Effect of total extraperitoneal herniorrhaphy <i>via</i> preperitoneal space approach on peritoneum based on peritoneal histopathology of external abdominal hernia_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

GUI Shiyu ^1,2 , HUANG Dan ¹ , ZHU Jialin ¹ , ZHOU Xiaoyu ¹ , GUO Wenkai ¹ ,  FANG Xiang ¹

1. Department of Hernia Surgery, Deyang People’s Hospital, Deyang, Sichuan 618099, P. R. China;
2. Chengdu University of Traditional Chinese Medicine, Chengdu 610075, P. R. China;

Corresponding?author：

FANG Xiang, Email: fangxiang76111@163.com

Keywords：

external abdominal hernia; total extraperitoneal; preperitoneal space; patch repair; peritoneal pathology

DOI：

10.7507/1007-9424.202304025

Video：

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Objective To observe the pathological changes of the peritoneum before and after the total extraperitoneal herniorrhaphy via preperitoneal space approach for incisional hernia in rats, and to explore the effects on the ischemia and necrosis of the peritoneum and its function after the extensive dissociation of the preperitoneal space and the implantation of the patch. Methods A total of 80 SD rats were randomly divided into normal control group (n=8), hernia model control group (n=8), patch implantation blank control group, and hernia model patch repair group. Eight rats were randomly selected at week 1, 4, 8, and 12 after patch implantation from the patch implantation blank control group and hernia model patch repair group. The normal peritoneum and surrounding tissues were taken from the normal control group, and the peritoneal tissues near the incision were taken from the hernia model control group, patch implantation blank control group, and the hernia model patch repair group. The hematoxylin-eosin staining was performed to observe the pathological changes of the peritoneum. The degrees of inflammatory cell infiltration and fiber hyperplasia among the different groups were compared. Results ① Comparison of the degree of inflammatory cell infiltration in the peritoneal tissue, which in the patch implantation blank control group at week 1 and 4 after patch implantation was more severe than the normal control group (P＜0.001, P=0.005) respectively, which at week 8 after patch implantation was alleviated (P=0.021) as compared to the 1st week after patch implantation in the patch implantation blank control group, which had no statistic difference between the patch implantation blank control group and normal control group (P=0.102), which at the 1st week after patch implantation was more severe than hernia model control group (P=0.014), which was alleviated at week 8 and 12 after patch implantation as compared to the 1st week after patch implantation in the hernia model patch repair group (P=0.040, P=0.040), which had no statistic differences between the patch implantation blank control group and the hernia model patch repair group at same time point after patch implantation (P>0.05). ② Comparison of the degree of fiber hyperplasia in the peritoneal tissue, which at week 1, 4, and 12 after patch implantation was more severe (P＜0.001, P=0.003, P＜0.001, respectively) in the patch implantation blank control group as compared with the normal control group; which was alleviated at week 8 after patch implantation as compared to the 1st week after patch implantation in the hernia model patch repair group（P=0.017); which was more severe in the hernia model control group as compared with the normal control group (P=0.012); which had no statistical differences between the hernia model control group and the hernia model patch repair group at different time point (P>0.05); which had no obvious change between-time point in the hernia model patch repair group (P>0.05); which had no statistic differences between the patch implantation blank control group and the hernia model patch repair group at same time point after patch implantation (P>0.05). Conclusions Based on the experimental results of this study, hernia itself will not stimulate inflammatory cell infiltration and fiber hyperplasia of peritoneal tissue. However, during the process of total extraperitoneal herniorrhaphy via preperitoneal space approach, extensive peritoneal space dissociation and patch implantation will cause peritoneal injury and affect its function. But through the body itself repair, the function caused by peritoneal injury can be fully restored to normal status on the 8th week after patch implantation.

Citation： GUI Shiyu, HUANG Dan, ZHU Jialin, ZHOU Xiaoyu, GUO Wenkai, FANG Xiang. Effect of total extraperitoneal herniorrhaphy via preperitoneal space approach on peritoneum based on peritoneal histopathology of external abdominal hernia. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(8): 919-925. doi: 10.7507/1007-9424.202304025 Copy

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2.	王成, 楊森. 成人腹股溝疝平片法無張力疝修補術的臨床應用與觀察. 世界最新醫學信息文摘, 2018, 18(33): 54.
3.	Senchenkov A, Moran SL, Petty PM, et al. Predictors of complications and outcomes of external hemipelvectomy wounds: account of 160 consecutive cases. Ann Surg Oncol, 2008, 15(1): 355-363.
4.	Campanelli G, Bruni PG, Cavalli M, et al. A complete sutureless, hernia repair for primary inguinal hernia the Trabucco repair: a tribute to Ermanno Trabucco. Surg Technol Int, 2016, 28: 141-146.
5.	康德新, 劉威, 張磊, 等. 腹腔鏡切口疝修補術與開放式切口疝修補術在治療腹壁切口疝的術式選擇與療效對比分析. 中華疝和腹壁外科雜志(電子版), 2016, 10(6): 455-457.
6.	秦超, 王超, 李明等. SD大鼠使用舒泰?50和鹽酸塞拉嗪麻醉比較研究. 中國藥事, 2021, 35(11): 1239-1245.
7.	菅鳳國, 孫宏杰, 劉國正, 等. 生物補片在腹壁不同層面組織相容性差異的動物實驗研究. 臨床醫藥文獻電子雜志, 2017, 4(12): 2188-2189.
8.	嚴斐霞, 朱徐東, 王松, 等. 基于蛋白質組學探討九蒸九曬地黃延緩去卵巢小鼠腦衰老的藥效與機制. 中國中藥雜志, 2022, 47(1): 141-150.
9.	National Toxicology Program. NTP toxicology and carcinogenesis studies of pyridine (CAS No. 110-86-1) in F344/N rats, wistar rats, and B6C3F1 mice (drinking water studies). Natl Toxicol Program Tech Rep Ser, 2000, 470: 1-330.
10.	National Toxicology Program. Toxicology and carcinogenesis studies of 4-methylimidazole (Cas No. 822-36-6) in F344/N rats and B6C3F1 mice (feed studies). Natl Toxicol Program Tech Rep Ser, 2007, (535): 1-274.
11.	謝頌狀, 克力木·阿不都熱依木, 李贊林. 腹壁切口疝發病誘因與治療研究進展. 中華實用診斷與治療雜志, 2016, 30(10): 946-949.
12.	王翀, 羅丹東, 屈榮榮, 等. 腹腔鏡經腹腹膜前疝修補術術中應用紗塊鈍性分離腹膜前間隙的效果分析. 中華臨床醫師雜志(電子版), 2020, 14(9): 690-693.
13.	Belyansky I, Daes J, Radu VG, et al. A novel approach using the enhanced-view totally extraperitoneal (eTEP) technique for laparoscopic retromuscular hernia repair. Surg Endosc, 2018, 32(3): 1525-1532.
14.	鄭培鴻, 陳維榮. 大鼠腹膜粘連的模型構建與評價. 中國比較醫學雜志, 2017, 27(9): 104-110.
15.	伍煒, 黃生福, 王群偉. 腹腔鏡下完全腹膜外補片植入術與開放無張力疝修補術的對照研究. 中國現代普通外科進展, 2012, 15(4): 315-317.
16.	陸光生, 戎禎祥, 陳小伍, 等. 腹腔鏡完全腹膜外補片植入術中常見問題及對策 // 中華醫學會外科學分會, 亞洲外科學會, 中華醫學會學術會務部. 2007中國外科周暨第16屆亞洲外科年會論文摘要集. 北京: 亞洲外科學會、中華醫學會外科學分會、中華醫學會學術會務部, 2007: 462-463.
17.	Mais V. Peritoneal adhesions after laparoscopic gastrointestinal surgery. World J Gastroenterol, . 2014, 20(17): 4917-4925.
18.	孟珠, 王涵, 何牧野, 等. 間皮細胞及其在腹膜粘連中的作用研究進展. 中國藥事, 2021, 35(12): 1398-1405.
19.	文君, 朱慧敏, 李雪梅, 等. TGF-β1通過上調Shh信號誘導大鼠腦膜成纖維細胞向肌成纖維細胞轉化. 南方醫科大學學報, 2022, 42(2): 250-255.
20.	Nitta T, Kataoka J, Ohta M, et al. Usefulness of repair using Hem-o-lok? for peritoneal tear as a complication of totally extraperitoneal repair: case series. Ann Med Surg (Lond), 2019, 49: 5-8.
21.	Ibrahim MM, Poveromo LP, Glisson RR, et al. Modifying hernia mesh design to improve device mechanical performance and promote tension-free repair. J Biomech, 2018, 71: 43-51.
22.	Urman B, Gomel V, Jetha N. Effect of hyaluronic acid on postoperative intraperitoneal adhesion formation in the rat model. Fertil Steril, 1991, 56(3): 563-567.
23.	Reijnen MM, Falk P, van Goor H, et al. The antiadhesive agent sodium hyaluronate increases the proliferation rate of human peritoneal mesothelial cells. Fertil Steril, 2000, 74(1): 146-151.
24.	Krediet RT, Parikova A. Relative contributions of pseudohypoxia and inflammation to peritoneal alterations with long-term peritoneal dialysis patients. Clin J Am Soc Nephrol, 2022, 17(8): 1259-1266.
25.	Catar R, Witowski J, Zhu N, et al. IL-6 trans-signaling links inflammation with angiogenesis in the peritoneal membrane. J Am Soc Nephrol, 2017, 28(4): 1188-1199.
26.	孟耀, 劉曼, 鄧倩楠. 正畸應力作用下牙齦肌成纖維細胞表達的初步研究. 華西口腔醫學雜志, 2019, 37(5): 537-540.
27.	李銳陽, 董秋霖, 胡金華等. 成纖維細胞與間充質干細胞來源外泌體修復急性皮膚創面的比較. 中山大學學報(醫學科學版), 2023, 44(3): 369-378.

1. 孫斌. 成人腹股溝疝采用經腹膜前間隙無張力疝修補術治療的方法及效果. 中國繼續醫學教育, 2017, 9(12): 129-131.
2. 王成, 楊森. 成人腹股溝疝平片法無張力疝修補術的臨床應用與觀察. 世界最新醫學信息文摘, 2018, 18(33): 54.
3. Senchenkov A, Moran SL, Petty PM, et al. Predictors of complications and outcomes of external hemipelvectomy wounds: account of 160 consecutive cases. Ann Surg Oncol, 2008, 15(1): 355-363.
4. Campanelli G, Bruni PG, Cavalli M, et al. A complete sutureless, hernia repair for primary inguinal hernia the Trabucco repair: a tribute to Ermanno Trabucco. Surg Technol Int, 2016, 28: 141-146.
5. 康德新, 劉威, 張磊, 等. 腹腔鏡切口疝修補術與開放式切口疝修補術在治療腹壁切口疝的術式選擇與療效對比分析. 中華疝和腹壁外科雜志(電子版), 2016, 10(6): 455-457.
6. 秦超, 王超, 李明等. SD大鼠使用舒泰?50和鹽酸塞拉嗪麻醉比較研究. 中國藥事, 2021, 35(11): 1239-1245.
7. 菅鳳國, 孫宏杰, 劉國正, 等. 生物補片在腹壁不同層面組織相容性差異的動物實驗研究. 臨床醫藥文獻電子雜志, 2017, 4(12): 2188-2189.
8. 嚴斐霞, 朱徐東, 王松, 等. 基于蛋白質組學探討九蒸九曬地黃延緩去卵巢小鼠腦衰老的藥效與機制. 中國中藥雜志, 2022, 47(1): 141-150.
9. National Toxicology Program. NTP toxicology and carcinogenesis studies of pyridine (CAS No. 110-86-1) in F344/N rats, wistar rats, and B6C3F1 mice (drinking water studies). Natl Toxicol Program Tech Rep Ser, 2000, 470: 1-330.
10. National Toxicology Program. Toxicology and carcinogenesis studies of 4-methylimidazole (Cas No. 822-36-6) in F344/N rats and B6C3F1 mice (feed studies). Natl Toxicol Program Tech Rep Ser, 2007, (535): 1-274.
11. 謝頌狀, 克力木·阿不都熱依木, 李贊林. 腹壁切口疝發病誘因與治療研究進展. 中華實用診斷與治療雜志, 2016, 30(10): 946-949.
12. 王翀, 羅丹東, 屈榮榮, 等. 腹腔鏡經腹腹膜前疝修補術術中應用紗塊鈍性分離腹膜前間隙的效果分析. 中華臨床醫師雜志(電子版), 2020, 14(9): 690-693.
13. Belyansky I, Daes J, Radu VG, et al. A novel approach using the enhanced-view totally extraperitoneal (eTEP) technique for laparoscopic retromuscular hernia repair. Surg Endosc, 2018, 32(3): 1525-1532.
14. 鄭培鴻, 陳維榮. 大鼠腹膜粘連的模型構建與評價. 中國比較醫學雜志, 2017, 27(9): 104-110.
15. 伍煒, 黃生福, 王群偉. 腹腔鏡下完全腹膜外補片植入術與開放無張力疝修補術的對照研究. 中國現代普通外科進展, 2012, 15(4): 315-317.
16. 陸光生, 戎禎祥, 陳小伍, 等. 腹腔鏡完全腹膜外補片植入術中常見問題及對策 // 中華醫學會外科學分會, 亞洲外科學會, 中華醫學會學術會務部. 2007中國外科周暨第16屆亞洲外科年會論文摘要集. 北京: 亞洲外科學會、中華醫學會外科學分會、中華醫學會學術會務部, 2007: 462-463.
17. Mais V. Peritoneal adhesions after laparoscopic gastrointestinal surgery. World J Gastroenterol, . 2014, 20(17): 4917-4925.
18. 孟珠, 王涵, 何牧野, 等. 間皮細胞及其在腹膜粘連中的作用研究進展. 中國藥事, 2021, 35(12): 1398-1405.
19. 文君, 朱慧敏, 李雪梅, 等. TGF-β1通過上調Shh信號誘導大鼠腦膜成纖維細胞向肌成纖維細胞轉化. 南方醫科大學學報, 2022, 42(2): 250-255.
20. Nitta T, Kataoka J, Ohta M, et al. Usefulness of repair using Hem-o-lok? for peritoneal tear as a complication of totally extraperitoneal repair: case series. Ann Med Surg (Lond), 2019, 49: 5-8.
21. Ibrahim MM, Poveromo LP, Glisson RR, et al. Modifying hernia mesh design to improve device mechanical performance and promote tension-free repair. J Biomech, 2018, 71: 43-51.
22. Urman B, Gomel V, Jetha N. Effect of hyaluronic acid on postoperative intraperitoneal adhesion formation in the rat model. Fertil Steril, 1991, 56(3): 563-567.
23. Reijnen MM, Falk P, van Goor H, et al. The antiadhesive agent sodium hyaluronate increases the proliferation rate of human peritoneal mesothelial cells. Fertil Steril, 2000, 74(1): 146-151.
24. Krediet RT, Parikova A. Relative contributions of pseudohypoxia and inflammation to peritoneal alterations with long-term peritoneal dialysis patients. Clin J Am Soc Nephrol, 2022, 17(8): 1259-1266.
25. Catar R, Witowski J, Zhu N, et al. IL-6 trans-signaling links inflammation with angiogenesis in the peritoneal membrane. J Am Soc Nephrol, 2017, 28(4): 1188-1199.
26. 孟耀, 劉曼, 鄧倩楠. 正畸應力作用下牙齦肌成纖維細胞表達的初步研究. 華西口腔醫學雜志, 2019, 37(5): 537-540.
27. 李銳陽, 董秋霖, 胡金華等. 成纖維細胞與間充質干細胞來源外泌體修復急性皮膚創面的比較. 中山大學學報(醫學科學版), 2023, 44(3): 369-378.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Effect of total extraperitoneal herniorrhaphy via preperitoneal space approach on peritoneum based on peritoneal histopathology of external abdominal hernia

Abstract Full text Figures/Tables Video References Cited by

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