CC BY
14УДК 617-007.43-089.843+616-018-092.4
EXPERIMENTAL EVALUATION OF ULTRASTRUCTURAL CHANGES IN CONNECTIVE TISSUE CAPSULES DURING INTEGRATION OF VARIOUS POLYPROPYLENE IMPLANTS INTO THE ABDOMINAL WALL TISSUES
Ilchenko F. N., Mahanta A., Grivenko S. G.
Department of surgery № 2, Medical Academy named after S. I. Georgievsky of Vernadsky CFU, Simferopol, Russia
For correspondence: Fedor N. Ilchenko, MD, Head of Department of surgery № 2, Medical Academy named after S.
I. Georgievsky of Vernadsky CFU, e-mail: ilchenko5252@mail.ru
Для корреспонденции: Ильченко Федор Николаевич, доктор медицинских наук, профессор, заведующий
кафедрой хирургии № 2, Медицинская академия имени
Вернадского», e-mail: ilchenko5252@mail.ru
Information about authors:
Ilchenko F. N. http://orcid.org/0000-0003-3703-6995
Mahanta A. http://orcid.org/0000-0003-1450-4819
Grivenko S. G. http://orcid.org/0000-0003-2602-0504
SUMMARY
The aim of the study is the evaluation of ultrastructural changes in the tissues of the anterior abdominal wall in the integration of various polypropylene synthetic materials as function of the size of cells and the density of mesh prosthesis.
The experimental study was carried out on 27 white non-linear male rats with a mass of 200-250 g, divided into three groups with 9 specimen in each. Under ether anesthesia, the polypropylene mesh was implanted into the abdominal wall tissue. For the first group, we used Opusmed PPM 601 manufactured in Ukraine, which is made of a biologically inert polypropylene monofilament 0.15 mm in diameter, with a grid density of 100 g /m2 and a cell size of 1.3x1.0 mm. For the second group, Opusmed PPM 403 manufactured in Ukraine was used, which is made of a biologically inert polypropylene monofilament 0.1 mm in diameter, a mesh density of 47 g / m2 and a mesh size of 1.3x1.0 mm. In the third group, the ProLite ™ Mesh (Atrium, USA) was used, which is made of a biologically inert polypropylene monofilament 0.15 mm in diameter, with an average cell size of 800 microns and a grid density of 85 g / m2. The animals were removed from the experiment on the 30th, 60th and 120th days after the implantation. Preparations for transmission electron microscopy were taken from the abdominal wall tissue sites with mesh implants. Viewing and photographing of preparations were made with a transmission electron microscope PEM-100 (Ukraine) (the magnification range from x1000 to x30000).
The transition of the excudation stage to the proliferation stage during the integration of various polypropylene implants into the abdominal wall tissue and the formation of the connective tissue paraprothesis capsule is associated with the mechanical and technological characteristics of the implants, namely the diameter of the monofilament, the density of the mesh, the size of the cells and the technology of weaving.
Keywords: anterior abdominal wall; mesh implant; mesh prosthesis.
ЭКСПЕРИМЕНТАЛЬНАЯ ОЦЕНКА УЛЬТРАСТРУКТУРНЫХ ИЗМЕНЕНИЙ СОЕДИНИТЕЛЬНОТКАННОЙ КАПСУЛЫ ПРИ ИНТЕГРАЦИИ РАЗЛИЧНЫХ ПОЛИПРОПИЛЕНОВЫХ ИМПЛАНТОВ В ТКАНИ ПЕРЕДНЕЙ БРЮШНОЙ СТЕНКИ
Ильченко Ф. Н., Маханта А., Гривенко С. Г.
Кафедра хирургии № 2, Медицинская академия имени С. И. Георгиевского ФГАОУ ВО «КФУ имени В. И.
Вернадского», Симферополь, Россия
РЕЗЮМЕ
Цель исследования: оценка ультраструктурных изменений в тканях передней брюшной стенки при интеграции различных полипропиленовых сетчатых материалов в зависимости от размера ячеек и плотности сетчатых имплантов.
Исследование проведено на 27 белых нелинейных крысах-самцах весом 200-250 г, в трех группах (по 9 животных в каждой), которым под эфирным наркозом в ткани передней брюшной стенки имплантировали полипропиленовый сетчатый имплант. У животных первой группы использовали импланты Opusmed РРМ 601 (Украина), изготовленные из биологически инертной полипропиленовой мононити диаметром 0,15 мм, плотность сетки 100 г/м2, размер ячеек 1,3x1,0 мм. У животных второй группы использовали импланты Opusmed РРМ 403 (Украина), изготовленные из аналогичной мононити диаметром 0,1 мм, плотность сетки 47 г/м2, размер ячеек 1,3х1,0 мм. У животных третьей группы использовали импланты ProLite™ MESH производства Atrium, USA, изготовленные из полипропиленовой мононити диаметром 0,15 мм, со средним размером ячеек 800 микрон и плотностью сетки 85г/м2. Животные выводились из опыта на 30, 60 и 120 сутки после имплантации. Препараты для трансмиссионной электронной микроскопии были взяты из участков ткани передней брюшной стенки с наличием сетчатого импланта. Просмотр и фотографирование препаратов производили на трансмиссионном электронном микроскопе ПЭМ-100 (Украина) (диапазон увеличения - от х1000 до х30000). Переход стадии экссудации в пролиферацию при интеграции различных полипропиленовых имплантатов в ткани передней
КРЫМСКИЙ ЖУРНАЛ ЭКСПЕРИМЕНТАЛЬНОЙ И КЛИНИЧЕСКОЙ МЕДИЦИНЫ
брюшной стенки при формировании соединительнотканной парапротезной капсулы связан с механическими и технологическими характеристиками имплантатов, а именно диаметром мононити, плотностью сетки, размером ячеек и технологией плетения.
Ключевые слова: передняя брюшная стенка; сетчатый имплант; сетчатый материал.
Hernias of the anterior abdominal wall (AAW) are one of the most common pathologies in surgical practice and account for 7% of the total adult population of the planet according to some data [1]. According to Lasarenko V.A. and co-authors, 2.5% to 6% of the adult population of Russian Federation suffer from hernia of the AAW, an average of 40 per 1000 of population [2]. In modern conditions, the conventional doctrine of surgical treatment of abdominal hernia is based on the principles of preferential use of non-tension hernioplasty of the AAW, which is impossible without the use of additional materials [3]. In 2012, A. Coda et al systematized data about 166 prostheses from 37 companies used in herniology [4]. However, most synthetic material (SM) implants currently used, being a foreign body, contribute to the inflammatory reaction in the wound due to insufficient biological inertness or inappropriate structure [5]. Nevertheless, at present, only polypropylene (PP), being the optimal material for making the mesh prosthesis (MP), has become the "golden standard" for practical use in surgical herniology [3, 6]. However, being a SM, a PP mesh causes an active and prolonged (chronic) inflammatory reaction of surrounding tissues in the implantation zone, which underlies the development of local retention and infection postoperative complications (up to mesh rejection) [3,7,8]. Taking into account that all currently used PP MP are biocompatible materials from the surgical point of view, some physical and structural properties, namely pore size and porosity cause complications and affect outcomes. Therefore, the research interest shifted towards the structure and its interaction with tissues, which made it possible to identify differences in tissue integration in prostheses having different designs and complications related to the structure of the mesh [9]. It has been proved that the characteristics of prostheses belonging to the same type can vary significantly depending on what material and compositions are put into this design. In this regard, each mesh implant has to be evaluated in accordance with its type. This will optimize the choice of MP of a certain type in a specific clinical situation [10-13]. However, the complexity of the final choice of MP is that those belonging to one class only have the same qualitative set of properties, but the properties can vary significantly among different representatives of the same class [9]. All of the above is the basis for an active study of complex histopathological reactions and the features of
the regenerative process in the interaction of the implanted material with living tissues [3].
Aim of experiment: evaluation of ultrastructural changes in tissues of AAW in the integration of various PP SM as function of the size of cells and the density of MP.
MATERIAL AND METHODS
The experimental study was carried out on 27 white non-linear male rats with a mass of 200-250 g, divided into three groups with 9 specimens in each. Under ether anesthesia, PP mesh was implanted into the abdominal wall tissue. For the first group, we used Opusmed PPM 601 manufactured in Ukraine, which is made of a biologically inert PP monofilament 0.15 mm in diameter, with a grid density of 100 g /m2 and a cell size of 1.3x1.0 mm. For the second group, we used Opusmed PPM 403 manufactured in Ukraine, which is made of a biologically inert PP monofilament 0.1 mm in diameter, with a mesh density of 47 g / m2 and a mesh size of 1.3x1.0 mm. In the third group, the ProLite ™ Mesh (Atrium, USA) was used, which is made of a biologically inert PP monofilament 0.15 mm in diameter, with an average cell size of 800 microns and a grid density of 85 g / m2. The comparative characteristics of meshes used in the experimental study are given in Table 1.
In all animals, mesh implant strips measuring 1.5 x 1.5 cm were fixed in the abdominal wall tisses with a suture material based on copolymers of polyglycolic acid (Demecryl), manufactured by DemeTECH, USA.
The experiment was carried out in the Vivarium of the CSMU named after S.I Georgievsky. The animals were kept under standard vivarium conditions with free access to water and food. Each animal was given an individual number. All interventions and slaughter of animals were carried out in compliance with the requirements of the "European Convention for the Protection of Vertebrates used for experimental and scientific purposes" (Strasbourg, 1986). The animals were removed from the experiment on the 30th, 60th and 120th days after initiation of the experiment. Euthanizing of animals was done in accordance with the "Bioethics Requirements of the Helsinki Declaration on the Moral Regulation of Medical Research".
Preparations for transmission electron microscopy (TEM) were taken from the abdominal wall tissue sites with MP. Fixation and mounting were carried out according to standard methods
Table 1
Comparative characteristics of MP
Opusmed РРМ 601 Opusmed РРМ 403 ProLite™MESH
Material PP PP PP
Filament type Monofilament Monofilament Monofilament
Diameter of filament 0.15 mm 0.1mm 0.15 mm
Density of mesh 100g/m2 47 g/m2 85 g/m2
Cell size 1.3x1.0mm 1.3x1.0mm 800 microns
[14]. For TEM, pieces 1x1x1 mm in size on a wax board were cut out and fixed on a 2.5% solution of glutaraldehyde on phosphate buffer (pH 7.2-7.4) for 1 hour in the cold; washed from the fixator with 0.1 M phosphate buffer 3 times after 10, 20, and 30 minutes; poured pieces of1% osmium OsO4 solution for 1 hour in the cold (+ 400C) or until the pieces are blackened (solution on the same phosphate buffer); were conducted on alcohols of ascending concentration (25%, 30%, 50%, 70%, 96%, 100%). After dewatering and impregnating the material in a mixture of epon-araldite, semi-thin sections (1 ^m) were made on the UMPT-7 ultrasound (Ukraine), stained with methylene blue, and examined in a light microscope to determine the nature of the material. Subsequently, ultrathin sections (3060 nm) were made and stained by Reynolds E. S.
[15]. Viewing and photographing of preparations were made on a TEM PEM-100 (Ukraine) (the range of magnification was x1000 to x30000).
RESULTS
In the animals of the first group, 30 days post implantation of PP SM, the PP mesh capsule surrounding the filaments of the MP appeared to be a collagen fiber bundle of different diameter and degree of maturity, infiltrated with cellular elements of loose connective tissue. The outer sections of the fibrous layer of the capsule consisted of more mature and thick bundles of collagen fibers, which give trabeculae in the central parts of the strands of interwoven MP filaments. These trabeculae, as well as fibers covering individual strands of MP were young, thin collagen fibers (Fig. 1).
The study of preparations from the animals of the second group at the same interval after implantation of MP has shown that the strands of MP are covered with a connective tissue capsule and have a pronounced two-layered organization. The outer layer is fibrous, consisting of bundles of mature collagen fibers, between which there are fibroblastic cells, mainly fibrocytes, having narrow, elongated hyperchromic nuclei. The inner layer of the capsule is cellular. Along with young and mature fibroblasts, macrophages and polymorphonuclear
Fig. 1. A segment of muscle fibers (marked by a dotted line) located among the collagen fibers.
There is a moderate perimisial edema (arrows) in the connective tissue - moderate swelling and separation of collagen fibrils. Electronogram x 4000.
leukocytes are found (Fig. 2). There is a moderate perimisial edema (arrows), in the connective tissue -moderate swelling and separation of collagen fibrils.
In the third group of animals, on the 30th day after MP implantation, around the filaments of the MP a loose connective tissue capsule with indistinct differentiation into the fibrous and cellular layers are observed. Around some strands of the MP, the fibrous layer is completely absent. In the infiltrate, directly surrounding the polymer filaments of the prosthetic MP, all types of cells of loose fibrous connective tissue were identified. Often there are giant cells of foreign bodies.
There are many young forms among fibroblasts. Mature fibroblasts and fibrocytes were found only on the periphery of the capsule and only in those places where the collagen fibers are organized into bundles.
In the cytoplasm of fibroblasts numerous enlightenments, enlarged cisterns of the endoplasmic reticulum, condensation of chromatin along the periphery of the karyoplasm are determined. Collagen fibrils have predominantly the same direction, the distance between the fibrils is slightly increased.
Fig. 2. A patch of connective tissue in which fibroblasts (O) and collagen fibrils (arrows) are identified. Electronogram x 15000.
On the 60th day after the implantation of PP MP, in animals of the first group, a pronounced connective tissue capsule tightly fused with the aponeurosis of the AAW muscles is determined. The degree of maturity, the thickness of the bundles and their order as well as their orientation make it possible to classify the capsule as a dense fibrous organized connective tissue (Figure 3). It should be noted that a mildly expressed cell layer consisting of young fibroblasts and rare macrophages is observed.
In contrast to the previous study group, in the animals of the second group, the reaction of connective tissue to the implantation of PP MP is more pronounced. This is manifested by thickening of the cell layer due to more active migration of mononuclear cells.
Among them, monocytes predominate, which differentiate into macrophages, and are found in large numbers among young and mature fibroblasts in the "relaxed" portions of the capsule. The chromatin is located on the periphery of the karyoplasm. These signs indicate a high synthetic activity of fibroblast-like cells, which are in the interphase (Fig. 4).
Thus, on the 60th day after the implantation of PP MP in the animals of the second group, the morphological picture of the connective tissue capsule around the MP filaments demonstrates continuation of the exudative stage of inflammation. This is also evidenced by the high content of phagocytic cells (neutrophils, macrophages and their precursors) in the infiltrate compared to the previous period of the experiment.
The study of AAW preparations of the animals of the third group on the 60th day after the implantation of the PP MP showed that the reaction of the anterior wall tissues to MP implantation differs little from the previous group of animals. The capsule is even more friable and just as weakly fused to the surrounding fascial structures. The only significant
Fig. 3. Collagen fibrils are densely packed into large bundles (arrows) that have a different directional orientation. Electronogram x 15000.
Fig. 4. Fibroblasts (O) have an elongated shape and are located among the multidirectional bundles of collagen fibrils (arrows). In the cytoplasm of fibroblasts, there are many dilated tubules of the granular endoplasmic reticulum. Electronogram x 15000.
difference is a more clear separation of the layers - fibrous and cellular - against the background of an unchanged correlation of fibroblasts and fibrocytes in the fibrous layer of the capsule. In the cytoplasm of fibroblasts, a large enlightened part is visible, which indicates intracellular edema, dilated tubules of the granular endoplasmic reticulum, which indicate active synthesis. The cytolemma of fibroblasts is in contact with collagen fibrils.
In examining the structure of the connective tissue capsule on the 120th day after the implantation of PP MP in the animals of the first group, it was found that the capsule is characterized by a high degree of maturity of the fibrous and cellular component and complete integration of bundles of collagen fibers of the capsule into the aponeurosis and perianoneurotic connective tissue structures. From the inner layers of the capsule towards the nearest lymphatic vessels, there is a migration of
macrophages involved in the remodeling of the capsule. In this group of animals, the morphological pattern is characterized as the stage of remodeling of the dense fibrous-shaped connective tissue of the SI capsule. However, even in such late terms, the electron microscopic study showed presence of bacteria among the collagen fibrils.
In the animals of the second group on the 120th day after MP implantation, the strands of PP MP are covered with a capsule loosely fused with the aponeurosis. However, MP filaments in bundles are separated by interlayers consisting of dense fibrous connective tissue. It should be noted that it is in such trabeculae that the highest maturity of collagen fibers was found and also almost complete absence of immature cells of the fibroblastic series were noted. Directly with the MP filament contacted the cell layer of the capsule, in which active macrophages and giant cells of foreign bodies are determined. Thus, within 120 days after the implantation of PP MP in this group of animals, the morphological picture is characterized by completeness of the formation of the connective tissue "frame" of the capsule against the background of the continued involvement of the mononuclear cells in the cell layer of the capsule. It should be noted that in this group of animals, as in the previous one, even at such late times, bacteria are found among the collagen fibrils.
Unlike the previous group of animals, in the third group of animals around the MP filaments, a capsule with a clear division into two layers -cellular and fibrous - is determined and the fibrous layer is tightly fused with the adjacent areas of the aponeurosis. From the outer layers of the capsule, trabeculae consisting of loose fibrous connective tissue goes out and they separate the filaments of the MP in such a way that each of them is in its own connective tissue "case", with a two-layered organization. It should be noted that fibroblasts are located between parallel bundles of collagen fibers and the degree of maturity varies from young to mature forms. In the enlightened cytoplasm of eosinophils, a characteristic type of crystal-like granules is determined. The nucleus is elongated, the chromatin is located along the periphery of the karyoplasm. At the same time among the loose fibrous connective tissue hemocapillaries are determined. In the lumen of the venules there are erythrocytes and platelets. The basal membrane of the endothelium is thin and clear. In the cytoplasm of endotheliocytes, numerous Weibel-Pallade bodies are determined. The nuclei are elongated, with chromatin distributed along the periphery of the karyoplasm. The basal membrane of the endothelium adjoins the collagenized matrix, with disjointed collagen fibrils. These ultrastructural changes at this observation period in the third
group of animals indicate that the processes of exudation in the cell layer of the capsule are still incomplete. At the same time, in the fibrous layer of the capsule, the processes of reparative regeneration are almost complete, as evidenced by strong integration of the periprosthetic capsule into the surrounding connective tissue structures. However, as in the previous two groups of animals, even at such late stages, bacteria are found.
DISCUSSION
The analysis of histological preparations from the animals of the first group on the 30th day after implantation of PP MP showed that the morphological pattern of the reaction of the AAW tissues of animals is characterized as an exudative stage of aseptic inflammation. The study of preparations from the second group at the same time after SI implantation showed that the MP filaments are covered with a connective tissue capsule and have a pronounced two-layered organization. In the third group of animals, a loose connective tissue capsule with indistinct differentiation into fibrous and cellular layers is observed around the MP filaments.
On the 60th day after the implantation of PP MP in animals of the first group, a pronounced connective tissue capsule is visible around its filaments, which allows it to be classified as a dense fibrous organized connective tissue. The quantitative predominance of fibroblasts and fibrocytes in the capsule allows us to conclude that, within 60 days after the implantation of MP, the reaction of AAW tissues in the animals of the first group is qualified as a stage of proliferation and remodeling of the connective tissue. In contrast to the previous study group, in the animals of the second group, the connective tissue reaction to implantation of PP MP is more pronounced and demonstrates continuation of the exudative stage of inflammation. The study of the AAW preparations of the animals of the third group on the 60th day after the implantation of PP MP showed that the reaction of the AAW tissues to MP implantation differs little from the previous group of animals. The only significant difference is a more distinct differentiation of the layers -fibrous and cellular - against the background of an unchanged correlation of fibroblasts and fibrocytes in the fibrous layer of the capsule. The above-mentioned peculiarities of the connective tissue reaction within 60 days after the implantation of the PP MP allow us to conclude about the "spatial" division of the phases of inflammation: immediately around the MP filaments (the cell capsule layer) there is an exudative phase, and in the fibrous layer of the capsule the proliferation phase begins.
When studying the structure of the connective tissue capsule on the 120th day after the
КРЫМСКИЙ ЖУРНАЛ ЭКСПЕРИМЕНТАЛЬНОЙ И КЛИНИЧЕСКОЙ МЕДИЦИНЫ
implantation of PP MP in the animals of the first group, it was found that the capsule is characterized by a high degree of maturity of the fibrous and cellular component and complete integration of bundles of collagen fibers of the capsule into the aponeurosis and perianoneurotic connective tissue structures. Taking into account the small number of macrophages and their precursors - monocytes in the cell layer, as well as the absence of giant foreign body cells, it can be argued that within 120 days after MP implantation in this group of animals the morphological picture is characterized as the remodeling stage of the dense fibrous connective tissue of the MP capsule. In the animals of the second group, on the 120th day after MP implantation, the morphological pattern is characterized by completeness of the formation of the connective tissue "frame" of the capsule against the background of continued involvement of the cell-mononuclear cells in the cell layer of the capsule. Unlike the previous group of animals, in the third group of animals, around the MP filaments a capsule with a distinct differentiation into two layers - cellular and fibrous - is determined. In this case, the revealed ultrastructural changes indicate that the process of exudation in the cell layer of the capsule is still not completed. At the same time, in the fibrous layer of the capsule, the processes of reparative regeneration are almost complete, as evidenced by the strong integration of the periprosthetic capsule into the surrounding connective tissue structures.
CONCLUSION
Taking into account the fact that the surgical intervention in all groups of the experiment was standardized and the postoperative period was the same, it can be concluded that the transition of the exudation stage to proliferation in different study groups can be related to the mechanical and technological characteristics of the polypropylene MP under study, namely, the monofilament diameter, the density of the grid, the size of the cells and the technology of weaving. These factors should be taken into account when performing surgical interventions on the AAW, primarily in patients with abdominal hernias, because they directly affect the course of the wound process and further on the functional and aesthetic consequences of the operations performed.
Conflict of interest. The authors have no conflict of interests to declare.
Конфликт интересов. Авторы заявляют об отсутствии конфликтов интересов.
REFERENSES
1. Shestakov AL, Fedorov DN, Ivanchik IJa, Boeva IA, Bitarov TT. Comparative Evaluation of Standard,
Composite and "Lightweight" Synthetic Prostheses for Hernioplasty (Experimental Work). Kursk Scientific and Practical Bulletin "Man and his health". 2017;(2):81-87. doi: 10.21626/vestnik/2017-2/14 (In Russian).
2. Lasarenko VA, Ivanov SV, Ivanov IS, Parfenov IP, Goryainova GN, Tsukanov AV, Ivanova IA, Ob'edkov EG. Morphological Changes in the Area Implanting "Parietene Progrip" Endoprosthesis as a Result of Using Solcoseryl. Kursk Scientific and Practical Bulletin "Man and his health". 2016;(3):74-80. doi: 10.21626/vestnik/2016-3/12 (In Russian).
3. Bogdan VG. Morphological and clinical features endoprosthesis use in surgery incisional abdominal hernias. Military medicine. 2015;35(2):14-17. (In Russian).
4. Coda A, Lamberti R, Martorana S. Classification of prosthetics used in hernia repair based on weight and biomaterial. Hernia. 2012;16(1):9-20. doi: 10.1007/ s10029-011-0868-z.
5. Anurov MV, Titkova SM, Oettinger AP. Biomechanical compatibility of surgical mesh and fascia being reinforced: dependence of experimental hernia defect repair results on anisotropic surgical mesh positioning. Hernia. 2012;16(2):199-210. doi: 10.1007/ s10029-011-0877-y.
6. Kingsnorth AN, LeBlanc KA. Management of Abdominal Hernias (ed.). London.: Springer; 2013:414 doi:10.1007/978-1-84882-877-3_15
7. Novitsky YW, Harrell AG, Hope WW, Kercher KW, Heniford BT. Meshes in hernia repair. Surgical Technology International. 2007;16:123-127.
8. Snyder CW, Graham LA, Vick CC, Gray SH, Finan KR, Hawn MT. Patient satisfaction, chronic pain, and quality of life after elective incisional Hernia repair: effects of recurrence and repair technique. Hernia. 2011;15(2):123-129. doi: 10.1007/s10029-010-0750-4.
9. Anurov MV, Titkova SM, Oettinger AP. Classification of Prostheses for Abdominal Hernia Repair: Analytical Literature Review. Bulletin of Russian State Medical University (Bulletin of RSMU). 2015;(1):5-10. (In Russian).
10. Deeken CR, Eliason BJ, Pichert MD. et al. Differentiation of biologic scaffold materials through physicomechanical, thermal, and enzymatic degradation techniques. Annals of Surgery. 2012;255(3):595-604. doi: 10.1097/SLA.0b013e3182445341.
11. Deeken CR, Abdo MS, Frisella MM, Matthews BD. Physicomechanical evaluation of polypropylene, polyester, and polytetrafluoroethylene meshes for inguinal hernia repair. Journal of the American College of Surgeons. 2011;212(1):68-79. doi: 10.1016/j. jamcollsurg.2010.09.012.
12. Deeken CR, Abdo MS, Frisella MM, Matthews BD. Physicomechanical evaluation of absorbable and nonabsorbable barrier composite meshes for laparoscopic ventral hernia repair. Surgical Endoscopy. 2011;25(5):1541-1552. doi: 10.1007/s00464-010-1432-0.
13. Deeken CR, Faucher KM, Matthews BD. A review of the composition, characteristics, and effectiveness of barrier mesh prostheses utilized for laparoscopic ventral hernia repair. Surgical Endoscopy. 2012;26(2):566-575. doi: 10.1007/s00464-011-1899-3.
14. Pavelka M, Roth J. Functional ultrastructure. Atlas of Tissue Biology and Pathology. Vienna.: Springer; 2005:326 pp. ISBN: 3211835644.
15. Reynolds ES. The use of lead citrate at high pH an electron-opaque stain in electron microscopy. Journal of Cell Biology. 1963;17(1):208-212.
ЛИТЕРАТУРА
1. Shestakov AL, Fedorov DN, Ivanchik IJa, Boeva IA, Bitarov TT. Comparative Evaluation of Standard, Composite and "Lightweight" Synthetic Prostheses for Hernioplasty (Experimental Work). Kursk Scientific and Practical Bulletin "Man and his health". 2017;(2):81-87. doi: 10.21626/vestnik/2017-2/14 (In Russian).
2. Lasarenko VA, Ivanov SV, Ivanov IS, Parfenov IP, Goryainova GN, Tsukanov AV, Ivanova IA, Ob'edkov EG. Morphological Changes in the Area Implanting "Parietene Progrip" Endoprosthesis as a Result of Using Solcoseryl. Kursk Scientific and Practical Bulletin "Man and his health". 2016;(3):74-80. doi: 10.21626/vestnik/2016-3/12 (In Russian).
3. Bogdan VG. Morphological and clinical features endoprosthesis use in surgery incisional abdominal hernias. Military medicine. 2015;35(2):14-17. (In Russian).
4. Coda A, Lamberti R, Martorana S. Classification of prosthetics used in hernia repair based on weight and biomaterial. Hernia. 2012;16(1):9-20. doi: 10.1007/ s10029-011-0868-z.
5. Anurov MV, Titkova SM, Oettinger AP. Biomechanical compatibility of surgical mesh and fascia being reinforced: dependence of experimental hernia defect repair results on anisotropic surgical mesh positioning. Hernia. 2012;16(2):199-210. doi: 10.1007/ s10029-011-0877-y.
6. Kingsnorth AN, LeBlanc KA. Management of Abdominal Hernias (ed.). London.: Springer; 2013:414 doi:10.1007/978-1-84882-877-3 15
7. Novitsky YW, Harrell AG, Hope WW, Kercher KW, Heniford BT. Meshes in hernia repair. Surgical Technology International. 2007;16:123-127.
8. Snyder CW, Graham LA, Vick CC, Gray SH, Finan KR, Hawn MT. Patient satisfaction, chronic pain, and quality of life after elective incisional Hernia repair: effects of recurrence and repair technique. Hernia. 2011;15(2):123-129. doi: 10.1007/s10029-010-0750-4.
9. Anurov MV, Titkova SM, Oettinger AP. Classification of Prostheses for Abdominal Hernia Repair: Analytical Literature Review. Bulletin of Russian State Medical University (Bulletin of RSMU). 2015;(1):5-10. (In Russian).
10. Deeken CR, Eliason BJ, Pichert MD. et al. Differentiation of biologic scaffold materials through physicomechanical, thermal, and enzymatic degradation techniques. Annals of Surgery. 2012;255(3):595-604. doi: 10.1097/SLA.0b013e3182445341.
11. Deeken CR, Abdo MS, Frisella MM, Matthews BD. Physicomechanical evaluation of polypropylene, polyester, and polytetrafluoroethylene meshes for inguinal hernia repair. Journal of the American College of Surgeons. 2011;212(1):68-79. doi: 10.1016/j. jamcollsurg.2010.09.012.
12. Deeken CR, Abdo MS, Frisella MM, Matthews BD. Physicomechanical evaluation of absorbable and nonabsorbable barrier composite meshes for laparoscopic ventral hernia repair. Surgical Endoscopy. 2011;25(5):1541-1552. doi: 10.1007/s00464-010-1432-0.
13. Deeken CR, Faucher KM, Matthews BD. A review of the composition, characteristics, and effectiveness of barrier mesh prostheses utilized for laparoscopic ventral hernia repair. Surgical Endoscopy. 2012;26(2):566-575. doi: 10.1007/s00464-011-1899-3.
14. Pavelka M, Roth J. Functional ultrastructure. Atlas of Tissue Biology and Pathology. Vienna.: Springer; 2005:326 pp. ISBN: 3211835644.
15. Reynolds ES. The use of lead citrate at high pH an electron-opaque stain in electron microscopy. Journal of Cell Biology. 1963;17(1):208-212.
