Lorem ipsum dolor sit amet, consectetur adipiscing elit. Integer nec odio. Praesent libero. Sed cursus ante dapibus diam. Sed nisi. Nulla quis sem at nibh elementum imperdiet. Duis sagittis ipsum. Praesent mauris. Fusce nec tellus sed augue semper porta. Mauris massa. Vestibulum lacinia arcu eget nulla. Class aptent taciti sociosqu ad litora torquent per conubia nostra, per inceptos himenaeos. Curabitur sodales ligula in libero. Sed dignissim lacinia nunc. Curabitur tortor. Pellentesque nibh. Aenean quam. In scelerisque sem at dolor. Maecenas mattis. Sed convallis tristique sem. Proin ut ligula vel nunc egestas porttitor. Morbi lectus risus, iaculis vel, suscipit quis, luctus non, massa. Fusce ac turpis quis ligula lacinia aliquet. Mauris ipsum. Nulla metus metus, ullamcorper vel, tincidunt sed, euismod in, nibh.

Currently, free plasty based on the use of synthetic implants is the method of choice in modern surgical hernia repair [1, 2]. Its implementation allows reducing several times the recurrence rate after abdominal wall reconstruction and the morbidity and mortality in emergency cases [2–4]. A large number of different polymer materials and the methods of their implantation are introduced in clinical practice [5, 6]. The choice of mesh type and variants of plasty to close an abdominal wall defect are still the subjects of discussion [3, 7]. Some problems associated with tension-free hernia repair have not been solved so far. The problems of adhesive process prevention in abdomen cavity have not been studied completely. In literature there have been described a chronic pain syndrome, foreign body sensation, mesh shrinkage after implantation, and male infertility [8, 9]. More serious complications — bowel obstruction, abscesses, fistulas, chronic paraprosthetic infection occur less frequently [10], though they impair the life quality of the operated patients and raise obstacles on the way to For contacts: Parshikov Vladimir Vyacheslavovich, phone: +7 901-800-14-26; e-mail: pv1610@mail.ru 14 СТМ ∫ 2013 — 5(2) V.V. Parshikov, V.А. Khodak, V.V. Petrov, А.V. Dvornikov, А.А. Mironov, V.A. Dudelson, S.N. Tsybusov a large-scale implementation of prosthetic technologies. Some clinics fall back on autoplasty, study the possibilities to use in herniology biological materials, and completely or partially resorbable absorbable mesh [5, 11]. Another area of possible solutions to these problems is based on the alternative methods of mesh fixation to the tissues – sutureless technique and glue using [12, 13]. A mesh is usually fixed to the abdominal wall by two rows of ligatures along the perimeter of the implant. Local ischemia in the suture area, lower pH, and leukocyte chemotaxis intensify the aseptic inflammation which is the most pronounced around the periphery of the implantation zone [14]. The formation of rough scars and intestinal adhesions is also observed just along the perimeter of an implanted mesh. Unfortunately, complete reduction of this phenomenon is not possible, but the rejection of suture in the intervention area has specific pathophysiological significance. There is evidence that the implantation of a mesh without sutures is devoid of these shortcomings [12]. Some studies demonstrate the fixing the mesh with biological adhesive to be accompanied by a minimal inflammatory reaction, good long–term results and the best indicators of life quality of patients [15]. The number of the researches carried out worldwide is few, and in Russia the experience of glue usage is limited to a few hospitals [13]. The necessity to study thoroughly the technique in experiment and clinical practice at present raises no doubt. the aim of the investigation was to assess the capabilities of abdominal wall plasty with glue fixation of synthetic endoprostheses in experiment. Materials and Methods. The tension-free plasty of abdominal wall with synthetic implants was modeled on rabbits. The research was performed according to the ethical principles established by the European Convention for the protection of vertebrata used for experimental and other scientific purposes (adopted in Strasbourg, Mar, 18, 1986, and confirmed in Strasbourg Jun, 15, 2006). The rabbits were operated under general anesthesia with Nembutal 30 mg/kg intravenously. The basic group animals (n=34) underwent the IPOM technique (intraperitoneal onlay mesh) with the use of “Sulfacrylate” (Russia) glue in mesh fixation to the abdominal wall, and there were used no sutures. The mesh was placed intraperitoneally, the glue was applied to the desired fixation points, and the mesh was hold in situ for 30–40 s, while we were observing the glue polymerization. After the exposure we made sure that the mesh evenly and firmly was fixed to the abdominal wall, and then sutured the wound. The control group animals (n=69) underwent IPOM plasty with a mesh fixed to the abdominal wall using a traditional method — by surgical suturing. The meshes were made of standard and lightweight polypropylene, and the materials manufactured in Russia — Reperen, Uniflex and Flexilen. The distributions of implant types in both groups were comparable. The operation techniques corresponded to those generally accepted in both clinical practice and in experiment [16]. The animals were taken from the experiment in terms on days 14, 21, 28, 90. We studied the fixation strength of an implant to the abdominal wall tissues and estimated the adhesion process in the abdominal cavity. For quantitative evaluation we used the modified Vanderbilt scale [17]. The results were statistically analyzed by the Mann–Whitney test using Origin Pro, Windows 7. results. There were observed no specific problems associated with the use of glue fixation and no endoprosthesis dislocation. The mesh fixation strength to the abdominal wall in both groups was quite sufficient and accounted to 2.625 and 2.725 points, respectively (p=0.936; Z=0.081; U=412.5). Thus, the application of cyanoacrylate glue when performing IPOM provides sufficient strength in fixing mesh to the abdominal wall tissues, and the results of the technique did not significantly differ from those after surgical suture. The intensity of adhesive process in the analyzed groups was 2.125 and 3.823 points, respectively (p=0.009; Z=2.606; U=583). Thus, intraperitoneal implantation of synthetic mesh with glue significantly reduces the intensity of an adhesive process compared to the fixation of meshes with surgical sutures. The participation of the colon in the adhesive process was found in the study group in 6.25% of cases, and in control group — in 33.3% (p=0.049; Z=–1.97; U=140). The glue application in IPOM significantly reduces the adnation rate of colon fixation to the mesh (more than fivefold). The figures illustrate the results of mesh implantation with glue fixation (Fig. 1–3). There is no adhesive process; the mesh is adequately fixed to the abdominal wall all over the fixation area with no implant shrinkage. Well vascularized neoperitoneum is visible on the mesh surface (Fig. 4).

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Integer nec odio. Praesent libero. Sed cursus ante dapibus diam. Sed nisi. Nulla quis sem at nibh elementum imperdiet. Duis sagittis ipsum. Praesent mauris. Fusce nec tellus sed augue semper porta. Mauris massa. Vestibulum lacinia arcu eget nulla. Class aptent taciti sociosqu ad litora torquent per conubia nostra, per inceptos himenaeos. Curabitur sodales ligula in libero. Sed dignissim lacinia nunc. Curabitur tortor. Pellentesque nibh. Aenean quam. In scelerisque sem at dolor. Maecenas mattis. Sed convallis tristique sem. Proin ut ligula vel nunc egestas porttitor. Morbi lectus risus, iaculis vel, suscipit quis, luctus non, massa. Fusce ac turpis quis ligula lacinia aliquet. Mauris ipsum. Nulla metus metus, ullamcorper vel, tincidunt sed, euismod in, nibh.