1
|
Vergote S, Joyeux L, Basurto D, Bleeser T, Valenzuela I, Valentyn B, Emam D, Watananirun K, De Bie FR, Aertsen M, van der Merwe J, Deprest J. Duration of fetoscopic spina bifida repair does not affect the central nervous system in fetal lambs. Am J Obstet Gynecol MFM 2023; 5:101156. [PMID: 37714330 DOI: 10.1016/j.ajogmf.2023.101156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/08/2023] [Accepted: 09/09/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND Prenatal spina bifida aperta repair improves neurologic outcomes yet comes with a significant risk of prematurity and uterine scar-related complications. To reduce such complications, different fetoscopic techniques, for example, with varying numbers of ports, are being explored. This has an effect on the duration of the procedure, potentially affecting central nervous system development. Both the condition and anesthesia can affect the central nervous system, particularly the hippocampus, a region crucial for prospective and episodic memory. Previous animal studies have shown the potential influence of anesthesia, premature delivery, and maternal surgery during pregnancy on this area. OBJECTIVE This study aimed to compare the effects of 2- vs 3-port fetoscopic spina bifida aperta repair in the fetal lamb model using neuron count of the hippocampus as the primary outcome. STUDY DESIGN Based on the hippocampal neuron count from previous lamb experiments, we calculated that we required 5 animals per group to achieve a statistical power of ≥ 80%. A spina bifida aperta defect was developed in fetal lambs at 75 days of gestation (term: 145 days). At 100 days, fetuses underwent either a 2-port or 3-port fetoscopic repair. At 143 days, all surviving fetuses were delivered by cesarean delivery, anesthetized, and transcardially perfused with a mixture of formaldehyde and gadolinium. Next, they underwent neonatal brain and spine magnetic resonance imaging after which these organs were harvested for histology. Hippocampus, frontal cortex, caudate nucleus, and cerebellum samples were immunostained to identify neurons, astrocytes, microglia, and markers associated with cell proliferation, myelination, and synapses. The degree of hindbrain herniation and the ventricular diameter were measured on magnetic resonance images and volumes of relevant brain and medulla areas were segmented. RESULTS Both treatment groups included 5 fetuses and 9 unoperated littermates served as normal controls. The durations for both skin-to-skin (341±31 vs 287±40 minutes; P=.04) and fetal surgery (183±30 vs 128±22; P=.01) were longer for the 2-port approach than for the 3-port approach. There was no significant difference in neuron density in the hippocampus, frontal cortex, and cerebellum. In the caudate nucleus, the neuron count was higher in the 2-port group (965±156 vs 767±92 neurons/mm2; P=.04). There were neither differences in proliferation, astrogliosis, synaptophysin, or myelin. The tip of the cerebellar vermis was closer to the foramen magnum in animals undergoing the 2-port approach than in animals undergoing the 3-port approach (-0.72±0.67 vs -2.47±0.91 mm; P=.009). There was no significant difference in the ratio of the hippocampus, caudate nucleus, or cerebellar volume to body weight. For the spine, no difference was noted in spine volume-to-body weight ratio for the lower (L1-L2), middle (L3-L4), and higher (L5-L6) levels. Compared with controls, in repaired animals, the cerebellar vermis tip laid closer to the foramen magnum, parietal ventricles were enlarged, and medulla volumes were reduced. CONCLUSION In the experimental spina bifida fetal lamb model, a 2-port repair took 40% longer than a 3-port repair. However, there was no indication of any relevant morphologic differences in the fetal brain.
Collapse
Affiliation(s)
- Simen Vergote
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium (Drs Vergote, Joyeux, Basurto, Bleeser, and Valenzuela, Ms Valentyn, and Drs Emam, Watananirun, De Bie, van der Merwe, and Deprest); Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, Katholieke Universiteit Leuven, Leuven, Belgium (Drs Vergote, Joyeux, Basurto, Bleeser, and Valenzuela, Ms Valentyn, and Drs Emam, Watananirun, De Bie, van der Merwe, and Deprest)
| | - Luc Joyeux
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium (Drs Vergote, Joyeux, Basurto, Bleeser, and Valenzuela, Ms Valentyn, and Drs Emam, Watananirun, De Bie, van der Merwe, and Deprest); Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, Katholieke Universiteit Leuven, Leuven, Belgium (Drs Vergote, Joyeux, Basurto, Bleeser, and Valenzuela, Ms Valentyn, and Drs Emam, Watananirun, De Bie, van der Merwe, and Deprest); Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX (Dr Joyeux)
| | - David Basurto
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium (Drs Vergote, Joyeux, Basurto, Bleeser, and Valenzuela, Ms Valentyn, and Drs Emam, Watananirun, De Bie, van der Merwe, and Deprest); Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, Katholieke Universiteit Leuven, Leuven, Belgium (Drs Vergote, Joyeux, Basurto, Bleeser, and Valenzuela, Ms Valentyn, and Drs Emam, Watananirun, De Bie, van der Merwe, and Deprest); Department of Fetal Medicine and Fetal Surgery, National Institute of Perinatology, Mexico City, Mexico (Dr Basurto)
| | - Tom Bleeser
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium (Drs Vergote, Joyeux, Basurto, Bleeser, and Valenzuela, Ms Valentyn, and Drs Emam, Watananirun, De Bie, van der Merwe, and Deprest); Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, Katholieke Universiteit Leuven, Leuven, Belgium (Drs Vergote, Joyeux, Basurto, Bleeser, and Valenzuela, Ms Valentyn, and Drs Emam, Watananirun, De Bie, van der Merwe, and Deprest); Department of Anaesthesiology, Universitair Ziekenhuis Leuven, Leuven, Belgium (Dr Bleeser); Department of Cardiovascular Sciences, Biomedical Sciences, Katholieke Universiteit Leuven, Leuven, Belgium (Dr Bleeser)
| | - Ignacio Valenzuela
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium (Drs Vergote, Joyeux, Basurto, Bleeser, and Valenzuela, Ms Valentyn, and Drs Emam, Watananirun, De Bie, van der Merwe, and Deprest); Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, Katholieke Universiteit Leuven, Leuven, Belgium (Drs Vergote, Joyeux, Basurto, Bleeser, and Valenzuela, Ms Valentyn, and Drs Emam, Watananirun, De Bie, van der Merwe, and Deprest)
| | - Britt Valentyn
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium (Drs Vergote, Joyeux, Basurto, Bleeser, and Valenzuela, Ms Valentyn, and Drs Emam, Watananirun, De Bie, van der Merwe, and Deprest); Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, Katholieke Universiteit Leuven, Leuven, Belgium (Drs Vergote, Joyeux, Basurto, Bleeser, and Valenzuela, Ms Valentyn, and Drs Emam, Watananirun, De Bie, van der Merwe, and Deprest)
| | - Doaa Emam
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium (Drs Vergote, Joyeux, Basurto, Bleeser, and Valenzuela, Ms Valentyn, and Drs Emam, Watananirun, De Bie, van der Merwe, and Deprest); Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, Katholieke Universiteit Leuven, Leuven, Belgium (Drs Vergote, Joyeux, Basurto, Bleeser, and Valenzuela, Ms Valentyn, and Drs Emam, Watananirun, De Bie, van der Merwe, and Deprest); Department of Obstetrics and Gynaecology, Tanta University Hospitals, Tanta, Egypt (Dr Emam)
| | - Kanokwaroon Watananirun
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium (Drs Vergote, Joyeux, Basurto, Bleeser, and Valenzuela, Ms Valentyn, and Drs Emam, Watananirun, De Bie, van der Merwe, and Deprest); Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, Katholieke Universiteit Leuven, Leuven, Belgium (Drs Vergote, Joyeux, Basurto, Bleeser, and Valenzuela, Ms Valentyn, and Drs Emam, Watananirun, De Bie, van der Merwe, and Deprest); Faculty of Medicine, Department of Obstetrics and Gynecology, Siriraj Hospital, Mahidol University, Bangkok, Thailand (Dr Watananirun)
| | - Felix R De Bie
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium (Drs Vergote, Joyeux, Basurto, Bleeser, and Valenzuela, Ms Valentyn, and Drs Emam, Watananirun, De Bie, van der Merwe, and Deprest); Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, Katholieke Universiteit Leuven, Leuven, Belgium (Drs Vergote, Joyeux, Basurto, Bleeser, and Valenzuela, Ms Valentyn, and Drs Emam, Watananirun, De Bie, van der Merwe, and Deprest)
| | - Michael Aertsen
- Department of Imaging and Pathology, Clinical Department of Radiology, University Hospitals Katholieke Universiteit Leuven, Leuven, Belgium (Dr Aertsen)
| | - Johannes van der Merwe
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium (Drs Vergote, Joyeux, Basurto, Bleeser, and Valenzuela, Ms Valentyn, and Drs Emam, Watananirun, De Bie, van der Merwe, and Deprest); Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, Katholieke Universiteit Leuven, Leuven, Belgium (Drs Vergote, Joyeux, Basurto, Bleeser, and Valenzuela, Ms Valentyn, and Drs Emam, Watananirun, De Bie, van der Merwe, and Deprest)
| | - Jan Deprest
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium (Drs Vergote, Joyeux, Basurto, Bleeser, and Valenzuela, Ms Valentyn, and Drs Emam, Watananirun, De Bie, van der Merwe, and Deprest); Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, Katholieke Universiteit Leuven, Leuven, Belgium (Drs Vergote, Joyeux, Basurto, Bleeser, and Valenzuela, Ms Valentyn, and Drs Emam, Watananirun, De Bie, van der Merwe, and Deprest); Institute for Women's Health, University College London, London, United Kingdom (Dr Deprest).
| |
Collapse
|
2
|
Russo Serafini M, Mowat A, Mustafa S, Saifzadeh S, Shabab T, Bas O, O’Rourke N, W. Hutmacher D, Medeiros Savi F. 3D-Printed Medical-Grade Polycaprolactone (mPCL) Scaffold for the Surgical Treatment of Vaginal Prolapse and Abdominal Hernias. Bioengineering (Basel) 2023; 10:1242. [PMID: 38002366 PMCID: PMC10669821 DOI: 10.3390/bioengineering10111242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/27/2023] [Accepted: 10/03/2023] [Indexed: 11/26/2023] Open
Abstract
The expected outcome after a scaffold augmented hernia repair is the regeneration of a tissue composition strong enough to sustain biomechanical function over long periods. It is hypothesised that melt electrowriting (MEW) medical-grade polycaprolactone (mPCL) scaffolds loaded with platelet-rich plasma (PRP) will enhance soft tissue regeneration in fascial defects in abdominal and vaginal sheep models. A pre-clinical evaluation of vaginal and abdominal hernia reconstruction using mPCL mesh scaffolds and polypropylene (PP) meshes was undertaken using an ovine model. Each sheep was implanted with both a PP mesh (control group), and a mPCL mesh loaded with PRP (experimental group) in both abdominal and vaginal sites. Mechanical properties of the tissue-mesh complexes were assessed with plunger tests. Tissue responses to the implanted meshes were evaluated via histology, immunohistochemistry and histomorphometry. At 6 months post-surgery, the mPCL mesh was less stiff than the PP mesh, but stiffer than the native tissue, while showing equitable collagen and vascular ingrowth when compared to PP mesh. The results of this pilot study were supportive of mPCL as a safe and effective biodegradable scaffold for hernia and vaginal prolapse repair, hence a full-scale long-term study (over 24-36 months) with an adequate sample size is recommended.
Collapse
Affiliation(s)
- Mairim Russo Serafini
- Department of Pharmacy, Universidade Federal de Sergipe, São Cristóvão 49100-000, Brazil;
- Centre in Regenerative Medicine, Faculty of Engineering, Queensland University of Technology, Brisbane, QLD 4059, Australia; (S.S.); (T.S.); (O.B.); (D.W.H.)
| | - Alexandra Mowat
- Faculty of Medicine, University of Queensland, Brisbane, QLD 4072, Australia
- Queen Elisabeth II Jubilee Hospital, Brisbane, QLD 4108, Australia;
| | - Susanah Mustafa
- Queen Elisabeth II Jubilee Hospital, Brisbane, QLD 4108, Australia;
| | - Siamak Saifzadeh
- Centre in Regenerative Medicine, Faculty of Engineering, Queensland University of Technology, Brisbane, QLD 4059, Australia; (S.S.); (T.S.); (O.B.); (D.W.H.)
- Medical Engineering Research Facility, Queensland University of Technology, Brisbane, QLD 4032, Australia
| | - Tara Shabab
- Centre in Regenerative Medicine, Faculty of Engineering, Queensland University of Technology, Brisbane, QLD 4059, Australia; (S.S.); (T.S.); (O.B.); (D.W.H.)
- Australian Research Council Industrial Transformation Training Centre in Additive Biomanufacturing, Queensland University of Technology, Brisbane, QLD 4059, Australia
| | - Onur Bas
- Centre in Regenerative Medicine, Faculty of Engineering, Queensland University of Technology, Brisbane, QLD 4059, Australia; (S.S.); (T.S.); (O.B.); (D.W.H.)
- Australian Research Council Industrial Transformation Training Centre in Additive Biomanufacturing, Queensland University of Technology, Brisbane, QLD 4059, Australia
| | - Nicholas O’Rourke
- Department of Hepato-Pancreato-Biliary Surgery, Royal Brisbane and Women’s Hospital, University of Queensland, Brisbane, QLD 4029, Australia;
| | - Dietmar W. Hutmacher
- Centre in Regenerative Medicine, Faculty of Engineering, Queensland University of Technology, Brisbane, QLD 4059, Australia; (S.S.); (T.S.); (O.B.); (D.W.H.)
- Australian Research Council Industrial Transformation Training Centre in Additive Biomanufacturing, Queensland University of Technology, Brisbane, QLD 4059, Australia
- ARC Training Centre for Multiscale 3D Imaging, Modelling and Manufacturing, Brisbane, QLD 4059, Australia
| | - Flavia Medeiros Savi
- Centre in Regenerative Medicine, Faculty of Engineering, Queensland University of Technology, Brisbane, QLD 4059, Australia; (S.S.); (T.S.); (O.B.); (D.W.H.)
- Australian Research Council Industrial Transformation Training Centre in Additive Biomanufacturing, Queensland University of Technology, Brisbane, QLD 4059, Australia
- ARC Training Centre for Multiscale 3D Imaging, Modelling and Manufacturing, Brisbane, QLD 4059, Australia
| |
Collapse
|
3
|
Helmedag MJ, Heise D, Eickhoff RM, Schmitz SM, Mechelinck M, Emonts C, Bolle T, Gries T, Neumann UP, Klink CD, Lambertz A. Ultra-Fine Polyethylene Hernia Meshes Improve Biocompatibility and Reduce Intraperitoneal Adhesions in IPOM Position in Animal Models. Biomedicines 2022; 10:biomedicines10061294. [PMID: 35740316 PMCID: PMC9220266 DOI: 10.3390/biomedicines10061294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/15/2022] [Accepted: 05/27/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Introduction: The intraperitoneal onlay mesh technique (IPOM) is widely used to repair incisional hernias. This method has advantages but suffers from complications due to intraperitoneal adhesion formation between the mesh and intestine. An ideal mesh minimizes adhesions and shows good biocompatibility. To address this, newly developed multifilamentous polyethylene (PET) meshes were constructed from sub-macrophage-sized monofilaments and studied regarding biocompatibility and adhesion formation. (2) Methods: We investigated fine (FPET, 72 filaments, 11 µm diameter each) and ultra-fine multifilament (UFPET, 700 filaments, 3 µm diameter each) polyethylene meshes for biocompatibility in subcutaneous implantation in rats. Adhesion formation was analyzed in the IPOM position in rabbits. Geometrically identical mono-filamentous polypropylene (PP) Bard Soft® PP meshes were used for comparison. Histologic and immune-histologic foreign body reactions were assessed in 48 rats after 7 or 21 days (four mesh types, with two different mesh types per rat; n = 6 per mesh type). Additionally, two different mesh types each were placed in the IPOM position in 24 rabbits to compile the Diamond peritoneal adhesion score after the same timeframes. The biocompatibility and adhesion score differences were analyzed with the Kruskal–Wallis nonparametric statistical test. (3) Results: Overall, FPET and, especially, UFPET showed significantly smaller foreign body granulomas compared to PP meshes. Longer observation periods enhanced the differences. Immunohistology showed no significant differences in the cellular immune response and proliferation. UFPET demonstrated significantly reduced peritoneal adhesion formation compared to all other tested meshes after 21 days. (4) Conclusions: Overall, FPET and, especially, UFPET demonstrated their suitability for IPOM hernia meshes in animal models by improving major aspects of the foreign body reaction and reducing adhesion formation.
Collapse
Affiliation(s)
- Marius J. Helmedag
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, 52074 Aachen, Germany; (D.H.); (R.M.E.); (S.M.S.); (U.P.N.); (C.D.K.); (A.L.)
- Correspondence:
| | - Daniel Heise
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, 52074 Aachen, Germany; (D.H.); (R.M.E.); (S.M.S.); (U.P.N.); (C.D.K.); (A.L.)
| | - Roman M. Eickhoff
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, 52074 Aachen, Germany; (D.H.); (R.M.E.); (S.M.S.); (U.P.N.); (C.D.K.); (A.L.)
| | - Sophia M. Schmitz
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, 52074 Aachen, Germany; (D.H.); (R.M.E.); (S.M.S.); (U.P.N.); (C.D.K.); (A.L.)
| | - Mare Mechelinck
- Department of Anesthesiology, Uniklinik RWTH Aachen, 52074 Aachen, Germany;
| | - Caroline Emonts
- Institut für Textiltechnik, RWTH Aachen University, 52074 Aachen, Germany; (C.E.); (T.B.); (T.G.)
| | - Tim Bolle
- Institut für Textiltechnik, RWTH Aachen University, 52074 Aachen, Germany; (C.E.); (T.B.); (T.G.)
| | - Thomas Gries
- Institut für Textiltechnik, RWTH Aachen University, 52074 Aachen, Germany; (C.E.); (T.B.); (T.G.)
| | - Ulf Peter Neumann
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, 52074 Aachen, Germany; (D.H.); (R.M.E.); (S.M.S.); (U.P.N.); (C.D.K.); (A.L.)
| | - Christian Daniel Klink
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, 52074 Aachen, Germany; (D.H.); (R.M.E.); (S.M.S.); (U.P.N.); (C.D.K.); (A.L.)
| | - Andreas Lambertz
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, 52074 Aachen, Germany; (D.H.); (R.M.E.); (S.M.S.); (U.P.N.); (C.D.K.); (A.L.)
| |
Collapse
|
4
|
Novik B, Sandblom G, Ansorge C, Thorell A. Association of Mesh and Fixation Options with Reoperation Risk after Laparoscopic Groin Hernia Surgery: A Swedish Hernia Registry Study of 25,190 Totally Extraperitoneal and Transabdominal Preperitoneal Repairs. J Am Coll Surg 2022; 234:311-325. [PMID: 35213495 PMCID: PMC8834140 DOI: 10.1097/xcs.0000000000000060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND International guidelines concerning mesh and mesh fixation options in laparoscopic totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) groin hernia repair are based on studies focusing on either mesh or fixation. We hypothesized that the value of such recommendations is limited by lacking knowledge on how mesh and fixation interact. The current registry-based nationwide cohort study compared different mesh/fixation combinations for relative risks for reoperation after TEP and TAPP groin hernia repair. STUDY DESIGN All TEP and TAPP registered in the Swedish Hernia Registry 2005 to 2017 with standard polypropylene (StdPPM) or lightweight (LWM) flat mesh, having tack, fibrin glue, or no fixation, were included. The endpoint was reoperation due to recurrence as of December 31, 2018. Multivariable Cox regression rendered relative risk differences between the exposures, expressed as hazard ratios (HR) with 95% CIs. RESULTS Of 25,190 repairs, 924 (3.7%) were later reoperated for recurrence. The lowest, mutually equivalent, reoperation risks were associated with StdPPM without fixation (HR 1), StdPPM with metal tacks (HR 0.8, CI 0.4 to 1.4), StdPPM with fibrin glue (HR 1.1, CI 0.7 to 1.6), and LWM with fibrin glue (HR 1.2, CI 0.97 to 1.6). Except for with fibrin glue, LWM correlated with increased risk, whether affixed with metal (HR 1.7, CI 1.1 to 2.7), or absorbable tacks (HR 2.4, CI 1.8 to 3.1), or deployed without fixation (HR 2.0, CI 1.6 to 2.6). CONCLUSIONS With StdPPM, neither mechanical nor glue fixation seemed to improve outcomes. Thus, for this mesh category, we recommend nonfixation. With LWM, we recommend fibrin glue fixation, which was the only LWM alternative on par with nonaffixed StdPPM.
Collapse
Affiliation(s)
- Bengt Novik
- From the Department of Clinical Sciences, Danderyd Hospital (Novik, Thorell), Karolinska Institutet, Stockholm, Sweden
- the Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden (Novik)
- the Swedish Hernia Registry Steering Committee, Sweden (Novik, Sandblom)
| | - Gabriel Sandblom
- the Department of Clinical Science and Education, South Hospital (Sandblom), Karolinska Institutet, Stockholm, Sweden
- the Swedish Hernia Registry Steering Committee, Sweden (Novik, Sandblom)
| | - Christoph Ansorge
- the Department of Clinical Science, Interventions and Technology (Ansorge), Karolinska Institutet, Stockholm, Sweden
| | - Anders Thorell
- From the Department of Clinical Sciences, Danderyd Hospital (Novik, Thorell), Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
5
|
Villalobos RN, Mias MC, Gas C, Maestre Y, Nogués M, Vilardell F, Olsina JJ. Atraumatic laparoscopic intraperitoneal mesh fixation using a new laparoscopic device: an animal experimental study. Hernia 2019; 23:1123-1132. [PMID: 31325053 DOI: 10.1007/s10029-019-02008-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 07/11/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Laparoscopic ventral and incisional hernia repair (LVIHR) has become a common procedure because of its feasibility and safety, but it is not free of complications. Acute and chronic post-operative pain and bleeding caused by traumatic fixation of the mesh are frequently prolonging the hospital stay. The aim of this study was to analyze the behavior of n-butyl-cyanoacrylate (GLUBRAN® 2) as only mesh fixation METHODS: Ten female pigs were involved in the study and were divided into two groups of five (A and B). Animals in each group underwent a laparoscopic procedure in which two meshes were placed intraperitoneally and fixed with the same synthetic glue only. Animals in group A were sacrificed after 3 weeks, and those in group B were sacrificed after 12 weeks. We studied the morphological, biomechanical, and histological characteristics of the intraperitoneal mesh-tissue interface RESULTS: No disruption, migration or folding was observed in any of the pigs. In group A, the mean tensile strength was 1.4 N/cm (± 0.2) while in group B, the mean tensile strength was 2.5 N/cm (± 0.8). Histological analyses, in areas where mesh was fixed using the glue, showed a chronic lymphocytic inflammatory reaction with a granulomatous component and a marked desmoplastic reaction made up of immature collagen and numerous fibroblasts acquiring myofibroblastic characteristics. In some areas corresponding to fixation, the desmoplastic reaction originated from mature lamellar bone tissue with osteocytes and osteoblasts. CONCLUSION Laparoscopic mesh fixation with only the synthetic comonomer glue GLUBRAN® 2 is feasible, effective, and safe in intraperitoneal incisional/ventral hernia repair in this animal model.
Collapse
Affiliation(s)
- R N Villalobos
- Abdominal Wall Surgery Unit, General Surgery Department, Arnau de Vilanova University Hospital, 80 Rovira Roure Avenue, 25198, Lleida, Catalonia, Spain.
| | - M C Mias
- General Surgery Department, Arnau de Vilanova University Hospital, Lleida, Spain
| | - C Gas
- General Surgery Department, Arnau de Vilanova University Hospital, Lleida, Spain
| | - Y Maestre
- General Surgery Department, Arnau de Vilanova University Hospital, Lleida, Spain
| | - M Nogués
- Engineering Faculty, University of Lleida, Lleida, Spain
| | - F Vilardell
- Pathology Department, Arnau de Vilanova University Hospital, Lleida, Spain
| | - J J Olsina
- Abdominal Wall Surgery Unit, General Surgery Department, Arnau de Vilanova University Hospital, 80 Rovira Roure Avenue, 25198, Lleida, Catalonia, Spain
| |
Collapse
|
6
|
Lu S, Hu W, Zhang Z, Ji Z, Zhang T. Sirolimus-coated, poly(L-lactic acid)-modified polypropylene mesh with minimal intra-peritoneal adhesion formation in a rat model. Hernia 2018; 22:1051-1060. [PMID: 29777326 DOI: 10.1007/s10029-018-1782-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 05/10/2018] [Indexed: 12/16/2022]
Abstract
PURPOSE This study evaluated the manufacturing method and anti-adhesion properties of a new composite mesh in the rat model, which was made from sirolimus (SRL) grafts on a poly(L-lactic acid) (PLLA)-modified polypropylene (PP) hernia mesh. METHODS PLLA was first grafted onto argon-plasma-treated native PP mesh through catalysis of stannous chloride. SRL was grafted onto the surface of PP-PLLA meshes using catalysis of 1-(3-dimethylaminopropyl)-3-ethylcarbodiimide hydrochloride (EDC) and 4-dimethylaminopyridine (DMAP) in a CH2Cl2 solvent. Sprague-Dawley female rats received either SRL-coated meshes, PP-PLLA meshes, or native PP meshes to repair abdominal wall defects. At different intervals, rats were euthanized by a lethal dose of chloral hydrate and adhesion area and tenacity were evaluated. Sections of the mesh with adjacent tissues were assessed histologically. RESULTS Attenuated total reflection Fourier transformed infrared (ATR-FTIR) spectroscopy indicated the existence of a C=O group absorption peak (1724.1 cm-1), and scanning electron microscope morphological analysis indicated that the surface of the PP mesh was covered with SRL. Compared to the native PP meshes and PP-PLLA meshes, SRL-coated meshes demonstrated the greatest ability to decrease the formation of adhesions (P < 0.05) and inflammation. CONCLUSIONS The SRL-coated composite mesh showed minimal formation of intra-abdominal adhesions in a rat model of abdominal wall defect repair.
Collapse
Affiliation(s)
- S Lu
- Department of General Surgery, Affiliated ZhongDa Hospital (Jiang Bei), Southeast University, No. 211 Jianmin Road, Nanjing, 210009, Jiangsu, China.,Department of General Surgery, Institute for Minimally Invasive Surgery, Affiliated ZhongDa Hospital, Medical School, Southeast University, No. 87 Dingjiaqiao Road, Nanjing, 210009, Jiangsu, China
| | - W Hu
- Jiangsu Key Laboratory for Biomaterials and Devices, State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, No. 2 Sipailou, Nanjing, 21009, China
| | - Z Zhang
- Department of General Surgery, Institute for Minimally Invasive Surgery, Affiliated ZhongDa Hospital, Medical School, Southeast University, No. 87 Dingjiaqiao Road, Nanjing, 210009, Jiangsu, China
| | - Z Ji
- Department of General Surgery, Institute for Minimally Invasive Surgery, Affiliated ZhongDa Hospital, Medical School, Southeast University, No. 87 Dingjiaqiao Road, Nanjing, 210009, Jiangsu, China.
| | - T Zhang
- Jiangsu Key Laboratory for Biomaterials and Devices, State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, No. 2 Sipailou, Nanjing, 21009, China
| |
Collapse
|
7
|
Capitano S. Laparoscopic transabdominal preperitoneal approach for umbilical hernia with rectus diastasis. Asian J Endosc Surg 2017; 10:334-335. [PMID: 28727317 DOI: 10.1111/ases.12365] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 01/13/2017] [Accepted: 01/17/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Rectus diastasis, when coexistent with umbilical hernia, can benefit from mesh-based repair of the midline. Laparoscopic correction of an umbilical hernia involves the placement of a mesh in the peritoneal cavity, but this comes with the risk of bowel complications. However, newly developed dual-sided composite meshes have helped to reduce this risk. MATERIALS AND SURGICAL TECHNIQUE Four men and three women with umbilical hernia and rectus diastasis were treated with laparoscopic transabdominal preperitoneal repair. Composite mesh with a hydrophilic 3-D polyester textile on the parietal side and an absorbable collagen barrier on the peritoneal side were placed in the preperitoneal pocket after hernial sac reduction. Mean hernia size was 2.5 cm, and no recurrences were observed during the mean follow-up period of 9.2 months. DISCUSSION The laparoscopic transabdominal preperitoneal approach for umbilical hernia and rectus diastasis may be a safe surgical option when trying to avoid potential complications related to intra-abdominal mesh positioning.
Collapse
Affiliation(s)
- Sante Capitano
- Department of General Surgery, Italian National Institute on Aging (INRCA), Ancona, Italy
| |
Collapse
|
8
|
Harsløf S, Zinther N, Harsløf T, Danielsen C, Wara P, Friis-Andersen H. Mesh shrinkage depends on mesh properties and anchoring device: an experimental long-term study in sheep. Hernia 2016; 21:107-113. [DOI: 10.1007/s10029-016-1528-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 07/29/2016] [Indexed: 11/29/2022]
|
9
|
Winny M, Grethe L, Maegel L, Jonigk D, Lippmann T, Klempnauer J, Poehnert D. Impairment of the Peritoneal Surface as a Decisive Factor for Intestinal Adhesions in Intraperitoneal Onlay Mesh Surgery - Introducing a New Rat Model. Int J Med Sci 2016; 13:108-12. [PMID: 26941568 PMCID: PMC4764776 DOI: 10.7150/ijms.14056] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 12/10/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Meshes implanted intraperitoneally are known to cause adhesions potentially resulting in complications such as chronic pain, enterocutaneous fistula, or mesh infection. This study introduces a model for investigation of intestine-to-mesh adhesions and evaluates as to whether missing of visceral peritoneum is causative. METHODS In 18 rats, rectangular 1.5 x 2 cm patches of an uncoated polypropylene mesh (Ultrapro(®)) were sewn to the inner abdominal wall next to the cecum. Additionally, a meso-suture ensured contact between cecum and mesh. Rats were assigned to 2 groups: in 8 rats the peritoneum was left intact, in 10 the cecum was depleted from peritoneum with abrasion. Sacrifice was on day 7. Macroscopic evaluation used two adhesion scores. Specimens were evaluated microscopically, statistical analyses employed student's t-test. RESULTS On day 7, rats with mesh implantation combined with locally de-peritonealization by cecal abrasion mostly showed severe cecum-to-mesh agglutination (mean Lauder score 92%, mean total Hoffmann score 90%), whereas meshes of most animals without cecal abrasion only had some coverage with intraabdominal fat (33%, 24%; p = 0.0002). Histological work-up showed adequate wall ingrowth of mesh in all rats. In animals with cecal abrasion, meshes were mostly adhesive with cecal wall. However, when the peritoneum of cecum was unimpaired, abdominal wall above the mesh as well as cecum usually revealed sub-peritoneal tissue and a mono-layer cell coverage as seen in normal peritoneum. CONCLUSION This study introduces a model mimicking a clinical situation of e.g. hernia repair by intraperitoneally implanted meshes when mesh has contact with normal and with de-peritonealized intestine. The model might be useful for testing mesh types and coatings as well as other devices for their efficacy in adhesion prevention. The high adhesion scores of rats with local de-peritonealization compared with the low scores of animals with intact peritoneum indicate that the integrity of intestinal peritoneum is a decisive factor for adhesion formation.
Collapse
Affiliation(s)
- M Winny
- 1. Clinic for General, Abdominal and Transplant Surgery, Hannover Medical School, Germany
| | - L Grethe
- 1. Clinic for General, Abdominal and Transplant Surgery, Hannover Medical School, Germany
| | - L Maegel
- 2. Institute of Pathology, Hannover Medical School, Germany
| | - D Jonigk
- 2. Institute of Pathology, Hannover Medical School, Germany
| | - T Lippmann
- 2. Institute of Pathology, Hannover Medical School, Germany
| | - J Klempnauer
- 1. Clinic for General, Abdominal and Transplant Surgery, Hannover Medical School, Germany
| | - D Poehnert
- 1. Clinic for General, Abdominal and Transplant Surgery, Hannover Medical School, Germany
| |
Collapse
|
10
|
Lambertz A, van den Hil LCL, Schöb DS, Binnebösel M, Kroh A, Klinge U, Neumann UP, Klink CD. Analysis of adhesion formation of a new elastic thermoplastic polyurethane (TPU) mesh in comparison to polypropylene (PP) meshes in IPOM position. J Mech Behav Biomed Mater 2015; 53:366-372. [PMID: 26406584 DOI: 10.1016/j.jmbbm.2015.08.036] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 08/28/2015] [Accepted: 08/30/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Postsurgical adhesions severely affect the patients' quality of life causing various complications like bowel obstruction or chronic pain. Especially the implantation of alloplastic prostheses in IPOM position for hernia repair carries a high risk of adhesion formation due to the close contact between mesh and viscera. The extent of adhesions mainly depends on the type and textile characteristics of the implanted mesh. The aim of this study was to examine the degree of adhesion formation of a newly developed, elastic thermoplastic polyurethane (TPU) mesh in comparison to polypropylene (PP) meshes in IPOM position in a rabbit model. METHODS Sixteen female chinchilla rabbits were laparoscopically operated. Two different meshes were placed to the left and the right lower abdominal wall in IPOM position in each rabbit. After 7 or 21 days, midline laparotomy was performed, the degree of adhesion formation was examined by the Diamond score and mesh elongation was measured under a force of 3N. Finally, the abdominal walls were explanted for immunohistochemical and histopathological investigations. RESULTS TPU meshes showed significantly lower Diamond scores than PP meshes. After explantation, mesh elongation of the TPU mesh was significantly larger than expansion of PP under a force of 3N. Thus, the TPU mesh preserved its elastic properties after 7 and 21 days. The amount of CD68 positive, Ki67 positive and apoptotic cells within the granuloma around the fibers did not show significant differences between the study groups. CONCLUSIONS The newly developed TPU mesh seems to reduce peritoneal adhesion formation in IPOM position in a rabbit model compared to PP meshes after 7 and 21 days. Immunohistochemistry did not reveal differences in biocompatibility of the two meshes used.
Collapse
Affiliation(s)
- A Lambertz
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Germany.
| | - L C L van den Hil
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Germany; Department of General Surgery, Maastricht University Medical Centre, Netherlands
| | - D S Schöb
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Germany
| | - M Binnebösel
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Germany
| | - A Kroh
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Germany
| | - U Klinge
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Germany
| | - U P Neumann
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Germany
| | - C D Klink
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Germany
| |
Collapse
|
11
|
Beyene RT, Kavalukas SL, Barbul A. Intra-abdominal adhesions: Anatomy, physiology, pathophysiology, and treatment. Curr Probl Surg 2015; 52:271-319. [PMID: 26258583 DOI: 10.1067/j.cpsurg.2015.05.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 05/12/2015] [Indexed: 12/18/2022]
|
12
|
Reynvoet E, Van Cleven S, Van Overbeke I, Chiers K, De Baets P, Troisi R, Berrevoet F. The use of cyanoacrylate sealant as simple mesh fixation in laparoscopic ventral hernia repair: a large animal evaluation. Hernia 2015; 19:661-70. [DOI: 10.1007/s10029-015-1347-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 01/17/2015] [Indexed: 11/24/2022]
|
13
|
Siassi M, Mahn A, Baumann E, Vollmer M, Huber G, Morlock M, Kallinowski F. Development of a dynamic model for ventral hernia mesh repair. Langenbecks Arch Surg 2014; 399:857-62. [PMID: 25139068 PMCID: PMC4167430 DOI: 10.1007/s00423-014-1239-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 08/05/2014] [Indexed: 11/28/2022]
Abstract
Introduction The adequate way of mesh fixation in laparoscopic ventral hernia repair is still subject to debate. So far, simulation has only been carried out in a static way, thereby omitting dynamic effects of coughing or vomiting. We developed a dynamic model of the anterior abdominal wall. Materials and methods An aluminium cylinder was equipped with a pressure controlled, fluid-filled plastic bag, simulating the abdominal viscera. A computer-controlled system allowed the control of influx and efflux, thus creating pressure peaks of up to 200 mmHg to simulate coughing and 290 mmHg to simulate vomiting. We tested fixation with tacks (Absorbatack, Covidien Deutschland, Neustadt a. D., Germany). The model was controlled for the friction coefficient of the tissue against the mesh and the physiologic elasticity of the abdominal wall surrogate. Results The model was able to create pressure peaks equivalent to physiologic coughs or vomiting. Physiologic elasticity was thereby maintained. We could show that the friction coefficient is crucial to achieve a physiologic situation. The meshes showed a tendency to dislocate with an increasing number of coughs (Fig. 4). Nevertheless, when applied in a plain manner, the meshes withstood more cough cycles than when applied with a bulge as in laparoscopic surgery. Conclusions The dynamic movement of the abdominal wall, the friction between tissue and mesh and the way of mesh application are crucial factors that have to be controlled for in simulation of ventral abdominal hernia closure. We could demonstrate that patient specific factors such as the frequency of coughing as well as the application technique influence the long term stability of the mesh.
Collapse
Affiliation(s)
- M Siassi
- Department of General Surgery, Asklepios Klinik Harburg, Eißendorfer Pferdeweg 52, 21075, Hamburg, Germany,
| | | | | | | | | | | | | |
Collapse
|
14
|
Abdalla RZ, Garcia RB, Said DF, Abdalla BMZ. Quality of life of in patients submitted to anterior abdominal wall laparoscopic hernioplasty. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2014; 27:30-3. [PMID: 24676295 PMCID: PMC4675490 DOI: 10.1590/s0102-67202014000100008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 12/17/2013] [Indexed: 08/30/2023]
Abstract
Background The laparoscopic ventral hernia repair technique made possible surgeries with
smaller skin incisions and smaller dissection of the soft tissue around the
hernia, therefore with a better wound, a quicker postoperative recovery and a
lower complication rate. Aim To evaluate the applicability of a quality of life survey based on the molds of
the American Hernia Society, European Hernia Society and Carolinas Equation for
Quality of Life, through telephone in patients submitted to laparoscopic
hernioplasty by IPOM technique. Methods A retrospective cohort study was made to evaluate the quality of life of 21
patients that underwent anterior abdominal wall laparoscopic hernioplasty by
intraperitoneal onlay mesh technique. Questionnaire was applied through
telephone. Results Of the 21 patients, 19% felt that the hernia recurred. Also 19% passed through
another abdominal wall surgery, and among these, 75% was related to the previously
hernia correction. Finally, 81% of patients did not undergo any other abdominal
wall surgery. Conclusion It was possible to apply the quality of life questionnary by telephone on patients
who underwent an anterior abdominal wall. The results, in its turn, were
satisfactory and showed that patients, in general, were satisfied with the
surgical procedure.
Collapse
|
15
|
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]
|
16
|
Adhesions to sutures, tackers, and glue for intraperitoneal mesh fixation: an experimental study. Hernia 2013; 18:865-72. [DOI: 10.1007/s10029-013-1192-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 11/07/2013] [Indexed: 10/26/2022]
|
17
|
Jamry A, Jałyński M, Piskorz Ł, Brocki M. Assessment of adhesion formation after laparoscopic intraperitoneal implantation of Dynamesh IPOM mesh. Arch Med Sci 2013; 9:487-92. [PMID: 23847671 PMCID: PMC3701981 DOI: 10.5114/aoms.2013.35345] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 07/18/2011] [Accepted: 09/26/2011] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Formation of adhesions after laparoscopic hernia repair using the intra-peritoneal onlay mesh (IPOM) procedure can lead to intestinal obstruction or mesh erosion into intestinal lumen. The aims of this study included: measurement of adhesion formation with Dynamesh IPOM after laparoscopic intraperitoneal implantation, and assessment of the occurrence of isolated adhesions at the fastening sites of slowly absorbable sutures. MATERIAL AND METHODS Twelve healthy pigs underwent laparoscopic implantation of 2 Dynamesh IPOM mesh fragments each, one was fastened with PDSII, and the other with Maxon sutures. An assessment of adhesion formation was carried out after 6 weeks and included an evaluation of surface area, hardness according to the Zhulke scale, and index values. The occurrence of isolated adhesions at slowly absorbable suture fixation points was also analyzed. RESULTS Adhesions were noted in 83.3% of Dynamesh IPOM meshes. Adhesions covered on average 37.7% of the mesh surface with mean hardness 1.46 and index value 78.8. In groups fixed with PDS in comparison to Maxon sutures adhesions covered mean 31.6% vs. 42.5% (p = 0.62) of the mesh surface, mean hardness was 1.67 vs.1.25 (p = 0.34) and index 85.42 vs. 72.02 (p = 0.95). CONCLUSIONS The Dynamesh IPOM mesh, in spite of its anti-adhesive layer of PVDF, does not prevent the formation of adhesions. Adhesion hardness, surface area, and index values of the Dynamesh IPOM mesh are close to the mean values of these parameters for other commercially available 2-layer meshes. Slowly absorbable sutures used for fastening did not increase the risk of adhesion formation.
Collapse
Affiliation(s)
| | - Marek Jałyński
- Surgery and Roentgenology Chair, Warmian-Masurian University, Olsztyn, Poland
| | - Łukasz Piskorz
- Department of Chest, General and Oncological Surgery, Medical University of Lodz, Poland
| | - Marian Brocki
- Department of Chest, General and Oncological Surgery, Medical University of Lodz, Poland
| |
Collapse
|
18
|
Ditzel M, Deerenberg EB, Grotenhuis N, Harlaar JJ, Monkhorst K, Bastiaansen-Jenniskens YM, Jeekel J, Lange JF. Biologic meshes are not superior to synthetic meshes in ventral hernia repair: an experimental study with long-term follow-up evaluation. Surg Endosc 2013; 27:3654-62. [DOI: 10.1007/s00464-013-2939-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 03/14/2013] [Indexed: 01/31/2023]
|
19
|
Fernandez-Gutierrez M, Olivares E, Pascual G, Bellon JM, Román JS. Low-density polypropylene meshes coated with resorbable and biocompatible hydrophilic polymers as controlled release agents of antibiotics. Acta Biomater 2013; 9:6006-18. [PMID: 23261925 DOI: 10.1016/j.actbio.2012.12.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 12/03/2012] [Accepted: 12/07/2012] [Indexed: 11/25/2022]
Abstract
The application of bioactive meshes in abdominal surgery for the repair of hernias is an increasing clinical activity in a wide sector of the population. The main secondary effect is the appearance of infections from bacteria, specifically Staphylococcus aureus and S. epidermidis. This paper describes the development and application of low-density polypropylene meshes coated with a biocompatible and resorbable polymer as a controlled release system of the antibiotic vancomycin. The polymeric coating (a non-cross-linked copolymer of 2-hydroxyethyl methacrylate and 2-acrylamido-2-methylpropanesulfonic acid) has a thickness of 14-15μm and contains 0.32mgcm(-2) of the antibiotic vancomycin. The in vitro experiments demonstrate the excellent inhibitory character of the coated meshes loaded with the antibiotic, following the standard protocol of inhibition of halo in agar diffusion test. This inhibitory effect is maintained for a relatively long period (at least 14days) with a low concentration of antibiotic. The acrylic polymer system regulates the release of the antibiotic with a rate of 24μgh(-1), due to its slow dissolution in the medium. Experiments in vivo, based on the implantation of coated meshes, demonstrate that the system controls the infection in the animal (rabbits) for at least 30days. The concentration of antibiotic in the blood stream of the rabbits was below the detection limit of the analytical technique (<1-2μgml(-1)), which demonstrates that the antibiotic is released in the local area of the implant and remains concentrated at the implantation site, without diffusion to the blood stream. The systems can be applied to other medical devices and implants for the application of new-generation antibiotics in a controlled release and targeted applications.
Collapse
|
20
|
Reynvoet E, Berrevoet F, De Somer F, Vercauteren G, Vanoverbeke I, Chiers K, Troisi R. Tensile strength testing for resorbable mesh fixation systems in laparoscopic ventral hernia repair. Surg Endosc 2012; 26:2513-20. [PMID: 22476828 DOI: 10.1007/s00464-012-2224-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Accepted: 02/17/2012] [Indexed: 01/05/2023]
Abstract
BACKGROUND In an attempt to improve patient outcome and quality of life after laparoscopic ventral hernia repair, resorbable fixation devices have been developed to allow adequate mesh fixation while minimizing accompanying side-effects as tack erosion and adhesion formation. MATERIALS AND METHODS In experimental set-up, 24 pigs were treated by laparoscopic mesh placement. Two different meshes (PP/ORC and PP/ePTFE) and four fixation devices were evaluated: a 6.4 mm poly(D,L: )-lactide pushpin (tack I), a 6.8 mm poly(D,L: )-lactide with blunt tip (tack II), a 4.1 mm poly(glycolide-co-L-lactide) (tack III) and one titanium tack (control tack). A first group of animals (n = 12) was euthanized after 2 weeks survival and a second group (n = 12) after 6 months. At euthanasia, a relaparoscopy was performed to assess adhesion formation followed by laparotomy with excision of the entire abdominal wall. Tensile strength of the individual fixation systems was tested with the use of a tensiometer by measuring the force to pull the tack out of the mesh. Additionally, the foreign body reaction to the fixation systems was evaluated histologically as was their potential degradation. RESULTS At 2 weeks the tensile strength was significantly higher for the control tack (31.98 N/cm²) compared to the resorbable devices. Except for tack II, the tensile strength was higher when the devices were fixed in a PP/ePTFE mesh compared to the PP/ORC mesh. After 6 months only tack III was completely resorbed, while tack I (9.292 N/cm²) had the lowest tensile strength. At this time-point similar tensile strength was observed for both tack II (29.56 N/cm²) and the control tack (27.77 N/cm²). Adhesions seem to be more depending on the type of mesh, in favor of PP/ePTFE. CONCLUSION At long term, the 4.1 mm poly(glycolide-co-L-lactide) tack was the only tack completely resorbed while the 6.8 mm poly(D,L: )-lactide tack with blunt tip reached equal strengths to the permanent tack.
Collapse
Affiliation(s)
- Emmelie Reynvoet
- Department of General and Hepatobiliary Surgery and Liver Transplantation Service, Ghent University Hospital and Medical School, De Pintelaan 185, 2K12-IC, 9000 Ghent, Belgium.
| | | | | | | | | | | | | |
Collapse
|
21
|
Prasad P, Tantia O, Patle NM, Khanna S, Sen B. Laparoscopic Ventral Hernia Repair: A Comparative Study of Transabdominal Preperitoneal Versus Intraperitoneal Onlay Mesh Repair. J Laparoendosc Adv Surg Tech A 2011; 21:477-83. [DOI: 10.1089/lap.2010.0572] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Parmanand Prasad
- Department of Minimal Access and Bariatric Surgery, ILS Hospital, Kolkata, India
| | - Om Tantia
- Department of Minimal Access and Bariatric Surgery, ILS Hospital, Kolkata, India
| | - Nirmal M. Patle
- Department of Minimal Access and Bariatric Surgery, ILS Hospital, Kolkata, India
| | - Shashi Khanna
- Department of Minimal Access and Bariatric Surgery, ILS Hospital, Kolkata, India
| | - Bimalendu Sen
- Department of Minimal Access and Bariatric Surgery, ILS Hospital, Kolkata, India
| |
Collapse
|
22
|
Impact of pressure and gas type on adhesion formation and biomaterial integration in laparoscopy. Surg Endosc 2011; 25:3605-12. [PMID: 21643882 DOI: 10.1007/s00464-011-1766-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Accepted: 04/18/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Laparoscopic mesh repair of inguinal and incisional hernias has been widely adopted. Nevertheless, knowledge about the impact of pneumoperitoneum on mesh integration is rare. The present study investigates pressure and gas-dependent effects of pneumoperitoneum on adhesion formation and biomaterial integration in a standardized animal model. METHODS Laparoscopic intraperitoneal onlay mesh implantation (IPOM) was performed in 32 female chinchilla rabbits using CO(2) or helium for pneumoperitoneum. Intra-abdominal pressures were 3 or 6 mmHg. Animals were killed after 21 days, and the abdominal wall was explanted for subsequent histopathological examinations. Adhesions were assessed qualitatively with a scoring system, and the adhesion surface was analyzed semiquantitatively by planimetry. Infiltration of macrophages (CD68), expression of matrix metalloproteinase 13 (MMP-13), and cell proliferation (Ki67) were analyzed at the mesh to host interface by immunohistochemistry. The collagen type I/III ratio was analyzed by cross-polarization microscopy to determine the quality of mesh integration. RESULTS After 21 days, perifilamental infiltration with macrophages (CD68) and percentage of proliferating cells (Ki67) were highest after 6 mmHg of CO(2) pneumoperitoneum. The extent of adhesions, as well as the expression of MMP-13 and the collagen type I/III ratio, were similar between groups. CONCLUSIONS Our experiments showed no pressure or gas-dependent alterations of adhesion formation and only minor effects on biomaterial integration. Altogether, there is no evidence for a clinically negative effect of CO(2) pneumoperitoneum.
Collapse
|
23
|
Evaluation of absorbable and permanent mesh fixation devices: adhesion formation and mechanical strength. Hernia 2011; 15:553-8. [PMID: 21594698 DOI: 10.1007/s10029-011-0826-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 04/22/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE Laparoscopic ventral hernia repair is commonly performed with mesh prostheses; however, there is no standard for fixation devices used to secure mesh to the abdominal wall. This study is a functional comparison of novel, screw-type absorbable and permanent fixation devices with a traditional titanium fixation device. METHODS Fifteen pigs each underwent the laparoscopic placement of two 11 × 14-cm mesh prostheses and were randomized for mesh fixation with either titanium spiral tacks (TS), absorbable screw-type fasteners (SF), or permanent screw-type fasteners (PF) (n = 10 mesh prostheses for each fixation group). Adhesions were assessed laparoscopically at 4 weeks. The fixation devices were also embedded in porcine abdominal rectus muscle for ex vivo mechanical testing along with partial thickness polypropylene suture (PR) as a control group (n = 40 for each group). Maximum pull-off forces were measured. All statistical tests were two-tailed, and a P-value < 0.05 was considered to be significant. RESULTS The mean tenacity adhesion scores were 1.40 ± 0.52 (PF), 1.7 ± 0.82 (SF), and 2.6 ± 1.07 (TS). Adhesions in the PF group were significantly less tenacious compared with the TS group (P = 0.01). Quantitative adhesion scores were not significantly different among groups. The maximum pull-off forces, measured in Newtons, were 28.61 N ± 4.89 N (TS), 22.71 N ± 7.86 N (SF), 16.98 N ± 7.59 N (PF), and 20.83 N ± 6.25 N (PR). The pull-off force in the TS group was higher than all of the other groups (P < 0.001). The SF group also had a higher pull-off force compared with the PF group (P < 0.001). CONCLUSIONS The screw-type absorbable and permanent fixation devices provided adequate fixation and were associated with decreased adhesions in this porcine model.
Collapse
|
24
|
Shrinkage of intraperitoneal onlay mesh in sheep: coated polyester mesh versus covered polypropylene mesh. Hernia 2010; 14:611-5. [DOI: 10.1007/s10029-010-0682-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2010] [Accepted: 05/15/2010] [Indexed: 12/29/2022]
|
25
|
Functional cine MRI and transabdominal ultrasonography for the assessment of adhesions to implanted synthetic mesh 5-7 years after laparoscopic ventral hernia repair. Hernia 2010; 14:499-504. [PMID: 20490585 DOI: 10.1007/s10029-010-0676-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Accepted: 05/02/2010] [Indexed: 12/25/2022]
Abstract
BACKGROUND Laparoscopic ventral hernia repair (LVHR) has gained worldwide acceptance, due to its minimally invasive character, feasibility and low rate of complications. Animal experiments have shown marked adhesions to the intraperitoneal mesh (IPM), the clinical consequences being unclear. This study aimed to describe the extension of adhesions to the mesh, 5-7 years after LVHR, using two validated non-invasive radiologic methods. METHODS Real-time transabdominal ultrasonography (TAU) and cine magnetic resonance imaging (MRI) was applied to 30 patients with prior LVHR and implantation of IPM (Intramesh W3, Cousin Biotech, France). The visceral slide was measured in nine predefined abdominal segments. Values <or=1 cm were defined as an area with adhesion. RESULTS The mean time between LVHR and TAU/cine MRI was 67 months (range, 58-80 months). We found adhesion to the mesh in 90% of the patients using TAU and 100% of the patients using cine MRI. In the latter, 65% were between the bowel and IPM. CONCLUSIONS LVHR is known to reduce recurrences and postoperative complications, while improving patient outcome. The intraperitoneal placement of the mesh has been shown to induce adhesions; the amount and extension in the clinical setting is unclear. The present study showed a marked proportion of adhesions to the mesh with an average surgery to scan time of 5.6 years, despite an anti-adhesive barrier on the visceral surface of the mesh. Together with existing data, this result increases the concern related to the long-term consequences of an IPM. As a consequence, a comprehensive and comparable test system for medical devices, i.e. IPM, is needed.
Collapse
|