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CNAA / Theses / 2019 / May /

Optimization of the plastic surgery methods in the surgical correction of congenital defects of the anterior abdominal wall


Author: Negru Ion
Degree:doctor of medicine
Speciality: 14.00.35 - Infantine Surgery
Year:2019
Scientific advisers: Stanislav Babuci
doctor habilitat, associate professor (docent), Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Tica Constantin
doctor, profesor universitar, Universitatea „Ovidius”, Constanţa, România
Scientific consultant: Viorel Nacu
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Institution: Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova

Status

The thesis was presented on the 22 May, 2019
Approved by NCAA on the 9 July, 2019

Abstract

Adobe PDF document – 1.16 Mb / in romanian

Thesis

CZU 617.55-007-053.1-089.844(043.2)

Adobe PDF document 10.33 Mb / in romanian
171 pages

Keywords

Congenital anterior abdominal wall defects, persistent intestinal dismotility syndrome, biological grafts, reconstructive intervention

Summary

Thesis structure: The thesis is exposed on 128 typewritten pages, it contains introduction, 5 chapters, conclusions, recomandations, 8 tables, 73 figures and 20 annexes. The bibliography includes 324 bibliographic references.

Purpose of the study: Improving the treatment results of malformative pathology of the abdominal wall by developing and testing biological xenografts.

Objectives of the study: The objectives of the study included the evaluation of the clinical results of abdominal wall malformations with the identification of congenital and acquired risk factors that influenced the prognosis of the disease; establishing the role of morphohistological changes of locoregional tissues and their estimation in the association of postoperative complications; studying the histopathological changes of the modified intestines and their role in the etiopathogenesis, evolution and exodus of gastroschisis in neonates; comparative analysis of surgical techniques used in anterior abdominal wall malformations as an argument for testing of some biological grafts that could be used in plastics; morphopathological argumentation of the advantages and disadvantages of decelularized biologic grafts used in the surgical treatment of malformative diseases of the anterior abdominal wall in the experimental model.

Innovation and scientific originality of the results obtained. The incidence of congenital malformations associated with gastroschisis and omphalocele was determined, as well as other risk factors that significantly influenced the unfavorable disease evolution and the increased mortality rate in these serious malformations. The morphopathological changes of the eviscerated intestinal loops in neonates with gastroschisis and their role in the pathogenesis of persistent disturbances of bowel peristalsis and intestinal transit were evaluated, as well as a complex evaluation of the regional morphopathological features of the congenital abdominal wall defect in neonates with gastroschisis and omphalocele. The comparative and morphologically justified efficiency of use of various bioprotective allografts in the experimental reconstruction of the abdominal wall defects was determined.

The important scientific problem solved in the thesis consists in the comparative analysis of the efficiency of the amniotic membrane, bovine pericardium, bovine fascia and bovine parietal peritoneum in the reconstruction of the abdominal wall defects in order to improve the results of the surgical treatment of these malformations.

Theoretical significance and applicative value of the results. The spectrum of structural changes of eviscerated intestinal loops responsible for persistent bowel peristalsis and intestinal transit disorders was found. The architectural structure and reparative processes of the embryonic sac was described, justifying the conservative tactics in major and giant omphalocele with viscero-abdominal proportion. There was made a comparative finding of the stability of the amniotic membrane treated with glutaraldehyde or formalin, and cryopreserved amniotic membrane as a temporary substitute for the peritoneum in abdominal defects. The biocompatibility and bioresistance of the parietal bovine peritoneum treated in 0.5% formaldehyde was determined and decellularized parietal bovine peritoneum in the closure of the major abdominal wall defects in experimental model, as well as the disadvantages of the neoperitoneum formed after the gradual replacement of the implant. It has been found that the use of the bovine pericardium graft provides acceptable resistance with some properties of stabilizing the abdominal wall, and insignificant irritant and inflammatory action of the bovine fascia graft preserved in formaldehyde on intestinal loops allows its use in the closure of abdominal fascial defects, having direct contact with the abdominal contents.

The results of the thesis research were reflected in 14 scientific papers, including 9 reviewed articles