Features of muscle structures in patients with morbid obesity correlated with preventive prosthetic plastic surgery of surgical access

Excess body mass and morbid obesity are some of the leading factors in the development of ventral hernias. Among many other factors (metabolic, psychological, and surgical features), this may be due to the structural features of the aponeurosis of the white line of the abdomen in patients with morbid obesity, and the predominance of type 3 collagen over type 1 collagen during the formation of a postoperative scar. The aim of the work was to develop measures aimed at preventing the development of postoperative ventral hernias through preventive abdominal wall plastic surgery with a polypropylene mesh endoprosthesis during surgery in overweight and obese patients. Material and methods. The study and comparison of the structure of the aponeurosis of the white line of the abdomen, the determination of different types of collagen in patients with normal body mass index and morbid obesity. We used methods to prevent the formation of postoperative ventral hernias in 82 patients with morbid obesity (43 after open laparotomy and 39 after laparoscopic interventions). Results. During the long-term examination, favorable treatment outcomes were obtained in all cases. Conclusion. The predominance of type 3 collagen over type 1 collagen in patients with morbid obesity has been experimentally proven, and as a result, a deterioration in the quality of aponeurosis and an increased risk of postoperative ventral hernias in patients of this group. Preventive endoprosthetics of the anterior abdominal wall as a preventive measure for the formation of postoperative ventral hernias in overweight and obese patients will reduce the incidence of postoperative ventral hernias and improve treatment outcomes in this category of patients.