Evaluation of the effectiveness of intraoperative transverse abdominal muscles stretching during retromuscular allohernioplasty

Introduction. Retromuscular alloplasty for postoperative ventral hernias in the classical version, without transversus abdominal release, often cannot be performed due to big tension during the suturing the posterior line. The reason for this is a width of the aponeurotic defect or the narrowness of the sheathes. The search for less traumatic alternatives to posterior component separation remains relevant. The purpose of this study is an evaluation of the possibility of acute stretching of the transverse abdominal muscle during Rives-Stoppa surgery to reduce the distance between the edges of the aponeuroses of the posterior sheathes. Materials and methods. During the study, this distance was measured intraoperatively in 20 patients with postoperative ventral hernias classified as M2,3W2, before stretching the transverse muscle and after manipulation. The stretching was performed by traction of the edges of the aponeuroses of the posterior sheathes in the medial direction for 2 minutes on each side. Previously, the posterior lamina of the internal oblique muscle aponeurosis, which covers the transverse muscle, was crossed. Results. Research results. It turned out that this manipulation can significantly reduce the transverse size of the aponeurotic wound by 5,8±0,9cm (p<0,001) and suture the aponeurosis in 16 out of 20 cases without transversus abdominal release. Conclusion. Acute stretching of the transversus abdominal muscles can be used in retromuscular hernioplasty in order to avoid its complete release in a number of patients.