1
|
Saiding Q, Chen Y, Wang J, Pereira CL, Sarmento B, Cui W, Chen X. Abdominal wall hernia repair: from prosthetic meshes to smart materials. Mater Today Bio 2023; 21:100691. [PMID: 37455815 PMCID: PMC10339210 DOI: 10.1016/j.mtbio.2023.100691] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/15/2023] [Accepted: 06/03/2023] [Indexed: 07/18/2023] Open
Abstract
Hernia reconstruction is one of the most frequently practiced surgical procedures worldwide. Plastic surgery plays a pivotal role in reestablishing desired abdominal wall structure and function without the drawbacks traditionally associated with general surgery as excessive tension, postoperative pain, poor repair outcomes, and frequent recurrence. Surgical meshes have been the preferential choice for abdominal wall hernia repair to achieve the physical integrity and equivalent components of musculofascial layers. Despite the relevant progress in recent years, there are still unsolved challenges in surgical mesh design and complication settlement. This review provides a systemic summary of the hernia surgical mesh development deeply related to abdominal wall hernia pathology and classification. Commercial meshes, the first-generation prosthetic materials, and the most commonly used repair materials in the clinic are described in detail, addressing constrain side effects and rational strategies to establish characteristics of ideal hernia repair meshes. The engineered prosthetics are defined as a transit to the biomimetic smart hernia repair scaffolds with specific advantages and disadvantages, including hydrogel scaffolds, electrospinning membranes, and three-dimensional patches. Lastly, this review critically outlines the future research direction for successful hernia repair solutions by combing state-of-the-art techniques and materials.
Collapse
Affiliation(s)
- Qimanguli Saiding
- Shanghai Key Laboratory of Embryo Original Diseases, The International Peace Maternal and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, 910 Hengshan Road, Shanghai, 200030, PR China
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, PR China
| | - Yiyao Chen
- Shanghai Key Laboratory of Embryo Original Diseases, The International Peace Maternal and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, 910 Hengshan Road, Shanghai, 200030, PR China
| | - Juan Wang
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, PR China
| | - Catarina Leite Pereira
- I3S – Instituto de Investigação e Inovação Em Saúde and INEB – Instituto de Engenharia Biomédica, Universidade Do Porto, Rua Alfredo Allen 208, 4200-135, Porto, Portugal
| | - Bruno Sarmento
- I3S – Instituto de Investigação e Inovação Em Saúde and INEB – Instituto de Engenharia Biomédica, Universidade Do Porto, Rua Alfredo Allen 208, 4200-135, Porto, Portugal
- IUCS – Instituto Universitário de Ciências da Saúde, CESPU, Rua Central de Gandra 1317, 4585-116, Gandra, Portugal
| | - Wenguo Cui
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, PR China
| | - Xinliang Chen
- Shanghai Key Laboratory of Embryo Original Diseases, The International Peace Maternal and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, 910 Hengshan Road, Shanghai, 200030, PR China
| |
Collapse
|
2
|
Belousov AM, Armashov VP, Shkarupa DD, Anushchenko TY, Filipenko TS, Zhukovskiy VA, Matveev NL. [Safety of mesh with fluoropolymer coating during intra-abdominal placement in large animals: results of the pilot study]. Khirurgiia (Mosk) 2023:43-58. [PMID: 36748870 DOI: 10.17116/hirurgia202302143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE When performing laparoscopic intraperitoneal hernioplasty (IPOM), endoprostheses made of fluoropolymers are often used. However, there is no data in the literature on the intra-abdominal use of inexpensive polyester prostheses with a fluoropolymer coating compared to composite implants. Thus, the aim of the pilot study was a preliminary assessment of the safety profile of FTOREX mesh endoprostheses during intra-abdominal placement in large animals. MATERIAL AND METHODS 6 endoprostheses were installed laparoscopically intraperitoneally in each of the 3 pigs: 1) FTOREX; 2) FTOREX with a layer of carboxymethylcellulose; 3) REPEREN-16-2; 4) SYMBOTEX; 5) VENTRALIGHT ST; 6) decellularized pork peritoneum. Fixation was performed with a herniator, transfascial sutures were not used. Relaparoscopy was performed after 45 days, and withdrawal from the experiment was performed after 90 days. Performance characteristics, signs of deformation and retraction, parameters of spike formation were evaluated. RESULTS All the animals survived, no complications were observed. There were no clinical manifestations or behavioral reactions indicating the presence of adhesions. The most convenient to use were the SYMBOTEX and FTOREX implants (5.0 points each). By the end of the experiment, deformation and retraction were noted in both variants of the FTOREX implants and the REPEREN prosthesis. These changes were completely absent only when using the SYMBOTEX endoprosthesis. According to the number of implants with adhesions, by the end of the observation, both variants of FTOREX prostheses occupied an intermediate position between the Reference (the worst indicator) and VENTRALIGHT ST (the best indicator). However, both FTOREX endoprostheses showed the best performance among all implants in the integral assessment of adhesions, as well as in terms of parameters such as the area and appearance of adhesions, and in terms of the strength of the joints, they were second only to the VENTRALIGHT ST endoprosthesis (0.67 vs. 0.5 points). During the study, there was no reliable dependence of deformation, retraction and adhesion formation indicators on the type of implant. CONCLUSION The results of the pilot study showed that all the implants used did not cause any clinically significant adverse reactions or complications. FTOREX endoprostheses with their intraperitoneal installation have anti-adhesive properties that are not inferior to VENTRALIGHT ST or SYMBOTEX composite implants. However, having less rigidity, they are more often deformed and subjected to retraction.
Collapse
Affiliation(s)
- A M Belousov
- St. Petersburg University's, St. Petersburg, Russia
| | - V P Armashov
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - D D Shkarupa
- St. Petersburg University's, St. Petersburg, Russia
| | | | | | | | - N L Matveev
- Pirogov Russian National Research Medical University, Moscow, Russia
| |
Collapse
|
3
|
Biomimetic Approach to Designing Adhesive Hydrogels: From Chemistry to Application. SPRINGER SERIES IN BIOMATERIALS SCIENCE AND ENGINEERING 2016. [DOI: 10.1007/978-3-319-22861-7_15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
4
|
Gigliobianco G, Roman Regueros S, Osman NI, Bissoli J, Bullock AJ, Chapple CR, MacNeil S. Biomaterials for pelvic floor reconstructive surgery: how can we do better? BIOMED RESEARCH INTERNATIONAL 2015; 2015:968087. [PMID: 25977927 PMCID: PMC4419215 DOI: 10.1155/2015/968087] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 08/19/2014] [Indexed: 12/21/2022]
Abstract
Stress urinary incontinence (SUI) and pelvic organ prolapse (POP) are major health issues that detrimentally impact the quality of life of millions of women worldwide. Surgical repair is an effective and durable treatment for both conditions. Over the past two decades there has been a trend to enforce or reinforce repairs with synthetic and biological materials. The determinants of surgical outcome are many, encompassing the physical and mechanical properties of the material used, and individual immune responses, as well surgical and constitutional factors. Of the current biomaterials in use none represents an ideal. Biomaterials that induce limited inflammatory response followed by constructive remodelling appear to have more long term success than biomaterials that induce chronic inflammation, fibrosis and encapsulation. In this review we draw upon published animal and human studies to characterize the changes biomaterials undergo after implantation and the typical host responses, placing these in the context of clinical outcomes.
Collapse
Affiliation(s)
| | | | - Nadir I. Osman
- Material Science Engineering, University of Sheffield, Sheffield S1 3JD, UK
- Royal Hallamshire Hospital, Sheffield S10 2JF, UK
| | - Julio Bissoli
- Hospital das Clínicas da Faculdade de Medicina, Universidade de Sao Paulo, 05410-020 São Paulo, Brazil
| | - Anthony J. Bullock
- Material Science Engineering, University of Sheffield, Sheffield S1 3JD, UK
| | | | - Sheila MacNeil
- Material Science Engineering, University of Sheffield, Sheffield S1 3JD, UK
| |
Collapse
|
5
|
Reply to Letter: "Biologic Mesh: Cautious Optimism Is Key". Ann Surg 2015; 263:e43. [PMID: 25876010 DOI: 10.1097/sla.0000000000001231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
6
|
Müller-Stich BP, Senft JD, Lasitschka F, Shevchenko M, Billeter AT, Bruckner T, Kenngott HG, Fischer L, Gehrig T. Polypropylene, polyester or polytetrafluoroethylene-is there an ideal material for mesh augmentation at the esophageal hiatus? Results from an experimental study in a porcine model. Hernia 2014; 18:873-81. [PMID: 25159558 DOI: 10.1007/s10029-014-1305-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 08/14/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE Knowledge about the influence of underlying biomaterial on behavior of surgical meshes at the esophageal hiatus is rare, but essential for safe and effective hiatal hernia surgery. This study aimed to characterize the influence of polymer material on mesh behavior at the hiatus. METHODS 24 pigs in three groups of eight underwent implantation of either polypropylene (PP), polyester (PET) or polytetrafluoroethylene (PTFE) mesh placed circularly at the esophageal hiatus. After 8 weeks, necropsy and measurements were performed evaluating mesh deformation, adhesion formation, fixation of the esophagogastric junction and mesh position. Foreign body reaction was assessed by mononuclear cell count and immunostaining of Ki-67. Tissue integration was evaluated by immunostaining of type I and type III collagen fibers. RESULTS Mesh shrinkage was the highest for PTFE, lower for PP and the lowest for PET (34.9 vs. 19.8 vs. 12.1 %; p = 0.002). Mesh aperture for the esophagus showed an enlargement within all groups, which was highest for PTFE compared to PP and PET (100.8 vs. 47.0 vs. 35.9 %; p = 0.001). The adhesion score was highest for PP, lower for PTFE and the lowest for PET (11.0 vs. 9.5 vs. 5.0; p = 0.001) and correlated positively with the score of esophagogastric fixation (r s = 0.784, p < 0.001). No mesh migration, erosion or stenosis of the esophagus occurred. Evaluation of foreign body reaction and tissue integration showed no significant differences. CONCLUSIONS In this experimental setting, PP-meshes showed the most appropriate characteristics for augmentation at the hiatus. Due to solid fixation of the esophagogastric junction and low shrinkage tendency, PP-meshes may be effective in preventing hiatal hernia recurrence. The use of PTFE-mesh at the hiatus may be disadvantageous due to high shrinkage rates and correlating enlargement of the aperture for the esophagus.
Collapse
Affiliation(s)
- B P Müller-Stich
- Department of General, Abdominal and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany,
| | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Pascual G, Rodríguez M, Sotomayor S, Moraleda E, Bellón JM. Effects of collagen prosthesis cross-linking on long-term tissue regeneration following the repair of an abdominal wall defect. Wound Repair Regen 2012; 20:402-13. [PMID: 22564232 DOI: 10.1111/j.1524-475x.2012.00781.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Collagen prostheses used to repair abdominal wall defects, depending on their pretreatment (noncross-linked vs. cross-linked), besides repair may also achieve tissue regeneration. We assessed the host tissue incorporation of different bioprostheses using a new tool that combines immunofluorescence confocal microscopy with differential interference contrast images, making it possible to distinguish newly formed collagen. Partial hernial defects in the abdominal wall of rabbits were repaired using cross-linked/noncross-linked bioprostheses. Expanded polytetrafluoroethylene (ePTFE) was used as control. After 14/30/90/180 days of implant, specimens were taken for microscopy, immunohistochemistry, and quantitative-reverse transcription-polymerase chain reaction to determine host tissue ingrowth and collagen I/III protein and 1a1/3a1 gene expression. Shrinkage and stress resistance were also examined. At 14 days, cross-linked prostheses had suffered significantly less shrinkage than ePTFE or noncross-linked prostheses. Significantly higher shrinkage was recorded for ePTFE in the longer term. Microscopy revealed encapsulation of ePTFE by neoformed tissue, while the bioprostheses became gradually infiltrated by host tissue. Noncross-linked prosthesis showed better tissue ingrowth, more intense inflammatory reaction and more rapid degradation than the cross-linked prostheses. At 14 days, cross-linked prostheses induced up-regulated collagen 1a1 and 3a1 gene expression, while noncross-linked only showed increased collagen III protein expression at 90 days postimplant. At 6 months, the tensile strengths of cross-linked prostheses were significantly greater compared with ePTFE. Our findings demonstrate that despite the cross-linked collagen prostheses promoting less tissue ingrowth than the noncross-linked meshes, they became gradually replaced by good quality host tissue and were less rapidly degraded, leading to improved stress resistance in the long term.
Collapse
Affiliation(s)
- Gemma Pascual
- Department of Medical Specialities, University of Alcala, Madrid, Spain
| | | | | | | | | |
Collapse
|
8
|
Prefabrication of axial vascularized tissue engineering coral bone by an arteriovenous loop: a better model. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2012; 32:1536-41. [PMID: 24364957 DOI: 10.1016/j.msec.2012.04.039] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Revised: 02/12/2012] [Accepted: 04/20/2012] [Indexed: 11/23/2022]
Abstract
The most important problem for the survival of thick 3-dimensional tissues is the lack of vascularization in the context of bone tissue engineering. In this study, a modified arteriovenous loop (AVL) was developed to prefabricate an axial vascularized tissue engineering coral bone in rabbit, with comparison of the arteriovenous bundle (AVB) model. An arteriovenous fistula between rabbit femoral artery and vein was anastomosed to form an AVL. It was placed in a circular side groove of the coral block. The complex was wrapped with an expanded-polytetrafluoroethylene membrane and implanted beneath inguinal skin. After 2, 4, 6 and 8 weeks, the degree of vascularization was evaluated by India ink perfusion, histological examination, vascular casts, and scanning electron microscopy images of vascular endangium. Newly formed fibrous tissues and vasculature extended over the surfaces and invaded the interspaces of entire coral block. The new blood vessels robustly sprouted from the AVL. Those invaginated cavities in the vascular endangium from scanning electron microscopy indicated vessel's sprouted pores. Above indexes in AVL model are all superior to that in AVB model, indicating that the modified AVL model could more effectively develop vascularization in larger tissue engineering bone.
Collapse
|
9
|
Comparative analysis of histopathologic effects of synthetic meshes based on material, weight, and pore size in mice. J Surg Res 2011; 176:423-9. [PMID: 22099590 DOI: 10.1016/j.jss.2011.09.031] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2011] [Revised: 08/16/2011] [Accepted: 09/15/2011] [Indexed: 12/31/2022]
Abstract
BACKGROUND While synthetic prosthetics have essentially become mandatory for hernia repair, mesh-induced chronic inflammation and scarring can lead to chronic pain and limited mobility. Mesh propensity to induce such adverse effects is likely related to the prosthetic's material, weight, and/or pore size. We aimed to compare histopathologic responses to various synthetic meshes after short- and long-term implantations in mice. MATERIAL AND METHODS Samples of macroporous polyester (Parietex [PX]), heavyweight microporous polypropylene (Trelex[TX]), midweight microporous polypropylene (ProLite[PL]), lightweight macroporous polypropylene (Ultrapro[UP]), and expanded polytetrafluoroethylene (DualMesh[DM]) were implanted subcutaneously in mice. Four and 12 wk post-implantation, meshes were assessed for inflammation, foreign body reaction (FBR), and fibrosis. RESULTS All meshes induced varying levels of inflammatory responses. PX induced the greatest inflammatory response and marked FBR. DM induced moderate FBR and a strong fibrotic response with mesh encapsulation at 12 wk. UP and PL had the lowest FBR, however, UP induced a significant chronic inflammatory response. Although inflammation decreased slightly for TX, marked FBR was present throughout the study. Of the three polypropylene meshes, fibrosis was greatest for TX and slightly reduced for PL and UP. For UP and PL, there was limited fibrosis within each mesh pore. CONCLUSION Polyester mesh induced the greatest FBR and lasting chronic inflammatory response. Likewise, marked fibrosis and encapsulation was seen surrounding ePTFE. Heavier polypropylene meshes displayed greater early and persistent fibrosis; the reduced-weight polypropylene meshes were associated with the least amount of fibrosis. Mesh pore size was inversely proportional to bridging fibrosis. Moreover, reduced-weight polypropylene meshes demonstrated the smallest FBR throughout the study. Overall, we demonstrated that macroporous, reduced-weight polypropylene mesh exhibited the highest degree of biocompatibility at sites of mesh implantation.
Collapse
|
10
|
Bellón JM, Rodríguez M, Gómez-Gil V, Sotomayor S, Buján J, Pascual G. Postimplant intraperitoneal behavior of collagen-based meshes followed by laparoscopy. Surg Endosc 2011; 26:27-35. [DOI: 10.1007/s00464-011-1823-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Accepted: 06/09/2011] [Indexed: 10/18/2022]
|
11
|
Abstract
OBJECTIVE To review mesh products currently available for ventral hernia repair and to evaluate their efficacy in complex repair, including contaminated and reoperative fields. BACKGROUND Although commonly referenced, the concept of the ideal prosthetic has never been fully realized. With the development of newer prosthetics and approaches to the ventral hernia repair, many surgeons do not fully understand the properties of the available prosthetics or the circumstances that warrant the use of a specific mesh. METHODS A systematic review of published literature from 1951 to June of 2009 was conducted to identify articles relating to ventral hernia repairs and the use of prosthetics in herniorrhaphy. RESULTS Important differences exist between the synthetics, composites, and biologic prosthetics used for ventral hernia repair in terms of mechanics, cost, and the ideal situation in which each should be used. CONCLUSIONS The use of synthetic mesh remains an appropriate solution for most ventral hernia repairs. Laparoscopic ventral hernia repair has created a niche for both expanded polytetrafluoroethylene and composite mesh, as they are suited to intraperitoneal placement. Preliminary studies have demonstrated that the newer biologic prosthetics are reasonable options for hernia repair in contaminated fields and for large abdominal wall defects; however, more studies need to be done before advocating the use of these biologics in other settings.
Collapse
|
12
|
Harth KC, Broome AM, Jacobs MR, Blatnik JA, Zeinali F, Bajaksouzian S, Rosen MJ. Bacterial clearance of biologic grafts used in hernia repair: an experimental study. Surg Endosc 2011; 25:2224-9. [PMID: 21298542 DOI: 10.1007/s00464-010-1534-8] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2010] [Accepted: 10/05/2010] [Indexed: 11/24/2022]
Abstract
BACKGROUND Biologic grafts used in ventral hernia repair are derived from various sources and undergo different post-tissue-harvesting processing, handling, and sterilization techniques. It is unclear how these various characteristics impact graft response in the setting of contamination. We evaluated four materials in an infected hernia repair animal model using fluorescence imaging and quantitative culture studies. METHODS One hundred seven rats underwent creation of a chronic hernia. They were then repaired with one synthetic polyester control material (n = 12) and four different biologic grafts (n = 24 per material). Biologic grafts evaluated included Surgisis (porcine small intestinal submucosa), Permacol (crosslinked porcine dermis), Xenmatrix (noncrosslinked porcine dermis), and Strattice (noncrosslinked porcine dermis). Half of the repairs in each group were inoculated with Staphylococcus aureus at 10(4) CFU/ml and survived for 30 days without systemic antibiotics. Animals then underwent fluorescence imaging and quantitative bacterial studies. RESULTS All clean repairs remained sterile. Rates of bacterial clearance were as follows: polyester synthetic 0%, Surgisis 58%, Permacol 67%, Xenmatrix 75%, and Strattice 92% (P=0.003). Quantitative bacterial counts had a similar trend in bacterial clearance: polyester synthetic 1×10(6) CFU/g, Surgisis 4.3×10(5) CFU/g, Permacol 1.7×10(3) CFU/g, Xenmatrix 46 CFU/g, and Strattice 31 CFU/g (P=0.001). Fluorescence imaging was unable to detect low bacterial fluorescence counts observed on bacterial studies. CONCLUSION Biologic grafts, in comparison to synthetic material, are able to clear a Staphylococcus aureus contamination; however, they are able to do so at different rates. Bacterial clearance correlated to the level of residual bacterial burden observed in our study. Post-tissue-harvesting processing, handling, and sterilization techniques may contribute to this observed difference in ability to clear bacteria.
Collapse
Affiliation(s)
- K C Harth
- Department of Surgery, University Hospitals Case Medical Center, and Department of Biomedical Engineering, Case Western Reserve School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106-5047, USA
| | | | | | | | | | | | | |
Collapse
|
13
|
Petter-Puchner AH, Fortelny RH, Mika K, Hennerbichler S, Redl H, Gabriel C. Human vital amniotic membrane reduces adhesions in experimental intraperitoneal onlay mesh repair. Surg Endosc 2010; 25:2125-31. [DOI: 10.1007/s00464-010-1507-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Accepted: 11/12/2010] [Indexed: 11/30/2022]
|
14
|
Murphy JL, Vollenweider L, Xu F, Lee BP. Adhesive performance of biomimetic adhesive-coated biologic scaffolds. Biomacromolecules 2010; 11:2976-84. [PMID: 20919699 DOI: 10.1021/bm1007794] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Surgical repair of a discontinuity in traumatized or degenerated soft tissues is traditionally accomplished using sutures. A current trend is to reinforce this primary repair with surgical grafts, meshes, or patches secured with perforating mechanical devices (i.e., sutures, staples, or tacks). These fixation methods frequently lead to chronic pain and mesh detachment. We developed a series of biodegradable adhesive polymers that are synthetic mimics of mussel adhesive proteins (MAPs), composed of 3,4-dihydroxyphenylalanine (DOPA)-derivatives, polyethylene glycol (PEG), and polycaprolactone (PCL). These polymers can be cast into films, and their mechanical properties, extent of swelling, and degradation rate can be tailored through the composition of the polymers as well as blending with additives. When coated onto a biologic mesh used for hernia repair, these adhesive constructs demonstrated adhesive strengths significantly higher than fibrin glue. With further development, a precoated bioadhesive mesh may represent a new surgical option for soft tissue repair.
Collapse
Affiliation(s)
- John L Murphy
- Nerites Corporation, Madison, Wisconsin 53719, United States
| | | | | | | |
Collapse
|
15
|
Use of porcine small intestine submucosa as a prosthetic material for laparoscopic hernia repair in infected and potentially contaminated fields: long-term follow-up assessment. Surg Endosc 2010; 25:1693-4. [DOI: 10.1007/s00464-010-1282-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
16
|
Fortelny RH, Petter-Puchner AH, Glaser KS, Offner F, Benesch T, Rohr M. Adverse effects of polyvinylidene fluoride-coated polypropylene mesh used for laparoscopic intraperitoneal onlay repair of incisional hernia. Br J Surg 2010; 97:1140-5. [PMID: 20632284 DOI: 10.1002/bjs.7082] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Polyvinylidene fluoride-coated polypropylene meshes have been developed specifically for intraperitoneal onlay mesh repair. They combine a macroporous design with biomechanical characteristics compatible with the abdominal wall and are reported to have favourable antiadhesive properties. This retrospective study reports complications related to one of these materials, DynaMesh. METHODS Twenty-nine patients underwent intraperitoneal onlay mesh repair with DynaMesh at one of two hospitals. Patients characteristics, surgical procedures and postoperative analgesia were comparable at both sites. RESULTS Six patients developed DynaMesh-related complications that required surgical reintervention by laparotomy within 1 year of operation. Surgical reintervention was for adhesions in five patients and the mesh had to be explanted in three. One mesh was explanted because of early infection. Adhesions to DynaMesh were found in two patients who had surgery for unrelated reasons. CONCLUSION Laparoscopic intraperitoneal onlay DynaMesh repair was associated with a high rate of complications.
Collapse
Affiliation(s)
- R H Fortelny
- Second Department of Surgery, Wilhelminenspital, Vienna, Austria
| | | | | | | | | | | |
Collapse
|
17
|
Small Intestine Submucosa (SIS) Implants in Experimental IPOM Repair. J Surg Res 2010; 161:264-71. [DOI: 10.1016/j.jss.2009.04.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2008] [Revised: 03/30/2009] [Accepted: 04/03/2009] [Indexed: 11/22/2022]
|
18
|
Moreira Lemos NLDB, Kamergorodsky G, Antunes Faria AL, Ayroza Galvão Ribeiro PA, Flores Auge AP, Aoki T. Small Intestinal Submucosa Patch for Extensive Vaginal Endometriosis Resection. J Minim Invasive Gynecol 2009; 16:765-7. [DOI: 10.1016/j.jmig.2009.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2009] [Revised: 07/06/2009] [Accepted: 07/11/2009] [Indexed: 10/20/2022]
|
19
|
Jin J, Voskerician G, Hunter SA, McGee MF, Cavazzola LT, Schomisch S, Harth K, Rosen MJ. Human Peritoneal Membrane Controls Adhesion Formation and Host Tissue Response Following Intra-Abdominal Placement in a Porcine Model. J Surg Res 2009; 156:297-304. [DOI: 10.1016/j.jss.2009.04.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2009] [Revised: 03/18/2009] [Accepted: 04/01/2009] [Indexed: 11/25/2022]
|
20
|
Ansaloni L, Catena F, Coccolini F, Fini M, Gazzotti F, Giardino R, Pinna AD. Peritoneal adhesions to prosthetic materials: an experimental comparative study of treated and untreated polypropylene meshes placed in the abdominal cavity. J Laparoendosc Adv Surg Tech A 2009; 19:369-74. [PMID: 19405799 DOI: 10.1089/lap.2008.0366] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Frequently, hernia repair requires polypropylene (PP) meshes, which carry a well-known adhesiogenic risk when placed in contact to the intestine. The aim of this experimental study in a rat model was to assess the role of some materials, when combined with PP, in preventing the adhesions' formation. MATERIALS AND METHODS Sixty male Sprague-Dawley rats were assigned to five groups for intraperitoneal mesh placement: untreated PP, PP+polyurethane (PP+PU), PP+Surgisis (PP+SIS), PP+expanded polytetrafluoroethylene (PP+ePTFE), and a control group without mesh. Twenty-one days and 3 and 6 months after the operation, an assessment of adhesion formation was performed, scoring adhesions in terms of extent and type and the adhesion index (AI; product of adhesions' extent and type). RESULTS No significant difference was seen between PP+SIS, PP+PU, and control groups in adhesions extent/quality and in AI. The PP+SIS group had significantly lower adhesions' quality value and AI than PP+ePTFE. PP+PU had significantly lower adhesions' extent/quality value and AI than PP+ePTFE. The control group had adhesions with significantly lower extent/quality and AI than PP+ePTFE. The PP group had significantly more and denser adhesions, compared to PP+ePTFE, as well as a significantly higher AI. CONCLUSIONS Adhesions' incidence is reduced by using treated PP meshes. PP+PU and PP+SIS were superior to PP+ePTFE in adhesion prevention.
Collapse
Affiliation(s)
- Luca Ansaloni
- Unit of General, Emergency, and Transplant Surgery, St. Orsola-Malpighi University Hospital, Bologna, Italy.
| | | | | | | | | | | | | |
Collapse
|
21
|
Szmulowicz UM, Hull TL. The Role of Biological Implants in the Repair and Prevention of Parastomal Hernia. SEMINARS IN COLON AND RECTAL SURGERY 2009. [DOI: 10.1053/j.scrs.2009.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
22
|
Petter-Puchner AH, Fortelny RH. Use of porcine small intestine submucosa as a prosthetic material for laparoscopic hernia repair in infected and potentially contaminated fields: long-term follow up assessment; Surg Endosc (2008) 22: 1941-1946. Surg Endosc 2009; 24:230-1. [PMID: 19633888 DOI: 10.1007/s00464-009-0631-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2009] [Accepted: 04/28/2009] [Indexed: 10/20/2022]
|
23
|
Voskerician G, Jin J, Hunter SA, Williams CP, White M, Rosen MJ. Human peritoneal membrane reduces the formation of intra-abdominal adhesions in ventral hernia repair: experimental study in a chronic hernia rat model. J Surg Res 2009; 157:108-14. [PMID: 19631344 DOI: 10.1016/j.jss.2009.03.055] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2009] [Revised: 02/24/2009] [Accepted: 03/22/2009] [Indexed: 01/05/2023]
Abstract
BACKGROUND Adhesions leading to intestinal obstructions and fistulae are severe complications related to the intraperitoneal placement of synthetic meshes. This study evaluated the efficacy of human peritoneal membrane (HPM) in a chronic hernia repair rat model as an anti-adhesive solution for preventing the development of intra-abdominal adhesions. MATERIALS AND METHODS The mechanical properties of HPM and human fascia lata (HFL) were evaluated prior to in vivo implantation. Twenty rats underwent midline laparotomy, which led to the development of chronic hernias 28 d later. Then, animals underwent incisional hernia repair in an underlay fashion (n=5/mesh group) with compressed poly(tetra-fluoro-ethylene) (cPTFE), onto which HPM or HFL were affixed pre-repair, along with two additional controls. The extent and tenacity of intra-abdominal adhesions were determined through qualitative gross evaluations and quantitative tensiometry at 30 d post-repair. The host tissue response was evaluated histologically. RESULTS In hydrated state, the elastic properties of HPM were superior to HFL. Repairs with HPM had significantly less surface area covered by adhesions, with significantly lower tenacity compared with all other groups. Furthermore, intra-abdominal adhesions developed in the presence of HPM were associated with omentum only, and were distributed around the perimeter of the exposed cPTFE. HPM served as an active tissue remodeling template, replacing the traditional foreign body encapsulation with an anatomically and physiologically superior outcome. CONCLUSIONS HPM significantly reduces the extent and tenacity of intra-abdominal adhesion formation, and represents a bioprosthetic template that encourages structural and functional neo peritonealization.
Collapse
|
24
|
Falco EE, Roth JS, Fisher JP. Skeletal muscle tissue engineering approaches to abdominal wall hernia repair. ACTA ACUST UNITED AC 2009; 84:315-21. [PMID: 19067424 DOI: 10.1002/bdrc.20134] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Abdominal wall hernias resulting from prior incisions are a common surgical complication affecting hundreds of thousands of Americans each year. The negative consequences associated with abdominal hernias may be considerable, including pain, bowel incarceration, vascular disruption, organ loss, and death. Current clinical approaches for the treatment of abdominal wall hernias focus on the implantation of permanent biomaterial meshes or acellular xenografts. However, these approaches are not infrequently associated with postoperative infections, chronic sinuses, or small bowel obstruction. Furthermore, the most critical complication, hernia recurrence, has been well described and may occur in a large percentage of patients. Despite many advances in repair techniques, wound healing and skeletal muscle regeneration is limited in many cases, resulting in a decrease in abdominal wall tissue function and contributing to the high hernia recurrence rate. This review will give an overview of skeletal muscle anatomy, skeletal muscle regeneration, and herniation mechanisms, as well as discuss the current and future clinical solutions for abdominal wall hernia repair.
Collapse
Affiliation(s)
- Erin E Falco
- Department of Chemical and Biomolecular Engineering, University of Maryland, College Park, MD 20742, USA
| | | | | |
Collapse
|
25
|
Campanelli G, Catena F, Ansaloni L. Prosthetic abdominal wall hernia repair in emergency surgery: from polypropylene to biological meshes. World J Emerg Surg 2008; 3:33. [PMID: 19055805 PMCID: PMC2614977 DOI: 10.1186/1749-7922-3-33] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2007] [Accepted: 12/04/2008] [Indexed: 11/10/2022] Open
Abstract
The use of nonabsorbable prosthetic materials such as polypropylene, polyester, and ePTFE, have expanded and are now widely used in reparative surgery for abdominal wall hernias.There are still difficulties to find correct indication for prosthetic implant in emergency hernia surgery: as a matter of fact there is still a great debate if to use non-absorbable prostheses in potentially or truly infected operating fields [e.g. after intestinal resections].All these problems can be avoided with the use of absorbable prosthetic materials such as those composed of lactic acid polymers or lactic and glycolic acid copolymers: however, the use of these absorbable prosthesis exposes the patient to a rapid and inevitable hernia recurrence.It is important to remember that prosthetic repair has been proven to have a significant less risk of recurrence than repair with direct sutures.Recently, new "biologic" prosthetic materials have been developed and proposed for the clinical use in infected fields. These materials can be called "remodeling" for the way by which they are replaced after their placement within the patient. The "remodeling" process is made possible through a process of incorporation, where a reproduction of a site-specific tissue similar to the original host tissue is created.
Collapse
Affiliation(s)
- G Campanelli
- Department, of Surgery University of Insubria, Varese, Italy.
| | | | | |
Collapse
|