The Influence of Tension on the Success of Aponeurotic Suture of the Anterior Abdominal Wall in Experiment

Abstract

Background: The problem of predicting the failure of aponeurotic sutures today is of current interest in abdominal surgery, especially in herniology. Methods and Results: The experimental study was carried out on 20 rabbits of the white giant breed (both sexes). Aponeurotic defects of various sizes were made to the animals’ middle zone of the anterior abdominal wall in the area of the anterior rectus sheath. The defects were sutured with a different tension of the aponeurosis depending on the size of the defect. This tension was determined by traction over ligatures conducted through the borders of the reduced aponeurosis by a digital dynamometer where the edges contact. To increase the rigidity of the layers, titanium frames were installed in the retromuscular space. Thus, tension from 0.012 MPa to 1.2 MPa was created. The results were evaluated on the 30th day of the postoperative period Macroscopic assessment under a loupe and histological examination were used. It was found that aponeurotic sutures failed at a higher tension index (TI) (0.66±0.16 MPa vs. 0.26±0.16 MPa, P<0.001). At the same time, histological changes were characterized by signs of inflammation with a pronounced alterative component. We did not find that the direction of the incision had any effect on the tension value in cases of suture failure. Conclusion: No failure of the suture in the early postoperative period was observed in cases of aponeurosis edge tension less than 0.4MPa. Exceeding this value in 68.7% of cases led to the failure of aponeurotic sutures.

Keywords

• tension
• aponeurosis
• abdominal wall
• suture failure