Undifferentiated connective tissue dysplasia as a risk factor for recurrence of postoperative ventral hernia

Backgraund. Despite the development of surgical techniques, the recurrence rate of postoperative hernias (PH) remains high. There is increasing evidence in the literature on the role of connective tissue pathology in the development and recurrence of postoperative ventral hernias

Aim. Establish the relationship between the severity of connective tissue dysplasia (CTD) and the results of plastic PH also identify the correspondence between the phenotypic and morphological signs of CTD in patients with PH.

Materials and methods. The study was conducted on the basis of the "Petrovsky National Research Centre of Surgery" and GBUZ "GCB No. 52 DZM" from 2018 to 2024. The main group consisted of 91 patients with postoperative hernia, the control group consisted of 10 patients who underwent surgery with a history of laparotomy, but without the formation of PH. The groups are identical in age, gender ratio, and comorbidity. 25 plastic surgeries were performed with local tissues and 66 with the use of a mesh prosthesis, morphometric studies of aponeurosis for the ratio of type 1 and type 3 collagen were performed in 50 patients. All patients were assessed for the severity of external signs of connective tissue dysplasia using the Luzgina-Shkurupiya method. The reliability of differences between the groups in the number of hernia recurrences was assessed for each group by the coefficient of statistically significant differences calculated using the Pearson's χ2 criterion. The ratio of collagen types was calculated by analyzing micrographs based on a color histogram in Adobe Photoshop with the calculation of the average number of pixels of different colors for the entire preparation: type 1 collagen - red spectrum, type 3 – green. Quantitative indicators were evaluated for compliance with the normal distribution using the Shapiro-Wilk criterion. Quantitative indicators, the sample distribution of which corresponded to the normal, were described using arithmetic averages (M) and standard deviations (SD). The boundaries of the 95% confidence interval (95% CI) were indicated as a measure of representativeness for the mean values. A comparison of three or more groups by a quantitative indicator, the distribution of which in each group corresponded to the normal one, was performed using a one-factor analysis of variance, aposteriori comparisons were carried out using the Tukey criterion (assuming equality of variances). The differences were considered statistically significant at p < 0.05.

Results. When comparing patients with PH and dysplasia of mild and severe severity, statistically significant differences in the number of relapses were revealed, including with mesh plastics (P<0.05). Statistically significant (P<0.05) differences in the number of pixels were found, reflecting the ratio of type 1 and type 3 collagen, in the direction of an increase in type 3 collagen with an increase in the severity of connective tissue dysplasia

Conclusions. It was found that the probability of PH recurrence significantly increases with increasing severity of CTD, therefore, assessment of the severity of CTD is an important element in the treatment of patients with PH. This makes it possible to prevent the recurrence of PH by choosing the most appropriate surgical technique. Diagnosis of CTD is carried out by phenotypic and morphological methods. The study proved that there is a direct relationship between the phenotypic manifestations of CTD and its morphological features. Therefore, both methods can be adequately applied to assess the severity of CTD.