Zugkräfte in der Leistenregion unter standardisierten Bedingungen am Tiermodell

The surgical reapir of inguinal hernia by the Shouldice technique is discussed to induce traction forces by doubling the fascia transversalis and by attaching the rectus sheath and the inguinal ligament with the result of a higher postoperative pain level, higher recurrence-rates and a longer reconvalescence in camparison to net-supported surgery of inguinal hernia. In the surgical literature there is only one study that quantified inatraoperatively the traction forces wich were employed during Shouldice repair of primary inguinal hernia. With the same equipement the tension force between the lateral edge of the rectus sheath and the base of the inguinal ligament was measured after simulation of the Shouldice repair in a porcine model. Standard stresses were imposed by (a) increasing the intraabdominal pressure actively by choughing and (b) passively by a small and a large pneumoperitoneum, (c) isolated maximal electrical stimulation of muscles of the abdominal wall and (d) straightening up into an uprigt position. Changes of intraabdominal pressure were recorded simultaneusly. The results in this animal model can be transmitted in human beings. During adaptation of the suture structures of 0.67 ± 0.08 centimeters a traction force of 3.75 ± 0.32 Newton was induced. In the human study 0.9 centimeters and 3.62 ± 0.60 Newton have been measured. The highest (mean ± SEM) intra-abdominal pressure was found during coughing (33.1 ± 5.2 mmHg) with an increase in inguinal tension force of 4.1 ± 0.6 Newton. The upright position (20 ± 0.07 mmHg) and the large pneumoperitoneum (25 ± 0.6 mmHg) produced similar values (4.7 ± 0.8 Newton and 3.7 ± 0.4 Newton, respectively). The small pneumoperitoneum (10.01 ± 0.4 mmHg) and electrical stimulation of muscles of the abdominal wall (4.4 ± 0.1 mmHg) resulted in distinctley smaller changes (1.1 ± 0.3 and 0.7 ± 0.1 Newton, respectively). The load of the simulated Shoudice repair was similar whereas coughing (0.18 ± 0.05 Newton / mmHg), upright position (0.24 ± 0.05 Newton / mmHg) and muscular contraction (0.25 ± 0.05 Newton / mmHg). The load induced by passive increasement of the intra-abdominal pressure was statistically not significantly lower. The amount of tension on the inguinal area is largely dependent of the intra-abdominal pressure. Contrations of abdominal muscles functionally and anatomically do not mean additional strain on the Shouldice repair. The inguinal load of all measured conditions is negligibly low . Compared with the force to disrupt the normal the normal inguinal canal (68.6 Newon) there is no risk of disruption of the inguinal hernia repair by immediate postoperative return to physical activity.

Grantor dc:publisher

Publikationsserver der RWTH Aachen University

Year dc:date

2003

Author dc:creator

• Bühner, Andreas

Contributors dc:contributor

• Schumpelick, Volker

• info:eu-repo/classification/ddc/610
• Medizin
• tension
• inguinal hernia

Statement dc:rights

• info:eu-repo/semantics/openAccess

Language dc:language

ger

Identifier

https://publications.rwth-aachen.de/search?p=id:%22RWTH-CONV-120713%22

OAI identifier oai:identifier

oai:publications.rwth-aachen.de:58886