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Xiao Y, Zuo X, Li H, Zhao Y, Wang X. Impact of titanium-coated polypropylene mesh on functional outcome and quality of life after inguinal hernia repair. Heliyon 2023; 9:e17691. [PMID: 37455954 PMCID: PMC10345250 DOI: 10.1016/j.heliyon.2023.e17691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/24/2023] [Accepted: 06/26/2023] [Indexed: 07/18/2023] Open
Abstract
Objective This study aims to compare the clinical outcomes of complications, quality of life, and chronic pain between titanium-coated polypropylene mesh and polypropylene mesh after Lichtenstein or TAPP surgery. Methods A retrospective cohort study was conducted, involving patients who underwent inguinal hernia repair using Timesh light®, Optilene LP®, or 3DMax™ meshes between January 2020 and May 2022. Based on the surgical method, patients were divided into Lichtenstein and TAPP groups, and further categorized according to the type of mesh used. The primary endpoints assessed postoperative complications, postoperative pain, and postoperative quality of life. Secondary endpoints included postoperative sensation in the surgical area and postoperative recurrence rate. Results A total of 180 Lichtenstein procedures and 478 TAPP procedures were included in the analysis after propensity score matching. The findings revealed that patients with titanium-coated polypropylene mesh did not exhibit significant advantages in perioperative data. Within three months to one year after TAPP surgery, patients with the titanium-coated polypropylene mesh reported improved foreign body sensation during activities (P = 0.002) and a lower incidence of chronic pain (P = 0.008). However, after one year, these advantages of titanium-coated polypropylene mesh were no longer significant during activity or at rest. In the TAPP group, the titanium-coated polypropylene mesh depicted advantages in the single score of the SF-36 questionnaire. Conclusions The utilization of titanium-coated polypropylene mesh resulted in reduced foreign body sensation and chronic pain in activity within one year after TAPP surgery, significantly enhancing certain aspects of the patient's quality of life compared to polypropylene mesh.
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Affiliation(s)
| | | | | | | | - Xuehu Wang
- Corresponding author. Department of the Hernia Surgery, The First Affiliated hospital of Chongqing Medical university, Chongqing Medical University, Chongqing, 400016, China.
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Ribeiro WG, Nascimento ACC, Ferreira LB, Marchi DDD, Rego GM, Maeda CT, Silva GEB, Artigiani Neto R, Torres OJM, Pitombo MB. Analysis of tissue inflammatory response, fibroplasia, and foreign body reaction between the polyglactin suture of abdominal aponeurosis in rats and the intraperitoneal implant of polypropylene, polypropylene/polyglecaprone and polyester/porcine collagen meshes. Acta Cir Bras 2021; 36:e360706. [PMID: 34495141 PMCID: PMC8428674 DOI: 10.1590/acb360706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 06/22/2021] [Indexed: 01/05/2023] Open
Abstract
Purpose To compare tissue inflammatory response, foreign body reaction, fibroplasia,
and proportion of type I/III collagen between closure of abdominal wall
aponeurosis using polyglactin suture and intraperitoneal implant of
polypropylene, polypropylene/polyglecaprone, and polyester/porcine collagen
meshes to repair defects in the abdominal wall of rats. Methods Forty Wistar rats were placed in four groups, ten animals each, for the
intraperitoneal implant of polypropylene, polypropylene/polyglecaprone, and
polyester/porcine collagen meshes or suture with polyglactin (sham) after
creation of defect in the abdominal wall. Twenty-one days later,
histological analysis was performed after staining with hematoxylin-eosin
and picrosirius red. Results The groups with meshes had a higher inflammation score (p < 0.05) and
higher number of gigantocytes (p < 0.05) than the sham group, which had a
better fibroplasia with a higher proportion of type I/III collagen than the
tissue separating meshes (p < 0.05). There were no statistically
significant differences between the three groups with meshes. Conclusions The intraperitoneal implant of polypropylene/polyglecaprone and
polyester/porcine collagen meshes determined a more intense tissue
inflammatory response with exuberant foreign body reaction, immature
fibroplasia and low tissue proportion of type I/III collagen compared to
suture with polyglactin of abdominal aponeurosis. However, there were no
significant differences in relation to the polypropylene mesh group.
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Akalin C, Karagulle OO. The effects of onlay titanium-coated mesh on recurrence, foreign body sensation and chronic pain after ventral hernia repair. Asian J Surg 2021; 44:1158-1165. [PMID: 33771424 DOI: 10.1016/j.asjsur.2021.02.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 01/12/2021] [Accepted: 02/08/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND/OBJECTIVE There are many complications of meshes in hernia repair. The aim of this study was to investigate the effects of onlay titanium-coated meshes (TCM) on recurrence, foreign body sensation and chronic pain in ventral hernia repair. METHODS In this retrospective study, 160 patients undergone TCM or polypropylene mesh (PM) surgery for onlay repair of ventral hernia were examined between May 2014 and January 2018 at our center. Patient characteristics, type of hernia, defect size, operative time, follow-up time, surgical site occurrence (infection, seroma and hematoma), recurrence, foreign body sensation and chronic pain were analyzed. Patients were divided into two groups according to mesh used: TCM (titanium group) or PM (polypropylene group). RESULTS Out of 160 patients, 63 (32.6%) had TCM and 97 (67.4%) had PM. There was no significant difference between groups in terms of recurrence (p = 0.757). Chronic pain and foreign body sensation were low in the titanium group (p = 0.047 and p = 0.029, respectively), a positive correlation was found between surgical site infection and recurrence (p = 0.020). In the polypropylene group, an increase in defect size was significantly associated with foreign body sensation and chronic pain (p < 0.001 for both comparisons). CONCLUSION In onlay repair of ventral hernia, TCM led to less foreign body sensation and chronic pain then PM. The surgical site infection was associated with recurrence for these meshes. Additionally, the increase in defect size causes a risk for foreign body sensation and chronic pain in repair using PM.
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Affiliation(s)
- Cagri Akalin
- Department of General Surgery, Ordu Training and Research Hospital, Ordu, Turkey
| | - Onur Olgac Karagulle
- Department of General Surgery, Istanbul Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.
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Berninghausen LK, Osterhoff G, Langer S, Kohler LH. Scar quality examination comparing titanium-coated suture material and non-coated suture material on flap donor sites in reconstructive surgery. BMC Surg 2020; 20:268. [PMID: 33143708 PMCID: PMC7640681 DOI: 10.1186/s12893-020-00932-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 10/27/2020] [Indexed: 01/27/2023] Open
Abstract
Background Wound healing and scar quality after trauma are subject to impairment through excessive wound healing, chronic wound or even surgical site infections. Optimizing the process of scar formation and skin healing is crucial in virtually all fields of medicine. In this regard, we tested the possible usage and advantages of titanium coated suture material. Methods We performed a prospective observational cohort study including 30 patients who underwent soft tissue reconstruction. One half of the donor flap site was sutured with titanium coated suture material, while the other half was closed with non-coated sutures. Scar quality of the donor flap site was assessed by photographs and POSAS scores on days 2–5, 14, 42, 72 and 180 postoperatively. Results No difference between the titanium coated sutures and non-coated sutures was seen in the POSAS assessment, neither for the patient scale at 14, 42, 72 and 180 days, nor for the observer scale on the same dates. Comorbidities like diabetes, chronic renal failure and smoking as well as the BMI of each patient affected the wound healing process to an equal degree on both sides of the suture. Conclusions No difference between the titanium coated and non-titanium-coated suture material was seen in the POSAS assessment in regard to scar quality and wound healing. The titanium-coated suture material can be considered to be equally as effective and safe in all qualities as the non-titanium-coated suture material, even in patients with comorbidities. Clinical trial register This study is registered at the German Clinical Trials Register (DRKS) under the registration number DRKS00021767. (https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00021767)
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Affiliation(s)
- Laura K Berninghausen
- Department of Orthopedic, Trauma and Plastic Surgery, Leipzig University Hospital, Liebigstraße 20, 04103, Leipzig, Saxony, Germany
| | - Georg Osterhoff
- Department of Orthopedic, Trauma and Plastic Surgery, Leipzig University Hospital, Liebigstraße 20, 04103, Leipzig, Saxony, Germany
| | - Stefan Langer
- Department of Orthopedic, Trauma and Plastic Surgery, Leipzig University Hospital, Liebigstraße 20, 04103, Leipzig, Saxony, Germany
| | - Lukas H Kohler
- Department of Orthopedic, Trauma and Plastic Surgery, Leipzig University Hospital, Liebigstraße 20, 04103, Leipzig, Saxony, Germany.
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Damous SHB, Damous LL, Miranda JS, Montero EFS, Birolini C, Utiyama EM. Could polypropylene mesh impair male reproductive organs? Experimental study with different methods of implantation. Hernia 2020; 24:1325-1336. [PMID: 32306141 DOI: 10.1007/s10029-020-02186-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 04/02/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the vas deferens and testicles of rats submitted to bilateral inguinotomy and polypropylene (PP) mesh placement. METHOD Sixty Wistar rats were randomized into three groups: Control (inguinotomy only), mesh placement over the vas deferens (Mesh-DD) or under the spermatic funiculus (Mesh-SF). The following analyses were performed: vas deferens morphometry (lumen area and wall thickness), quantification of collagen fibers, spermatogenesis, apoptosis (cleaved caspase-3 and TUNEL) and cellular proliferation (Ki67). Quantitative gene expression (qPCR) for apoptosis and inflammatory cytokines were evaluated by RT-PCR. RESULTS In the apoptosis pathway, Mesh-DD showed one upregulated gene (Il10) and three downregulated genes (Fadd, Tnfrsf1b and Xiap). In Mesh-SF, 17 genes were downregulated. In the inflammation pathway (Mesh-DD), one gene was upregulated (Il1r1), and one gene was downregulated (Ccl12). In Mesh-SF, three genes were upregulated (Il1r1, Tnfsf13b and Csf1), and two were downregulated (Ccl12 and Csf2). PP mesh placement preserved spermatogenesis and did not alter the vas deferens or the testicle. In the ductus deferens, there was reduced luminal area (30 days), increased wall thickness (90 days), and increased type III collagen and cell proliferation (30 and 90 days) (p < 0.05). In the testicle, cell proliferation was greater in the Mesh-DD (p < 0.05). CONCLUSIONS PP mesh, whether or not in direct contact with spermatic funicular structures, induces changes that were not sufficient to cause damage to the evaluated organs.
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Affiliation(s)
- S H B Damous
- Division of General Surgery and Trauma, Department of Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC/FMUSP), Dr. Enéas de Carvalho Aguiar Av. 255. Cerqueira Cesar, São Paulo, 05402-000, Brazil. .,, Baturite St, 120. Ap 91. Aclimação, São Paulo, 01530-030, Brazil.
| | - L L Damous
- Department of Obstetrics and Gynecology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Dr. Enéas de Carvalho Aguiar Av. 255. Cerqueira Cesar, São Paulo, 05402-000, Brazil
| | - J S Miranda
- Division of General Surgery and Trauma, Department of Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC/FMUSP), Dr. Enéas de Carvalho Aguiar Av. 255. Cerqueira Cesar, São Paulo, 05402-000, Brazil
| | - E F S Montero
- Division of General Surgery and Trauma, Department of Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC/FMUSP), Dr. Enéas de Carvalho Aguiar Av. 255. Cerqueira Cesar, São Paulo, 05402-000, Brazil
| | - C Birolini
- Division of General Surgery and Trauma, Department of Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC/FMUSP), Dr. Enéas de Carvalho Aguiar Av. 255. Cerqueira Cesar, São Paulo, 05402-000, Brazil
| | - E M Utiyama
- Division of General Surgery and Trauma, Department of Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC/FMUSP), Dr. Enéas de Carvalho Aguiar Av. 255. Cerqueira Cesar, São Paulo, 05402-000, Brazil
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Damous SHB, Damous LL, Miranda JDS, Montero EFDS, Birolini C, Utiyama EM. Does a bilateral polypropylene mesh alter the duct deferens morphology, testicular size and testosterone levels? Experimental study in rats. Acta Cir Bras 2020; 35:e202000201. [PMID: 32320995 PMCID: PMC7184941 DOI: 10.1590/s0102-865020200020000001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 01/10/2020] [Indexed: 11/21/2022] Open
Abstract
Purpose To evaluate the effect of a PP mesh on duct deferens morphology, testicular size and testosterone levels. Methods Forty adult male rats were distributed into groups: 1) no surgery; 2) inguinotomy; 3) mesh placed on the duct deferens; and 4) mesh placed on the spermatic funiculus. After 90 postoperative days, the inguinal region was resected, and blood samples were collected for the measurement of serum testosterone (pg/dl). The ducts deferens were sectioned in three axial sections according to the relationship with the mesh — cranial, medial and caudal. The wall thickness and duct deferens lumen area were measured. Results The morphology of the duct deferens was preserved in all groups. The mesh placement did not alter this morphology in any of the analyzed segments. Surgery, with or without mesh placement, did not alter the morphology, wall thickness or lumen area (p>0.05). In all operated groups, serum testosterone levels were similar (p>0.05) but there was a decrease in testicle size (p<0.05). Conclusion Surgery, with or without mesh placement, did not alter the morphology of the duct deferens and, although this treatment resulted in testicular size reduction, it did not affect serum testosterone levels.
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Fuziy RA, Artigiani Neto R, Caetano Junior EM, Alves AKS, Lopes Filho GJ, Linhares MM. Comparative study of four different types of intraperitoneal mesh prostheses in rats. Acta Cir Bras 2019; 34:e201900703. [PMID: 31531538 PMCID: PMC6746566 DOI: 10.1590/s0102-865020190070000003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 06/13/2019] [Indexed: 11/25/2022] Open
Abstract
Purpose: To compare four types of mesh regarding visceral adhesions, inflammatory response and incorporation. Methods: Sixty Wistar rats were divided into four groups, with different meshes implanted intraperitoneally: polytetrafluoroethylene (ePTFE group); polypropylene with polydioxanone and oxidized cellulose (PCD); polypropylene (PM) and polypropylene with silicone (PMS). The variables analyzed were: area covered by adhesions, incorporation of the mesh and inflammatory reaction (evaluated histologically and by COX2 immunochemistry). Results: The PMS group had the lowest adhesion area (63.1%) and grade 1 adhesions. The ePTFE and PM groups presented almost the total area of their surface covered by adherences (99.8% and 97.7% respectively) The group ePTFE had the highest percentage of area without incorporation (42%; p <0.001) with no difference between the other meshes. The PMS group had the best incorporation rate. And the histological analysis revealed that the inflammation scores were significantly different. Conclusions: The PM mesh had higher density of adherences, larger area of adherences, adherences to organs and percentage of incorporation. ePTFE had the higher area of adherences and lower incorporation. The PMS mesh performed best in the inflammation score, had a higher incorporation and lower area of adherences, and it was considered the best type of mesh.
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Affiliation(s)
- Rogério Aoki Fuziy
- Fellow Master degree, Postgraduate Program in Interdisciplinary Surgical Sciences, Division of Surgical Gastroenterology, Department of Surgery, Universidade Federal de São Paulo (UNIFESP), Brazil. Design of the study; acquisition, analysis and interpretation of data; manuscript preparation; critical revision; final approval
| | - Ricardo Artigiani Neto
- PhD, Division of Surgical Gastroenterology, Department of Surgery, UNIFESP, Sao Paulo-SP, Brazil. Design of the study; acquisition, analysis and interpretation of data; manuscript preparation; critical revision; final approval
| | - Elesiario Marques Caetano Junior
- PhD, Division of Surgical Gastroenterology, Department of Surgery, UNIFESP, Sao Paulo-SP, Brazil. Design of the study; acquisition, analysis and interpretation of data; manuscript preparation; critical revision; final approval
| | - Ana Karina Soares Alves
- MD, Division of Surgical Gastroenterology, Department of Surgery, UNIFESP, Sao Paulo-SP, Brazil. Acquisition and interpretation of data, critical revision, final approval
| | - Gaspar Jesus Lopes Filho
- PhD, Chairman, Division of Surgical Gastroenterology, Department of Surgery, UNIFESP, Sao Paulo-SP, Brazil. Acquisition and interpretation of data, critical revision, final approval
| | - Marcelo Moura Linhares
- PhD, Full Professor, Division of Surgical Gastroenterology, Department of Surgery, UNIFESP, Sao Paulo-SP, Brazil. Design of the study; acquisition, analysis and interpretation of data; critical revision; final approval
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Integration of Biomechanical and Biological Characterization in the Development of Porous Poly(caprolactone)-Based Membranes for Abdominal Wall Hernia Treatment. INT J POLYM SCI 2018. [DOI: 10.1155/2018/2450176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Aims. Synthetic meshes are the long-standing choice for the clinical treatment of abdominal wall hernias: the associated long-term complications have stimulated the development of a new generation of bioresorbable prostheses. In this work, polycaprolactone (PCL) porous membranes prepared by solvent casting/porogen leaching of PCL/poly(ethylene glycol) (PEG) blends with different compositions (different PCL/PEG weight ratios and PEG molecular weights) were investigated to be applied in the field. An optimal porous membrane structure was selected based on the evaluation of physicochemical, biomechanical, and in vitro biological properties, compared to a reference commercially available hernia mesh (CMC). Findings. Selected PCL7-2i membranes, derived from PCL/PEG 70/30 (PCL: Mw 70,000-90,000 Da; PEG: 35,000 Da), showed suitable pore size for the application, intermediate surface hydrophilicity, and biomimetic mechanical properties. In vitro cell tests performed on PCL7-2i membranes showed their cytocompatibility, high cell growth during 21 days, a reduced production of proinflammatory IL-6 with respect to CMC, and a significant secretion of collagen type I. Conclusions. PCL7-2i membranes showed biomimetic biomechanical properties and in vitro biological properties similar to or even better than - in the case of anti-inflammatory behavior and collagen production - CMC, a commercially available product, suggesting potentially improved integration in the host tissue.
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Biondo-Simões MDLP, Sichciopi AA, Ioshii SO, Robes RR, Biondo-Simões R. Comparative study of fibrosis induced by Marlex®, Parietex Composite®, Vicryl® and Ultrapro® meshes1. Acta Cir Bras 2018; 33:792-798. [PMID: 30328911 DOI: 10.1590/s0102-865020180090000007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 08/13/2018] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To evaluate the fibrosis induced by four different meshes: Marlex®, Parietex Composite®, Vicryl® and Ultrapro®. METHODS Histological cutouts of abdominal wall were analyzed with polarized light 28 days after the meshes implants and colorized by picrosirius to identify the intensity of collagen types I and III, and their maturation index. RESULTS When the four groups were compared, the total collagen area analyzed was bigger in groups A and D, with no difference between them. The collagen type I density was bigger in group A, with an average of 9.62 ± 1.0, and smaller in group C, with an average of 3.86 ± 0.59. The collagen type III density was similar in groups A, B and C, and bigger in group D. The collagen maturation index was different in each of the four groups, bigger in group A with 0.87, group B with 0.66, group D with 0.57 and group C with 0.33 (p = 0.0000). CONCLUSION The most prominent fibrosis promotion in the given meshes was found on Marlex® (polypropylene mesh) and the Parietex Composite® (non-biodegradable polyester); the collagen maturation index was higher in the Marlex® mesh, followed by Ultrapro®, Parietex Composite® and Vicryl® meshes.
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Affiliation(s)
- Maria de Lourdes Pessole Biondo-Simões
- PhD, Full Professor, Department of Surgery, Universidade Federal do Paraná (UFPR), Brazil. Intellectual and design of the study, analysis of data, manuscript writing, final approval the version to be published
| | | | - Sérgio Ossamu Ioshii
- PhD, Associate Professor, Division of Pathology, UFPR, and Postgraduate Program in Technology in Health, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba-PR, Brazil. Intellectual and scientific content of the study, critical revision
| | - Rogério Ribeiro Robes
- Master, Full Professor, Department of Anesthesiology, Faculty of Veterinary Medicine, UFPR, Curitiba-PR, Brazil. Analgesia and post-operative care, manuscript writing
| | - Rachel Biondo-Simões
- Surgeon Oncologist, Hospital Angelina Caron, Campina Grande do Sul-PR, Brazil. Technical procedures
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Biondo-Simões MDLP, Morais CGD, Tocchio AFZ, Miranda RAD, Moura PAP, Colla K, Robes RR, Ioshii SO, Tomasich FDS. Characteristics of the fibroplasia and collagen expression in the abdominal wall after implant of the polypropylene mesh and polypropylene/polyglecaprone mesh in rats. Acta Cir Bras 2017; 31:294-9. [PMID: 27275849 DOI: 10.1590/s0102-865020160050000001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 04/12/2016] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To compare fibroplasia and the resistance of the abdominal wall when polypropylene meshes and polypropylene/poliglecaprone are used. METHODS Seventy-seven male Wistar rats were divided into three groups: Control Group (for resistance); Group E (polypropylene mesh); and Group U (polypropylene/poliglecaprone mesh). The animals in Groups E and U had a standard muscular and aponeurotic defect, with integral peritoneum, and correction with the mesh. Measurements were taken 4, 7, 14, 28 and 56 days after surgery. The resistance, and collagen density were studied. RESULTS Resistance on the 56th day was similar in both meshes. The gain in resistance described an ascending curve for the polypropylene mesh and was irregular in the case of the polypropylene/poliglecaprone. Fibroplasia showed a gain in type I and type III collagen in both groups (p<0.001). Collagen III stabilized in the 14th day and collagen I continued to ascend. CONCLUSIONS The gain in resistance of the polypropylene mesh is regular and ascending, whereas the polypropylene/poliglecaprone is not regular. The final resistance of both meshes is similar; the collagen density increases over time, and show the same inflammatory potential.
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Affiliation(s)
- Maria de Lourdes Pessole Biondo-Simões
- PhD, Associate Professor, Department of Surgery, Universidade Federal do Paraná (UFPR), Brazil. Intellectual and design of the study, analysis of data, manuscript writing, final approval the version to be published., Universidade Federal do Paraná, Department of Surgery, Universidade Federal do Paraná, Brazil
| | - Camila Gomes de Morais
- Graduate student, Scientific Initiation Program, UFPR, Curitiba-PR, Brazil. Technical procedures., Universidade Federal do Paraná, UFPR, Curitiba PR , Brazil
| | - Anna Flávia Zonato Tocchio
- Graduate student, Scientific Initiation Program, UFPR, Curitiba-PR, Brazil. Technical procedures., Universidade Federal do Paraná, UFPR, Curitiba PR , Brazil
| | - Renata Augusta de Miranda
- Graduate student, Scientific Initiation Program, UFPR, Curitiba-PR, Brazil. Technical procedures., Universidade Federal do Paraná, UFPR, Curitiba PR , Brazil
| | - Paula Almeida Pamponet Moura
- Graduate student, Scientific Initiation Program, UFPR, Curitiba-PR, Brazil. Technical procedures., Universidade Federal do Paraná, UFPR, Curitiba PR , Brazil
| | - Kelly Colla
- Graduate student, Scientific Initiation Program, UFPR, Curitiba-PR, Brazil. Technical procedures., Universidade Federal do Paraná, UFPR, Curitiba PR , Brazil
| | - Rogério Ribeiro Robes
- Master, Full Professor, Department of Anesthesiology, Faculty of Veterinary Medicine, UFPR, Curitiba-PR, Brazil. Analgesia and post-operatory care, manuscript writing., Universidade Federal do Paraná, Department of Anesthesiology, Faculty of Veterinary Medicine, UFPR, Curitiba PR , Brazil
| | - Sérgio Ossamu Ioshii
- PhD, Associate Professor, Division of Pathology, Pontifícia Universidade Católica do Paraná (PUCPR), and UFPR, Curitiba-PR, Brazil. Critical revision., Pontifícia Universidade Católica do Paraná, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba PR , Brazil
| | - Flávio Daniel Saavedra Tomasich
- PhD, Head, Division of Experimental Surgery, Department of Surgery, UFPR, Curitiba-PR, Brazil. English language, critical revision., Universidade Federal do Paraná, Department of Surgery, UFPR, Curitiba PR , Brazil
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Ioannis T, George S, Nikolaos K, George M, Charalampos P, Nikolaos D, Spyridon S, Michael S. Evaluation of diaphragmatic mobility following intra-abdominal sub-diaphragmatic fixation of a double-layered mesh in rats. Acta Cir Bras 2017; 31:235-42. [PMID: 27168535 DOI: 10.1590/s0102-865020160040000003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 03/11/2016] [Indexed: 01/16/2023] Open
Abstract
PURPOSE To evaluate the tissue integration of a double-sided mesh after fixation in diaphragm and to study the diaphragmatic mobility by ultrasound. METHODS Twenty male Wistar rats were used. The animals were assigned into two equal groups according to the day of euthanasia. The animals were anesthetized and a 1.5 x 1.5 cm of double-layer mesh was inserted between the diaphragm and the liver. For the evaluation of the diaphragm mobility a sonographic method was used. Measurements on specific breathing parameters were taking place. Pathological evaluation took place after the animal's euthanasia. RESULTS Extra-hepatic granuloma was not differentiated overtime, (χ2=0.04, p>0.05). Neither fibrosis was significantly differentiated, (χ2=0.04, p>0.05). Intra-hepatic granuloma was significantly differentiated overtime, (χ2=10.21, p<0.05). Concerning Te parameter, means were significantly differentiated over time, F (3, 30) = 5.12, (p<0.01). Ttot parameter, it was differentiated over time, F (3, 8)=4.79, (p<0.05). IR parameter was also longitudinally differentiated, F (3, 30)=3.73, (p<0.05). CONCLUSION The measurements suggest a transient malfunction of diaphragmatic mobility despite the fact that inflammatory reaction, fibrosis and extra-hepatic granuloma were not significantly differentiated with the passage of time.
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Vozzi F, Guerrazzi I, Campolo J, Cozzi L, Comelli L, Cecchettini A, Rocchiccioli S, Domenici C. Biological and proteomic characterization of a composite mesh for abdominal wall hernia treatment: Reference Study. J Biomed Mater Res B Appl Biomater 2016; 105:2045-2052. [PMID: 27388578 DOI: 10.1002/jbm.b.33749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 05/25/2016] [Accepted: 06/26/2016] [Indexed: 02/02/2023]
Abstract
AIMS The industrial development of a product requires performing a deep analysis to highlight its characteristics useful for future design. The clinical use of a product stimulates knowledge improvement about it in a constant effort of progress. This work shows the biological characterization of CMC composite mesh. CMC polypropylene prosthesis was seeded with Human fibroblast BJ. Samples (cells and medium) were collected at different time points in order to perform different analysis: inflammatory markers quantification; collagens immunohistochemistry; matrix metalloproteinases zimography; extracellular matrix proteomic profile. FINDINGS CMC presented a good cell viability rate and cell growth during the 21 days. The inflammatory profile showed an initial secretion of anti-inflammatory IL-10 and a final increase of pro-inflammatory IL-6. Immunocytochemistry highlighted a similar Collagen type I/type III ratio. The proteomic analysis evidenced the ECM protein content profile composed, mainly, by collagens, fibronectin, laminin. MMPs resulted both expressed when in contact to mesh. CONCLUSIONS CMC shows a good cell biocompatibility and growth. The increase of pro-inflammatory markers could stimulate proliferation, influencing the integration process in human body. Proteomics highlights the ECM modulation by CMC. An integrated investigation of these biological analyses with mechanical data should improve the design process of a new product. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 2045-2052, 2017.
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Affiliation(s)
- Federico Vozzi
- Laboratory of Biomimetic Materials and Tissue Engineering, Institute of Clinical Physiology IFC-CNR, Via Moruzzi 1, 56124, Pisa, Italy
| | - Ilenia Guerrazzi
- Laboratory of Biomimetic Materials and Tissue Engineering, Institute of Clinical Physiology IFC-CNR, Via Moruzzi 1, 56124, Pisa, Italy
| | - Jonica Campolo
- Cardiothoracovascular Department, Niguarda Ca' Granda Hospital, Institute of Clinical Physiology IFC-CNR, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Lorena Cozzi
- Cardiothoracovascular Department, Niguarda Ca' Granda Hospital, Institute of Clinical Physiology IFC-CNR, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Laura Comelli
- Laboratory of Proteomics, Institute of Clinical Physiology IFC-CNR, Via Moruzzi 1, 56124, Pisa, Italy
| | - Antonella Cecchettini
- Laboratory of Proteomics, Institute of Clinical Physiology IFC-CNR, Via Moruzzi 1, 56124, Pisa, Italy
| | - Silvia Rocchiccioli
- Laboratory of Proteomics, Institute of Clinical Physiology IFC-CNR, Via Moruzzi 1, 56124, Pisa, Italy
| | - Claudio Domenici
- Laboratory of Biomimetic Materials and Tissue Engineering, Institute of Clinical Physiology IFC-CNR, Via Moruzzi 1, 56124, Pisa, Italy
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Donati M, Brancato G, Grosso G, Li Volti G, La Camera G, Cardì F, Basile F, Donati A. Immunological reaction and oxidative stress after light or heavy polypropylene mesh implantation in inguinal hernioplasty: A CONSORT-prospective, randomized, clinical trial. Medicine (Baltimore) 2016; 95:e3791. [PMID: 27310955 PMCID: PMC4998441 DOI: 10.1097/md.0000000000003791] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
UNLABELLED The relationship between mesh weight and host tissue reaction has, so far, not been fully investigated. Lightweight meshes (LWM) are thought to give less inflammatory response compared with heavyweight meshes (HWM). The present study is a randomized, controlled, double-blind clinical trial performed in 61 patients who underwent an elective inguinal hernioplasty. The primary outcome of the study was to investigate the relationship between total amount of prosthetic material (polypropylene), immunological reaction, and oxidative stress. The study was double-blinded. Sixty-one patients were recruited for the study and randomly assigned to 2 groups (groups A and B). Levels of inflammation markers (interleukin-6 [IL-6] and tumor necrosis factor-α [TNF-α]) and oxidative stress markers (reduced glutathione [GSH] and lipid hydroperoxides [LOOH]) were determined preoperatively and after undergoing inguinal hernioplasty (after 6, 72, and 288 hours), respectively, with LWM and HWM. There was no significant difference in IL-6 levels between HWM and LWM (P = 0.3, 0.7, 0.8 after 6, 72, and 288 hours, respectively). A statistically significant difference was found after 72 hours for TNF-α (P = 0.01), for GSH after 6 hours (P < 0.01), and after 6 and 72 hours for LOOH (P = 0.05, 0.01, respectively). Oxidative stress occurred at earlier time points and was pore accentuated HWM versus LWM and prodromal to TNF-α increase.Also, in randomized clinical trial, the use of LWM gives advantages in terms of less inflammatory response when compared with HWM. Moreover, there is a significant higher oxidative stress after implantation of HWM. The intensity of oxidative stress seems to be strongly related to the amount of implanted polypropylene. ( TRIAL REGISTRATION NUMBER NCT01090284).
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Affiliation(s)
- Marcello Donati
- Department of Surgery and Medical-Surgical Specialties, Vittorio-Emanuele University Hospital of Catania, Catania, Italy
| | - Giovanna Brancato
- Department of Surgery and Medical-Surgical Specialties, Vittorio-Emanuele University Hospital of Catania, Catania, Italy
| | - Giuseppe Grosso
- Department “G.F. Ingrassia,” Section of Hygiene and Public Health, University of Catania, Catania, Italy
| | - Giovanni Li Volti
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
- Department of Stress Biology, Epigenetic and Biomarkers, EuroMediterranean Institute of Science and Technology, Palermo, Italy
| | - Giuseppina La Camera
- Department of Surgery and Medical-Surgical Specialties, Vittorio-Emanuele University Hospital of Catania, Catania, Italy
| | - Francesco Cardì
- Department of Surgery and Medical-Surgical Specialties, Vittorio-Emanuele University Hospital of Catania, Catania, Italy
| | - Francesco Basile
- Department of Surgery and Medical-Surgical Specialties, Vittorio-Emanuele University Hospital of Catania, Catania, Italy
| | - Angelo Donati
- Department of Surgical Sciences, Organ Transplants and New Technologies, General Surgery and Week Hospital Unit, University Hospital of Catania, Catania, Italy
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Gao Y, Krpata DM, Criss CN, Liu L, Posielski N, Rosen MJ, Novitsky YW. Effects of mesenchymal stem cell and fibroblast coating on immunogenic potential of prosthetic meshes in vitro. Surg Endosc 2014; 28:2357-67. [PMID: 24972922 DOI: 10.1007/s00464-014-3470-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Accepted: 01/20/2014] [Indexed: 01/01/2023]
Abstract
BACKGROUND The aim of this study was to reveal the effect of fibroblast or mesenchymal stem cell (MSC) coating on the mesh-induced production of IL-1β, IL-6, and VEGF by macrophages. METHODS Four commonly used surgical meshes were tested in this study, including Parietex, SoftMesh, TIGR, and Strattice. One-square-centimeter pieces of each mesh were placed on top of a monolayer of human fibroblasts or rat MSCs. The coating status was monitored with a light microscope. The human promonocytic cell line U937 was induced to differentiate into macrophages (MΦ). Three weeks later, meshes were transferred to new 24-well plates and cocultured with the MΦs for 72 h. Culture medium was collected and analyzed for IL-1β, IL-6, and VEGF production using standard ELISA essays. Parallel mesh samples were fixed with paraformaldehyde or glutaraldehyde for histology or transmission electronic microscopy (TEM) analyses, respectively. RESULTS Uncoated meshes induced increased production of all three cytokines compared with macrophages cultured alone. HF coating further increased the production of both IL-6 and VEGF but reduced IL-1β production. Except for the SoftMesh group, MSC coating significantly blunted release of all cytokines to levels even lower than with MΦs cultured alone. MΦs tended to deteriorate in the presence of MSCs. Both histology and TEM revealed intimate interactions between cell-coated meshes and MΦs. CONCLUSIONS Cytokine response to fibroblast coating varied, while MSC coating blunted the immunogenic effect of both synthetic and biologic meshes in vitro. Cell coating appears to affect mesh biocompatibility and may become a key process in mesh evolution.
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Affiliation(s)
- Yue Gao
- University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
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15
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Sanders DL, Kingsnorth AN. Prosthetic mesh materials used in hernia surgery. Expert Rev Med Devices 2014; 9:159-79. [DOI: 10.1586/erd.11.65] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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16
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Early and late postoperative inflammatory and collagen deposition responses in three different meshes: an experimental study in rats. Hernia 2013; 18:563-70. [PMID: 24370605 DOI: 10.1007/s10029-013-1206-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Accepted: 12/12/2013] [Indexed: 01/05/2023]
Abstract
PURPOSE Although meshes reduce abdominal hernia recurrence, they increase the risk of inflammatory complications. This study aimed to compare the early and late postoperative inflammation and collagen deposition responses induced by three meshes. METHODS Rats were allocated into three groups. In group I, a polypropylene (PP) mesh was implanted in the abdominal wall. In groups II and III, PP + polyglactin (PP + PG) and PP + titanium (PP + TI) meshes were employed, respectively. On the seventh (7th) postoperative day, collagen deposition and inflammation were evaluated, and immunohistochemistry was performed on abdominal wall biopsies. These data were compared with those obtained on the fortieth (40th) postoperative day in a previous study. RESULTS The early inflammatory responses were the same in all groups. With time, it decreased in group I (p = 0.047) and increased in group II (p = 0.003). Group I exhibited early elevated VEGF (p < 0.001), COX2 (p < 0.001), and collagen (p = 0.023) levels, and group II exhibited the most severe inflammatory tissue response. On the 40th postoperative day, the VEGF (p < 0.001) and collagen (p < 0.005) were reduced as compared with the 7th postoperative day in all groups. CONCLUSIONS Belatedly, the inflammatory reaction decreased in PP mesh group and increased in PP + PG mesh group. The PP mesh induced early great elevations in VEGF, COX2 and collagen levels, whereas the PP + PG mesh caused severe tissue inflammation with small elevation in these levels. PP + TI mesh induced inflammatory response levels between the others. In conclusion, the inflammatory response depends on the mesh density and also the mesh material with clinical implications.
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17
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Quinino RME, Araújo-Filho I, Lima FP, Barbosa ALC, Maia TDC, Goldenberg A. Adhesion prevention in reabsorbable polyethylene glycol hydrogel (Coseal®) coated polypropylene mesh in rabbits. Acta Cir Bras 2013; 28:807-14. [DOI: 10.1590/s0102-86502013001200001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 11/12/2013] [Indexed: 11/22/2022] Open
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Köckerling F, Schug-Pass C. What do we know about titanized polypropylene meshes? An evidence-based review of the literature. Hernia 2013; 18:445-57. [PMID: 24253381 PMCID: PMC4113678 DOI: 10.1007/s10029-013-1187-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 11/02/2013] [Indexed: 12/18/2022]
Abstract
PURPOSE Despite the vast selection of brands available, nearly all synthetic meshes for hernia surgery continue to use one or other of three basic materials: polypropylene, polyester and ePTFE. These are used in combination with each other or with a range of additional materials such as titanium, omega 3, monocryl, PVDF and hyaluronate. This systematic review of all experimental and clinical studies is aimed at investigating whether titanized meshes confer advantages over other synthetic meshes in hernia surgery. MATERIALS AND METHODS A search of the medical literature from 2002 to 2012, as indexed by Medline, was performed, using the PubMed search engine (http://www.pubmed.gov). The search terms were: hernia mesh, titanium coating, lightweight mesh, TiMesh, mesh complications. All papers were graded according to the Oxford hierarchy of evidence. RESULTS Patients operated on with the Lichtenstein technique performed using the lightweight titanium-coated mesh have a shorter convalescence than those with the heavy-weight mesh Prolene. For inguinal hernias operated on with the TAPP technique and using a lightweight titanium-coated mesh in comparison to a heavy-weight Prolene mesh, the early postoperative convalescence seems to improve. Titanized meshes do exhibit a negative effect on sperm motility 1 year after a TEP operation, but not after 3 years. The laparoscopic IPOM technique with a titanium-coated polypropylene mesh was associated with less postoperative pain in the short term, lower analgesic consumption and a quicker return to everyday activities compared with the Parietex composite mesh. CONCLUSION In clinical studies, the titanium-coated polypropylene mesh shows in inguinal hernia repair certain benefits compared with the use of older heavy-weight meshes.
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Affiliation(s)
- F Köckerling
- Department of Surgery and Center of Minimally Invasive Surgery, Vivantes Hospital Spandau, Academic Teaching Hospital of Charité University Medicine, Neue Bergstraße 6, 13585, Berlin, Germany,
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19
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Zogbi L, Trindade EN, Trindade MRM. Comparative study of shrinkage, inflammatory response and fibroplasia in heavyweight and lightweight meshes. Hernia 2013; 17:765-72. [PMID: 23344668 DOI: 10.1007/s10029-013-1046-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 01/09/2013] [Indexed: 01/05/2023]
Abstract
PURPOSE In this manuscript, the authors describe an animal study comparing shrinkage, inflammatory response and fibroplasia in heavyweight (HW-PP) and lightweight polypropylene (LW-PP) meshes. METHODS Both meshes were fixed on abdominal fascia of 25 Wistar rats (epifascial onlay placement). They were killed at 7, 28 and 90 days to measure the prostheses. Histological analysis was performed with hematoxylin-eosin for cellular counting and immunohistochemistry to measure collagen types I and III. RESULTS The authors found that the LW-PP mesh presented greater median shrinkage than HW-PP mesh at 7 (P = .036), 28 (P = .674) and 90 days (P = .038) postoperatively. There were more neutrophils on LW-PP mesh (P = .008) at 7 days, gradually diminishing in both prostheses. Lymphocytes were similar between the implants at 7 days, diminishing about 50 % on LW-PP mesh (P < .001) at 90 days. Macrophages and giant cells diminished on LW-PP and increased on HW-PP meshes (P < .001). Collagen I/III ratio presented a progressive, almost fivefold rise at 90 days, on both mesh types (P < .001). The collagen I/III ratio was similar between LW-PP and HW-PP meshes at the three times studied. CONCLUSIONS It is concluded that LW-PP showed more shrinkage than HW-PP mesh at 7 and 90 days, despite the fact that HW-PP presented more lately foreign body reaction. The collagen I/III ratio was similar between the prostheses and increased during the postimplant period.
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Affiliation(s)
- L Zogbi
- Programa de Pós-Graduação em Cirurgia, Universidade Federal do Rio Grande do Sul (UFRGS), Ramiro Barcelos Street 2400, 90035-003, Porto Alegre, RS, Brazil,
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20
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Ulrich D, Edwards SL, White JF, Supit T, Ramshaw JAM, Lo C, Rosamilia A, Werkmeister JA, Gargett CE. A preclinical evaluation of alternative synthetic biomaterials for fascial defect repair using a rat abdominal hernia model. PLoS One 2012. [PMID: 23185528 PMCID: PMC3502256 DOI: 10.1371/journal.pone.0050044] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Fascial defects are a common problem in the abdominal wall and in the vagina leading to hernia or pelvic organ prolapse that requires mesh enhancement to reduce operation failure. However, the long-term outcome of synthetic mesh surgery may be unsatisfactory due to post-surgical complications. We hypothesized that mesh fabricated from alternative synthetic polymers may evoke a different tissue response, and provide more appropriate mechanical properties for hernia repair. Our aim was to compare the in vivo biocompatibility of new synthetic meshes with a commercial mesh. METHODS We have fabricated 3 new warp-knitted synthetic meshes from different polymers with different tensile properties polyetheretherketone (PEEK), polyamide (PA) and a composite, gelatin coated PA (PA+G). The rat abdominal hernia model was used to implant the meshes (25 × 35 mm, n = 24/ group). After 7, 30, 60, 90 days tissues were explanted for immunohistochemical assessment of foreign body reaction and tissue integration, using CD31, CD45, CD68, alpha-SMA antibodies. The images were analysed using an image analysis software program. Biomechanical properties were uniaxially evaluated using an Instron Tensile® Tester. RESULTS This study showed that the new meshes induced complex differences in the type of foreign body reaction over the time course of implantation. The PA, and particularly the composite PA+G meshes, evoked a milder early inflammatory response, and macrophages were apparent throughout the time course. Our meshes led to better tissue integration and new collagen deposition, particularly with the PA+G meshes, as well as greater and sustained neovascularisation compared with the PP meshes. CONCLUSION PA, PA+G and PEEK appear to be well tolerated and are biocompatible, evoking an overlapping and different host tissue response with time that might convey mechanical variations in the healing tissue. These new meshes comprising different polymers may provide an alternative option for future treatment of fascial defects.
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Affiliation(s)
- Daniela Ulrich
- Monash Institute of Medical Research, Clayton, Victoria, Australia
- Medical University Graz, Graz, Austria
- Department of Obstetrics and Gynaecology and Monash Micro Imaging, Monash Medical Centre, Monash University, Clayton, Victoria, Australia
| | - Sharon L. Edwards
- CSIRO Materials Science and Engineering, Clayton, Victoria, Australia
| | - Jacinta F. White
- CSIRO Materials Science and Engineering, Clayton, Victoria, Australia
| | - Tommy Supit
- Monash Institute of Medical Research, Clayton, Victoria, Australia
| | | | - Camden Lo
- Monash Institute of Medical Research, Clayton, Victoria, Australia
| | - Anna Rosamilia
- Department of Obstetrics and Gynaecology and Monash Micro Imaging, Monash Medical Centre, Monash University, Clayton, Victoria, Australia
| | | | - Caroline E. Gargett
- Monash Institute of Medical Research, Clayton, Victoria, Australia
- Department of Obstetrics and Gynaecology and Monash Micro Imaging, Monash Medical Centre, Monash University, Clayton, Victoria, Australia
- * E-mail:
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Pascual G, Rodríguez M, Sotomayor S, Pérez-Köhler B, Bellón JM. Inflammatory reaction and neotissue maturation in the early host tissue incorporation of polypropylene prostheses. Hernia 2012; 16:697-707. [PMID: 22744412 DOI: 10.1007/s10029-012-0945-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 06/13/2012] [Indexed: 11/24/2022]
Abstract
PURPOSE The use prosthetic materials for the surgical repair of abdominal wall defects has become almost standard practice. This study was designed to assess the expression of different growth factors (VEGF/TGF-β1) and macrophages during the early host tissue incorporation of several polypropylene lightweight (PP-LW)-including one partially absorbable-and heavyweight (PP-HW) prosthetic meshes. METHODS Ventral defects were created in the anterior abdominal wall of New Zealand rabbits and repaired by fixing PP-LW meshes of different pore size and a low porosity PP-HW mesh to the edges of the defect. Following killing 14 days after implant, specimens were taken to examine TGF-β1/VEGF gene and protein expression by qRT-PCR and immunohistochemistry. The macrophage response was also assessed. RESULTS All the materials showed good host tissue incorporation, with a more severe inflammatory reaction and greater numbers of macrophages recorded in the partially absorbable LW implants. Relative amounts of VEGF mRNA were significantly lower for the LW partially absorbable implants compared with the remaining LW meshes. Protein expression of VEGF showed undetectable or minimum staining in the different groups. TGF-β1 mRNA levels were also lower in the partially absorbable group compared with one of PP-LW type of mesh. Gene expression patterns were consistent with the TGF-β1 protein levels detected. CONCLUSIONS The results suggest that VEGF and TGF-β1 expression were independent of mesh pore size. The expression of both growth factors and the macrophage response were correlated with the presence of biodegradable material in the mesh. The presence of absorbable material in the LW mesh gave rise to a more intense inflammatory reaction and the reduced synthesis of growth factors known to contribute to neotissue maturation.
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Affiliation(s)
- G Pascual
- Department of Medical Specialities, University of Alcalá, Alcalá de Henares, Madrid, Spain.
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Bilsel Y, Abci I. The search for ideal hernia repair; mesh materials and types. Int J Surg 2012; 10:317-21. [PMID: 22588090 DOI: 10.1016/j.ijsu.2012.05.002] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Revised: 05/06/2012] [Accepted: 05/06/2012] [Indexed: 11/18/2022]
Abstract
Hernia surgery continues to draw the attention of surgeons, patients, and the industry. This strong interest has driven the establishment of professional medical societies with the sole purpose of furthering the understanding of hernias and hernia repair. In the more than 100 years of development, industry has played a major role in advancing the technology to perfect the performance of hernia repair with the hope of establishing the "best" technique and its associated technology. However, with the development of newer prosthetics and approaches to hernia repair, many surgeons do not fully understand the properties of the available prosthetics. The goal of this review is to highlight the different types of meshes in an effort to clarify to surgeons what types of materials are available to them and how to select an appropriate one for a given case.
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Affiliation(s)
- Yilmaz Bilsel
- Hisar Intercontinental Hospital, General Surgery Department, Alemdag Caddesi, Site Yolu Sokak, Istanbul, Turkey.
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Walschus U, Hoene A, Patrzyk M, Finke B, Polak M, Lucke S, Nebe B, Schroeder K, Podbielski A, Wilhelm L, Schlosser M. Serum profile of pro- and anti-inflammatory cytokines in rats following implantation of low-temperature plasma-modified titanium plates. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2012; 23:1299-1307. [PMID: 22402792 DOI: 10.1007/s10856-012-4600-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 02/20/2012] [Indexed: 05/31/2023]
Abstract
Surface modification of Titanium (Ti) by low-temperature plasma influences cell-material interactions. Therefore, this study aimed at examining serum cytokine levels and associations after intramuscular implantation (n = 8 rats/group) of Ti-plates with Plasma Polymerized Allyl Amine (Ti-PPAAm), Plasma Polymerized Acrylic Acid (Ti-PPAAc), and without such layers (Ti-Controls). Pro-inflammatory (IL-2, IFNγ, IL-6) and anti-inflammatory (IL-4, IL-10, IL-13) cytokines were measured weekly for 56 days. Ti-PPAAm caused increased IL-2 (d7-14, d35), increased IFNγ (d35) and decreased IL-10 (d35, d49-56). Ti-PPAAc induced divergent anti-inflammatory cytokine changes with increased IL-4 (d28-56) and decreased IL-10 (d42-56). Ti-Controls elicited increased IL-2 (d42) and IFNγ (d35-42, d56). IL-6 was not detected and IL-13 only in three samples, thus they do not influence the response against these Ti implants. Correlation analysis revealed surface-dependent associations between cytokines indicating the involvement of different inflammatory cell populations. Concluding, different plasma modifications induce specific serum cytokine profiles and associations indicating distinct inflammatory responses.
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Affiliation(s)
- Uwe Walschus
- Department of Medical Biochemistry and Molecular Biology, Research Group of Predictive Diagnostics, Ernst Moritz Arndt University of Greifswald, Greifswalder Str. 11c, 17495 Karlsburg, Germany
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