OBJECTIVE

Comparative assessment of the effectiveness of methods for perioperative preparation of the anterior abdominal wall before the plastic closure of its defects performed on the pig model.

MATERIAL AND METHODS

The subject of the study was 23 female pigs with a ventral hernia model. Three groups were formed: I — with prebilitation of muscles with botulinum toxin; II — with intraoperative stretching of muscular-aponeurotic structures; III — a combination of methods. The change in the width of the hernial defect, the change in the force applied to the edges of the defect until the edges fully close, and the time of extension were investigated. Botulinum toxin type A was injected 30 days prior to surgery into the abdominal lateral muscles with 10 BTA using up to 5 dots on each side. For intraoperative stretching, the original author’s device was used to create a separate uniformly directed traction on the muscular-fascial components of the abdominal wall.

RESULTS

The average width of the defect was 13.14±1.89 cm. Group II recorded a decrease in the width of the hernia defect by 69.4%, in group III — by 88.4%. The largest indicator of strength was in the epigastric region, the smaller indicator was in the hypogastric and minimal in the mesogastria. In group I, the tension force averaged 7.3±03 H, in group II — 5.9±0.5 H, III — 3.6±0.6 H (r≤0.05). Time required until complete approach of defect edges in group II was 40±2min, in group III — 25±3 min.

CONCLUSION

The combination of two methods of preparation — muscle prebilitation with botulinum toxin and intraoperative extension of the musculoaponeurotic structures of the anterior abdominal wall allows to effectively prepare it for plastic surgery, reduce the operation time and complements the positive effects of each of the studied methods.