Date Published: August 19, 2019
Publisher: Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia
Author(s): Aline Ribeiro Pedroso, Renato Miranda de Melo, Enio Chaves de Oliveira.
To analyze the resistance to medial traction of abdominal wall muscles, before and after performing relaxing incisions.
Seventeen live pigs were used. After a median laparotomy, the handles were made in the rectus abdominis muscles (RAM) to fit the dynamometer. Step 1 (control phase): tensile strength measured without performing relaxant incisions. Step 2: A curvilinear relaxant incision was made on the anterior blade of the right RAM sheath and then the tensile strength was measured by the edge of the wound. The same procedure was adopted after incision of the left posterior blade. Step 3: Relaxing incisions were made in the right posterior and left anterior blade, so that both sides were left with a relaxing incision on both blades. Measurements of resistance were performed.
There was no statistically significant difference between the sides. On the right and left side, all treatments reduced the tensile strength when compared to each other and to the control. There was a reduction of 12% and 9.8% after incision of the anterior and posterior blade, respectively.
Relaxing incisions reduced tensile strength in the ventral abdominal wall.
Laparotomy is considered a routine procedure in medical practice, with the median incision being the main access route to the abdominal cavity, offering wide visceral exposure. This incision, if performed in the alba line, causes little blood loss; however, in the supra-umbilical region, there is a greater incidence of eviscerations and eventrations, since it is a place subject to greater tensions 1 – 4 .
The present study was carried out respecting the ethical principles of animal experimentation, according to the rules of the National Council for the Control of Animal Experimentation (CONCEA), Law N o 11.794 of October 8, 2008 (Lei Arouca) and Decree N o 6.899 of July 15, 2009. The Ethics Committee on the Use of Animals of the Pontifícia Universidade Católica de Goiás (CEUA/PUC-GO) approved the study under protocol N o 1745220817.
The averages of the values obtained for each variable are shown in Figure 4 .
The reconstruction of the abdominal wall after surgical procedure, maintaining its physiological characteristics, becomes a challenge for each new patient. Regardless of the technique used, the repair of abdominal wall hernias has the objective of closing the defect without tension, with or without the use of prosthetic material, restoring the abdominal wall physiology, providing the patient with a quality of life, with a lasting and aesthetic 15 result.
After assessing the tensile strength of the abdominal-wall muscle aponeurotic components, before and after the relaxation incisions practiced, it was concluded that these reduced the tensile strength in the abdominal wall, being more significant after the incision of the anterior leaf of the sheath of the abdomen muscle, compared to the posterior blade. In relation to the experimental model used, the live pig was effective to the objectives proposed in this study.