Morphological features of postoperative biopsies of scar tissue of the subdermal structures of the abdominal wall in patients with diastasis of the rectus abdominis

Background. Poor integration of scar tissue with the prosthetic mesh may be the cause of recurrence of diastasis recti abdominis. Autologous platelet-rich plasma is a promising candidate for improving the integration of scar tissue with the prosthetic mesh. Purpose – to investigate the morphological and morphometric features of scar tissue of the subdermal structures of the anterior abdominal wall around the mesh prosthesis in patients with diastasis recti abdominis. Materials and Methods. Postoperative biopsies of scar tissue around the installed mesh prosthesis were examined. The obtained histological specimens were stained with hematoxylin and eosin. The morphometric parameters of collagen fiber bundles were measured using standard ocular microscopic morphometric rulers and grids. Statistical analysis of the study materials was performed using the program «TIBCO Statistica» (v13.5.0.17, USA). Results. Conventional methods of surgical treatment led to the formation of a massive and dense fibrous scar (p<0.05), which contained significantly thickened (p<0.05) and almost straight (p<0.05) bundles of collagen fibers with a significant violation of their orientation, which makes it impossible to integrate the prosthetic mesh with scar tissue and significantly increases the risk of recurrence of diastasis and postoperative hernias. Laparoscopic methods of surgical treatment led to the formation of a moderate fibrous scar (p<0.05), which contained thickened (p<0.05) and insufficiently wavy (p<0.05) collagen fiber bundles with a moderate violation of their orientation, which moderately disrupts the integration of the prosthetic mesh with scar tissue and poses a risk of recurrence of diastasis and postoperative hernias. Laparoscopic methods of surgical treatment with the injection of autologous platelet-rich plasma led to the formation of a moderate fibrous scar (p<0.05), which contained thickened (p<0.05) and wavy (p<0.05) bundles of collagen fibers without significant disturbance of their orientation, which significantly improves the integration of the prosthetic mesh with scar tissue and reduces the risk of recurrence of diastasis and postoperative hernias. Conclusions. Conventional methods of surgical treatment resulted in the formation of a massive and dense fibrous scar that did not integrate with the prosthetic mesh at all. Laparoscopic methods of surgical treatment led to the formation of a moderate fibrous scar, which was insufficiently integrated with the prosthetic mesh. Laparoscopic methods of surgical treatment with the injection of autologous platelet-rich plasma led to the formation of a moderate fibrous scar, which was well integrated with the prosthetic mesh.