type I/III ratio of supplemented mesh samples and control group., Conclusions: In summary, we found an influence of supplemented mesh materials on collagen deposition. However, the investigated bioactive agents with reported influence on wound healing were not associated with an improved quality in scar formation.

Burn trauma increased blood chemiluminescence, while lipopolysaccharide in a dose of 1 mg/kg potentiated this effect, activated LPO, and decreased plasma antioxidant activity. In erythrocytes, superoxide dismutase activity increased, while activity of peroxide-utilizing enzymes decreased. Myeloperoxidase content increased in the lungs and epidermis. The preparation of alpha-tocopherol, selenium aspartate, and ubiquinone abolished the effect of lipopolysaccharide, but did not modulate the increase in chemiluminescence under the influence of this agent.

Histological study and electron microscopy of the anterior abdominal wall and laparotomy wound closed using a polytetrafluoroethylene film was performed on rats with experimental peritonitis. We studied 4 types of polytetrafluoroethylene films differing in the size of micropores and technology of treatment. The tissue response differed after implantation of various films. A multilayer film with minimum size of pores was optimal to repair the laparotomy wound.

The production of blood radicals and activity of superoxide dismutase in erythrocytes increased in rats with contact burn trauma (20%). In animals with burn trauma antioxidant activity of the plasma was much lower, while myeloperoxidase content in the lung tissue and epidermis was higher than in control rats. The complex of antioxidants (Immudzhen) inhibited radical generation at the peak of inflammation (day 4), increased antioxidant activity of the plasma, and normalized myeloperoxidase content in the lung tissue.

Treatment with the phytopreparation from papaya accelerated wound healing and reduced the severity of local inflammation in rats with burn wounds. The effect of this phytopreparation can be related to an increase in the effectiveness of intracellular bacterial killing by tissue phagocytes due to the inhibition of bacterial catalase. Antioxidant activity of the preparation decreases the risk of oxidative damage to tissues.

Four variants of polytetrafluorethylene films differing by size of micropores and manufacturing technology were used for closing of the abdominal cavity under conditions of experimental peritonitis in rats. The results of tensiometry and planimetry helped us to select the optimal variant of polytetrafluorethylene film characterized by sufficient strength, minimum size of micropores, and causing minimum complications.

Laparotomy closure relies on the incisional edges as anchor for the suture material. The results of these techniques are not satisfying, with failure rates of up to 20%. To investigate the effect of different conventional closure techniques and a novel "bridging technique" on abdominal wall perfusion an animal study was performed in rabbits. Abdominal wall perfusion was measured using the method of dynamic laser-fluorescence videography in the first 72 h of incisional wound healing in 25 animals. Suture tension was controlled with a water-filled polyurethane balloon connected to a pressure detector. The effect of laparotomy closure on abdominal wall tissue perfusion depends significantly on the applied technique and suture tension. Avoiding direct sutures in the incisional edges during laparotomy closure leads to a better tissue perfusion of the incisional region than conventional suture techniques. Suture tension can be controlled and adjusted using a water-filled polyurethane balloon as a pressure sensor.

Background: The duration of the postoperative ileus after laparoscopic surgery remains a controversial topic. The aim of our study was to compare the restoration of intestinal motility after laparoscopically assisted and conventional resection of the distal colon in a canine model., Methods: Two weeks after the implantation of three electrodes on the jejunum, the distal colon was resected in a laparoscopic-assisted or conventional procedure in two groups of four dogs each. Gastrointestinal motility was monitored by registration of the electromyograhic activity of the small intestine and by intermittent fluoroscopies of radiopaque markers., Results: Electrical activity in the early postoperative period was characterized by the basic electrical rhythm and the absence of spike activity. The first postoperative activity front of the migrating motility complex (MMC), indicating the restoration of motility, occurred significantly earlier after laparoscopic-assisted resection (4.5 +/- 1 hr) than after conventional resection (31 +/- 10 h). Radiological observations showed a significantly delayed gastric emptying and a prolonged transit of radiopaque markers to the rectum after open surgery., Conclusion: These results support the hypothesis that laparoscopic-assisted resection of the colon leads to a shortened postoperative atony in comparison to open surgery.

This study aimed to compare new adhesion formation after laparoscopic and conventional adhesiolysis. In a first operation, 24 rabbits underwent fixation of deserosated cecum (6 cm2) to the lateral abdominal wall to induce standardized adhesions. After 4 weeks, adhesiolysis was performed by laparoscopy (n = 12) or laparotomy (n = 12). Outcome was assessed by the incidence, extent, and location of adhesion reformation. After conventional adhesiolysis, new adhesions developed in all the rabbits, as compared with 75% after laparoscopic adhesiolysis. The extent of newly formed adhesions was significantly reduced (p < 0.001) after laparoscopic adhesiolysis (368+/-115 mm2) as compared with conventional adhesiolysis (2434+/-245 mm2). There were no adhesions to trocar wounds, but adhesions to the abdominal incision were found in 33% of the conventional group. In a rabbit model comparing laparoscopic and conventional adhesiolysis in a standardized experimental setting, laparoscopic adhesiolysis is associated with a significantly reduced formation of new postoperative adhesions.