THE RISK OF VENTRAL HERNIA RECURRENCE IN SURGICAL PATIENTS MORPHOLOGICAL FORECASTING

Over the past three decades, repair using synthetic prostheses has been the priority in ventral hernia surgery. Currently, there is a pressing need to develop criteria for predicting recurrence. Of particular relevance are the need for an individualized approach to choosing a prosthetic repair method and the development of new techniques, including a thorough study of immediate and long-term results and the prognosis of late complications associated with mesh migration and hernia recurrence. The aim of this study was to morphologically assess the risk of ventral hernia recurrence in surgical patients. The hernial orifice in the examined 100 patients was located in the middle third of a previously performed laparotomy, requiring repeat surgery. The patients underwent ventroplasty using a mesh graft, which was positioned retro-muscularly with mesh graft fixation. To achieve the study's objectives, 14 days after ventroplasty, patients underwent an ultrasound examination of the postoperative scar. Regenerative processes were analyzed, and the presence or absence of a postoperative seroma, its volume, shape, and depth were recorded. A postoperative scar biopsy was performed under aseptic conditions and local anesthesia. To achieve the best results, three columns of postoperative scar tissue from the most altered areas were examined. The biopsy material was examined using iron hematoxylin and orange-red-blue staining. To differentiate between smooth muscle fibers and collagen in connective tissue, the biopsy material was stained using the Masson trichrome method. Morphological examination revealed that in uncomplicated wound healing, the biopsy material was characterized by the presence of mature collagen fibers and the formation of new vessels. Taken together, the morphological features of mature collagen in the postoperative scar, minimal leukocyte infiltration, the formation of a dense hyalinized scar, and the presence of angiogenesis sites represented by newly formed vessels indicate a favorable wound healing process, sufficient quality of the performed ventroplasty, and the absence of subsequent hernia recurrence.

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