Comparative Characteristics of Separation Techniques in Treatment of Median Ventral Hernias of Anterior Abdominal Wall in the Experiment

INTRODUCTION: A method of separation plasty of the anterior abdominal wall in surgical treatment of giant ventral hernias is often chosen empirically. A model of ventral hernia in experiment allows for assessment of the effectiveness of surgical intervention and introduction of the obtained data in practice. AIM: Comparative assessment of the anterior and posterior separation plasty techniques for median ventral hernias of the anterior abdominal wall in an acute cadaver experiment. MATERIALS AND METHODS: The study was conducted on 15 deceased patients aged from 55 to 85 years with a model of a median ventral hernia. The hernia was modeled by dissecting the aponeurosis of the white line with controlled intra-abdominal hypertension (40.0±5 mm Hg) and preset tension of the edges of the dissected aponeurosis (4N). The deceased were divided into three groups. Five separation plastic surgeries of the anterior abdominal wall using Ramirez II, Carbonell and Novitsky techniques were conducted one in each group. RESULTS: The tension of the posterior lamina of the rectus sheath in the group with use of Ramirez II separation technique was 59.5±8% N, in the group with use of Carbonell technique — 49.0±8% N, in the group with use of Novitsky technique — 36.5±10% N. The tension of the anterior lamina of the rectus sheath after use of Carbonell posterior separation technique (3.96±0.04 H) and Novitsky technique (4.04±0.04 N) did not change. Only with use of Ramirez anterior separation technique, the tension of the anterior lamina of the rectus sheath decreased to 53.0±8% N. CONCLUSION: The median ventral hernia was for the first time proposed to be modeled on cadaver. The tension of the aponeurosis of the white line of the abdomen after Ramirez II procedure decreased by 40.5±8%, after Carbonell procedure — by 51.0±8%. The most significant decrease in the tension of the aponeurosis of the white line of the abdomen was noted after Novitsky separation plasty technique (63.5±10%). The tension of the anterior lamina of the rectus sheath after use of Carbonell and Novitsky posterior techniques did not statistically significant. A decrease in the tension of the anterior lamina of the rectus sheath by 53.0±8% was noted only with use of Ramirez II anterior plasty technique.