A Model of Median Ventral Hernia in Acute Experiment

Introduction. The treatment of ventral hernia is still of great current interest. If faced with large hernias, a surgeon addresses two problems that can worsen clinical outcomes: intra-abdominal hypertension and excessive tissue tension when suturing the wound. Experimental testing of various hernioplasty techniques considering the tension of the edges of the simulated hernial defect and intra-abdominal pressure is of great importance for improving clinical outcomes of surgical treatment and reducing the number of relapses. Modern hernioplasty techniques are to be thoroughly analyzed in terms of their effectiveness and impact on damaged tissues. Study of the tension mechanics, load distribution on the sutures, dynamics of intra-abdominal pressure during surgery allows identifying the most optimal techniques, which significantly increases the potential successful outcomes of the intervention.

The aim of the study was to create and test a simulated ventral hernia with controlled indices of intra-abdominal hypertension and aponeurosis tension in an acute experiment in animals.

Materials and methods. The study involved 15 pigs weighed 30-35 kg. A special device consisting of an elastic balloon fixed on a tube, a manometer and a squeeze pressure pump was applied to create intra-abdominal hypertension. The tension of the aponeurosis was measured in newtons (N) using an original device equipped with a tensiometer and a monitor.

Results. Intra-abdominal hypertension was simulated by introducing an elastic balloon on a tube into the animal's abdominal cavity through a mini-access, through which air was pumped using a squeeze pressure pump. The pressure value was recorded by the manometer. With total longitudinal dissection of the white line of the abdomen (without damage to the peritoneum), edges of the aponeurosis diverged, which simulated a hernial defect. When intra-abdominal pressure reached 39-41 mm Hg (on average 40,00 ± 0.84) and aponeurosis tension reached 3.8 N, edges of the aponeurosis diverged for three to seven cm (on average 4.9 ± 1.9). One animal with a simulated ventral hernia was exposed to anterior separation plastic surgery according to Ramires II. The tension of the aponeurosis decreased by 52%, intra-abdominal hypertension - by 54%.

Conclusion. The proposed technique for simulating a median ventral hernia allows for an acute experiment, which reduces the time of the experimental study and the material costs associated with the management of the animal. The proposed technique allows not only regulating the initial and final level of aponeurosis tension and intra-abdominal pressure, but also monitoring these parameters at all stages of surgical intervention.