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, 杨森. 成人腹股沟疝平片法无张力疝修补术的临床应用与观察. 世界最新医学信息文摘, 2018, 18(33): 54.
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5.	康德新, 刘威, 张磊, 等. 腹腔镜切口疝修补术与开放式切口疝修补术在治疗腹壁切口疝的术式选择与疗效对比分析. 中华疝和腹壁外科杂志(电子版), 2016, 10(6): 455-457.
6.	秦超, 王超, 李明等. SD大鼠使用舒泰®50和盐酸塞拉嗪麻醉比较研究. 中国药事, 2021, 35(11): 1239-1245.
7.	菅凤国, 孙宏杰, 刘国正, 等. 生物补片在腹壁不同层面组织相容性差异的动物实验研究. 临床医药文献电子杂志, 2017, 4(12): 2188-2189.
8.	严斐霞, 朱徐东, 王松, 等. 基于蛋白质组学探讨九蒸九晒地黄延缓去卵巢小鼠脑衰老的药效与机制. 中国中药杂志, 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.	谢颂状, 克力木·阿不都热依木, 李赞林. 腹壁切口疝发病诱因与治疗研究进展. 中华实用诊断与治疗杂志, 2016, 30(10): 946-949.
12.	王翀, 罗丹东, 屈荣荣, 等. 腹腔镜经腹腹膜前疝修补术术中应用纱块钝性分离腹膜前间隙的效果分析. 中华临床医师杂志(电子版), 2020, 14(9): 690-693.
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14.	郑培鸿, 陈维荣. 大鼠腹膜粘连的模型构建与评价. 中国比较医学杂志, 2017, 27(9): 104-110.
15.	伍炜, 黄生福, 王群伟. 腹腔镜下完全腹膜外补片植入术与开放无张力疝修补术的对照研究. 中国现代普通外科进展, 2012, 15(4): 315-317.
16.	陆光生, 戎祯祥, 陈小伍, 等. 腹腔镜完全腹膜外补片植入术中常见问题及对策 // 中华医学会外科学分会, 亚洲外科学会, 中华医学会学术会务部. 2007中国外科周暨第16届亚洲外科年会论文摘要集. 北京: 亚洲外科学会、中华医学会外科学分会、中华医学会学术会务部, 2007: 462-463.
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19.	文君, 朱慧敏, 李雪梅, 等. TGF-β1通过上调Shh信号诱导大鼠脑膜成纤维细胞向肌成纤维细胞转化. 南方医科大学学报, 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, 刘曼, 邓倩楠. 正畸应力作用下牙龈肌成纤维细胞表达的初步研究. 华西口腔医学杂志, 2019, 37(5): 537-540.
27.	李锐阳, 董秋霖, 胡金华等. 成纤维细胞与间充质干细胞来源外泌体修复急性皮肤创面的比较. 中山大学学报(医学科学版), 2023, 44(3): 369-378.

1. 孙斌. 成人腹股沟疝采用经腹膜前间隙无张力疝修补术治疗的方法及效果. 中国继续医学教育, 2017, 9(12): 129-131.
2. 王成, 杨森. 成人腹股沟疝平片法无张力疝修补术的临床应用与观察. 世界最新医学信息文摘, 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, 刘威, 张磊, 等. 腹腔镜切口疝修补术与开放式切口疝修补术在治疗腹壁切口疝的术式选择与疗效对比分析. 中华疝和腹壁外科杂志(电子版), 2016, 10(6): 455-457.
6. 秦超, 王超, 李明等. SD大鼠使用舒泰®50和盐酸塞拉嗪麻醉比较研究. 中国药事, 2021, 35(11): 1239-1245.
7. 菅凤国, 孙宏杰, 刘国正, 等. 生物补片在腹壁不同层面组织相容性差异的动物实验研究. 临床医药文献电子杂志, 2017, 4(12): 2188-2189.
8. 严斐霞, 朱徐东, 王松, 等. 基于蛋白质组学探讨九蒸九晒地黄延缓去卵巢小鼠脑衰老的药效与机制. 中国中药杂志, 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. 谢颂状, 克力木·阿不都热依木, 李赞林. 腹壁切口疝发病诱因与治疗研究进展. 中华实用诊断与治疗杂志, 2016, 30(10): 946-949.
12. 王翀, 罗丹东, 屈荣荣, 等. 腹腔镜经腹腹膜前疝修补术术中应用纱块钝性分离腹膜前间隙的效果分析. 中华临床医师杂志(电子版), 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. 郑培鸿, 陈维荣. 大鼠腹膜粘连的模型构建与评价. 中国比较医学杂志, 2017, 27(9): 104-110.
15. 伍炜, 黄生福, 王群伟. 腹腔镜下完全腹膜外补片植入术与开放无张力疝修补术的对照研究. 中国现代普通外科进展, 2012, 15(4): 315-317.
16. 陆光生, 戎祯祥, 陈小伍, 等. 腹腔镜完全腹膜外补片植入术中常见问题及对策 // 中华医学会外科学分会, 亚洲外科学会, 中华医学会学术会务部. 2007中国外科周暨第16届亚洲外科年会论文摘要集. 北京: 亚洲外科学会、中华医学会外科学分会、中华医学会学术会务部, 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. 间皮细胞及其在腹膜粘连中的作用研究进展. 中国药事, 2021, 35(12): 1398-1405.
19. 文君, 朱慧敏, 李雪梅, 等. TGF-β1通过上调Shh信号诱导大鼠脑膜成纤维细胞向肌成纤维细胞转化. 南方医科大学学报, 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, 刘曼, 邓倩楠. 正畸应力作用下牙龈肌成纤维细胞表达的初步研究. 华西口腔医学杂志, 2019, 37(5): 537-540.
27. 李锐阳, 董秋霖, 胡金华等. 成纤维细胞与间充质干细胞来源外泌体修复急性皮肤创面的比较. 中山大学学报(医学科学版), 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

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