Experimental study on an alternative to suturing the laparotomy wound with a mesh thread

BACKGROUND: Incisional ventral hernias (IVH) in abdominal surgery remain relevant because the frequency of their formation after laparotomy reaches 10%–30.7%. AIM: This study aimed to develop a method for the primary closure of a laparotomy wound via mesh endoprosthesis, which is superior to laparorrhaphy with traditional suture materials in terms of morphophysical properties. MATERIALS AND METHODS: Laparorrhaphy with a mesh thread was developed (Patent for invention RUS No 2714439 02/14/2020) as an alternative to preventive prosthetics with narrow indications to avoid herniation. An experimental work was conducted to investigate the wound process in the suture area on days 14 and 60 and determine the effectiveness and safety of the proposed method. RESULTS: Video laparoscopy data showed that no cases of adhesions were observed between the internal organs and the area of laparorrhaphy on days 14 and 60 of the postoperative period. Defects in the area of the application of sutures on the aponeurosis of the white line were absent. In the wound, the mesh thread fully integrated into the regenerating tissue, including at the site of the knot. The tissue also grew through the meshed cells. On day 14, the strength of the regenerating tissue with the sutured mesh thread was greater than that sutured without it (11.198 ± 1.499, p < 0.01). This finding was confirmed by the larger area of granulations and fibrosis in cases of mesh suture than that of the checkerwise-reinforcing suture, suture with a mesh thread, and suture with a strip of mesh endoprosthesis. Another peculiarity of the connective tissue newly formed in the area of the mesh endoprosthesis in the form of the mesh thread was that collagen fibrils were arranged concentrically. By contrast, the mesh strip had collagen fibrils arranged in a longitudinal orientation parallel to the endoprosthesis. On day 60 of the experiment, all the series showed signs of maturation of the connective tissue in the form of the predomination of fibrils in cellular elements and their compaction. The area of fibrosis and granulations still prevailed in cases of the mesh suture, where neocollagenogenesis in the cells of the endoprosthesis was more pronounced than that after the application of a reinforcing suture, a mesh thread, and a strip of mesh endoprosthesis. CONCLUSION: The absence of wound complications and negative impact on the surrounding tissues indicated the safety of using the mesh suture. The strengthened characteristics associated with the peculiarities of the wound process showed that the mesh suture was effective in preventing the occurrence of postoperative hernia. Therefore, this method could be used in clinical practice.