Possibilities of physical rehabilitation using myostimulation after ventral hernia repair retro-rectus
Abstract
Aim. To experimentally study the role and impact of
electrical myostimulation on the wound process in the postoperative period
using a model of retromuscular hernia repair with a synthetic polypropylene
implant.
Material and methods. A model of open retromuscular hernia repair using a
mesh implant (retro-rectus, n=31) was implemented on miniature
pigs during the experiment. Standard polypropylene (PP) meshes were used during
the course of the hernia repair. In the postoperative period, myostimulation of
the anterior abdominal wall muscles was done through the use of apparatus for
electrical myostimulation COMPEX® SP2.0. In the postoperative period, we
performed Doppler ultrasound for anterior abdominal wall structures within the
surgical site, as well as morphological analysis of the PP-mesh landing zone on
the 31th and 60th postoperative days.
Results. Morphometric analysis revealed a statistically
significant increase in the total vessel transection of the muscular tissue
structure on the surgical site, vascularization index (IV=13.2%, per unit area
(1 mm²), provided electrical myostimulation of the anterior abdominal wall
muscles from the 30th postoperative day in comparison with the
control group of animals IV=7.5% which were not exposed to postoperative
electrical myostimulation.
Conclusion. The use of electrical myostimulation in the
postoperative period during the 1st and 2nd phases (from
the 1st to the 30th postoperative days) of the wound
process has been insufficiently studied and is liable to cause unwanted sequela
as a result of the postoperative wound. Nevertheless, the use of electrical
myostimulation since the 30th postoperative day after using
retro-rectus hernia repair had a favorable impact on tissue postoperative
reparative potential on the surgical site. This peculiarity should be taken
into account when drawing up a personalized post-operative recovery plan
including physical exercises and physiotherapy.
Keywords:postoperative rehabilitation; ventral hernia; incisional hernia; retro-rectus; mini-pigs; electrical myostimulation
Funding. This study was carried out within the framework of
agreement No. 171-C “On scientific and technical cooperation” dated August 05,
2019.
Conflict of interest. The authors declare no conflict of interest.
For citation: Demin N.A., Achkasov Е.Е., Karkischenko V.N., Abdurashidova M.R., Shishkin
A.A. Possibilities of physical rehabilitation using myostimulation after
ventral hernia repair retro-rectus. Clinical and Experimental Surgery.
Petrovsky Journal. 2022; 10 (3): 114–24. DOI: https://doi.org/10.33029/2308-1198-2022-10-3-114-124
(in Russian)
References
1. Gogia B.Sh., Alyautdinov V.R., Kopyltsov A.A. et al. Modern view on the treatment of postoperative hernias of the abdominal wall // Khirurgiya. Supplement to Consilium Medicum. 2016. No. 2. P. 6–8. (in Russian)
2. Bittner J.G. 4th, Alrefai S., Vy M., et al. Comparative analysis of open and robotic transversus abdominis release for ventral hernia repair. Surg Endosc. 2018; 32 (2): 727–34. DOI: https://doi.org/10.1007/s00464-017-5729-0 Epub 2017 Jul 20. PMID: 28730275.
3. Pushkin S.Yu., Belokonev V.I. Results of treatment of patients with median ventral hernia using synthetic endoprostheses. Khirurgiya. Journal named after N.I. Pirogov. 2010. No. 6. P. 43–45. (in Russian)
4. Muysoms F.E., Deerenberg E.B., Peeters E., et al. Recommendations for reporting outcome results in abdominal wall repair: results of a Consensus meeting in Palermo, Italy, 28–30 June 2012. Hernia. 2013; 17 (4): 423–33. DOI: https://doi.org/10.1007/s10029-013-1108-5 Epub 2013 May 15. PMID: 23673408.
5. Criss C.N., Petro C.C., Krpata D.M., et al. Functional abdominal wall reconstruction improves core physiology and quality-of-life. Surgery. 2014; 156 (1): 176–82. DOI: https://doi.org/10.1016/j.surg.2014.04.010 PMID: 24929767.
6. Vinnik Yu.S., Petrushko S.I., Michurov E.I. Modern methods of surgical treatment of hernias and postoperative rehabilitation of patients with hernias of the anterior abdominal wall // Modern problems of science and education. 2019. No. 2. P. 124. (in Russian)
7. Pezeshk R.A., Pulikkottil B.J., Mapula S., et al. Complex abdominal wall reconstruction: a novel approach to postoperative care using physical medicine and rehabilitation. Plast Reconstr Surg. 2015; 136 (3): 362e–9e. DOI: https://doi.org/10.1097/PRS.0000000000001532 PMID: 26313841.
8. Langbach O., Bukholm I., Benth J.Š., et al. Long-term quality of life and functionality after ventral hernia mesh repair. Surg Endosc. 2016; 30 (11): 5023–33. DOI: https://doi.org/10.1007/s00464-016-4850-9 Epub 2016 Mar 11. PMID: 26969665.
9. Cox T.C., Blair L.J., Huntington C.R., et al. The cost of preventable comorbidities on wound complications in open ventral hernia repair. J Surg Res. 2016; 206 (1): 214–222. DOI: https://doi.org/10.1016/j.jss.2016.08.009 Epub 2016 Aug 9. PMID: 27916364.
10. Ratnovsky A., Elad D., Halpern P. Mechanics of respiratory muscles. Respir Physiol Neurobiol. 2008; 163 (1–3): 82–9. DOI: https://doi.org/10.1016/j.resp.2008.04.019 Epub 2008 May 15. PMID: 18583200.
11. Koo P., Gartman E.J., Sethi J.M., et al. Physiology in medicine: physiological basis of diaphragmatic dysfunction with abdominal hernias-implications for therapy. J Appl Physiol. 1985; 118 (2): 142–7. DOI: https://doi.org/10.1152/japplphysiol.00276.2014 Epub 2014 Nov 6. PMID: 25377882.
12. Clark R.A., Mentiplay B.F., Pua Y.H., et al. Reliability and validity of the Wii Balance Board for assessment of standing balance: a systematic review. Gait Posture. 2018; 61: 40–54. DOI: https://doi.org/10.1016/j.gaitpost.2017.12.022 Epub 2017 Dec 30. PMID: 29304510.
13. Khan S.K., Malviya A., Muller S.D., et al. Reduced short-term complications and mortality following enhanced recovery primary hip and knee arthroplasty: results from 6,000 consecutive procedures. Acta Orthop. 2014; 85 (1): 26–31. DOI: https://doi.org/10.3109/17453674.2013.874925 Epub 2013 Dec 20. PMID: 24359028.
14. Kiel M.K. Cardiac rehabilitation after heart valve surgery. PM R. 2011; 3 (10): 962–7. DOI: https://doi.org/10.1016/j.pmrj.2011.06.007 PMID: 22024327.
15. Testa A., Iannace C., Di Libero L. Strengths of early physical rehabilitation programs in surgical breast cancer patients: results of a randomized controlled study. Eur J Phys Rehabil Med. 2014; 50 (3): 275–84. Epub 2014 Feb 11. PMID: 24518147.
16. Slim K., Standaert D. Enhanced recovery after surgical repair of incisional hernias. Hernia. 2020; 24 (1): 3–8. DOI: https://doi.org/10.1007/s10029-019-01992-y Epub 2019 Jun 8. PMID: 31177341.
17. Timerbulatov M.V., Timerbulatov Sh.V., Gataullina E.Z. Postoperative ventral hernias: the current state of the problem // Medical Bulletin of Bashkortostan 2013. No. 5. P. 101–107. (in Russian)
18. Keller T., Popovic M.R., Pappas I.P., et al. Transcutaneous functional electrical stimulator «Compex Motion». Artif Organs. 2002; 26 (3): 219–23. DOI: https://doi.org/10.1046/j.1525-1594.2002.06934.x PMID: 11940017.
19. Belokonev V.I., Gogia B.Sh., Gorsky V.A. and other National Clinical Guidelines for Herniology. Inguinal and postoperative hernias. Moscow, 2018. 102 p. (in Russian)
20. Parker S.G., Halligan S., Liang M.K., Muysoms F.E., Adrales G.L., Boutall A., et al. International classification of abdominal wall planes (ICAP) to describe mesh insertion for ventral hernia repair. Br J Surg. 2020; 107 (3): 209–17. DOI: https://doi.org/10.1002/bjs.11400 Epub 2019 Dec 25. PMID: 31875954