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van den Hil LCL, Mommers EHH, Bosmans JWAM, Morales-Conde S, Gómez-Gil V, LeBlanc K, Vanlander A, Reynvoet E, Berrevoet F, Gruber-Blum S, Altinli E, Deeken CR, Fortelny RH, Greve JW, Chiers K, Kaufmann R, Lange JF, Klinge U, Miserez M, Petter-Puchner AH, Schreinemacher MHF, Bouvy ND. META Score: An International Consensus Scoring System on Mesh-Tissue Adhesions. World J Surg 2021; 44:2935-2943. [PMID: 32621037 DOI: 10.1007/s00268-020-05568-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Currently, the lack of consensus on postoperative mesh-tissue adhesion scoring leads to incomparable scientific results. The aim of this study was to develop an adhesion score recognized by experts in the field of hernia surgery. METHODS Authors of three or more previously published articles on both mesh-tissue adhesion scores and postoperative adhesions were marked as experts. They were queried on seven items using a modified Delphi method. The items concerned the utility of adhesion scoring models, the appropriateness of macroscopic and microscopic variables, the range and use of composite scores or subscores, adhesion-related complications and follow-up length. This study comprised two questionnaire-based rounds and one consensus meeting. RESULTS The first round was completed by 23 experts (82%), the second round by 18 experts (64%). Of those 18 experts, ten were able to participate in the final consensus meeting and all approved the final proposal. From a total of 158 items, consensus was reached on 90 items. The amount of mesh surface covered with adhesions, tenacity and thickness of adhesions and organ involvement was concluded to be a minimal set of variables to be communicated separately in each future study on mesh adhesions. CONCLUSION The MEsh Tissue Adhesion scoring system is the first consensus-based scoring system with a wide backing of renowned experts and can be used to assess mesh-related adhesions. By including this minimal set of variables in future research interstudy comparability and objectivity can be increased and eventually linked to clinically relevant outcomes.
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Affiliation(s)
- L C L van den Hil
- Department of General Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands. .,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
| | - E H H Mommers
- Department of General Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - J W A M Bosmans
- Department of General Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - S Morales-Conde
- Unit of Innovation and Minimally Invasive Surgery, University Hospital Virgen Del Rocío, Seville, Spain
| | - V Gómez-Gil
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, Networking Research Centre on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - K LeBlanc
- Our Lady of the Lake Physician Group, Minimally Invasive Surgery Institute, Baton Rouge, LA, USA
| | - A Vanlander
- Department of General and Hepatobiliary Surgery, Ghent University Hospital, Ghent, Belgium
| | - E Reynvoet
- Department of General and Hepatobiliary Surgery, Ghent University Hospital, Ghent, Belgium
| | - F Berrevoet
- Department of General and Hepatobiliary Surgery, Ghent University Hospital, Ghent, Belgium
| | - S Gruber-Blum
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - E Altinli
- Department of General Surgery, Bilim University, Istanbul, Turkey
| | | | - R H Fortelny
- Department of General Surgery, Wilhelminenspital Der Stadt Wien, Vienna, Austria
| | - J W Greve
- Department of General Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - K Chiers
- Department of Veterinary Pathology, Faculty of Veterinary Medicine, University of Ghent, Ghent, Belgium
| | - R Kaufmann
- Department of Surgery, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - J F Lange
- Department of Surgery, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - U Klinge
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - M Miserez
- Department of Abdominal Surgery, University Hospitals, KU Leuven, Leuven, Belgium
| | - A H Petter-Puchner
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Austrian Cluster for Tissue Regeneration, Vienna, Austria.,Department of General Surgery, Wilhelminenspital Der Stadt Wien, Vienna, Austria
| | - M H F Schreinemacher
- Department of General Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - N D Bouvy
- Department of General Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
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The effects of ozone therapy on postoperative adhesions and ovarian functions: An experimental study. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.681999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2022] Open
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Sahoo S, Ma J, Tastaldi L, Baker AR, Loftis J, Rosen MJ, Derwin KA. Biodegradable hyaluronan hydrogel coatings on acellular dermis grafts-A potential strategy to improve biologic graft durability in hernia repair application. J Biomed Mater Res B Appl Biomater 2019; 107:2664-2672. [PMID: 30860665 DOI: 10.1002/jbm.b.34357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 01/28/2019] [Accepted: 02/20/2019] [Indexed: 11/07/2022]
Abstract
Biologic grafts used in hernia repair undergo rapid cellular infiltration and remodeling, but their premature degradation often results in hernia recurrence. We hypothesize that a temporary barrier that prevents infiltration of acute inflammatory cells into the graft during the initial 4 weeks of implantation could mitigate graft degradation. The purpose of this study is to design tyramine-substituted hyaluronan (THA) hydrogel coatings with tunable degradation properties, as a means to develop a resorbable barrier for human acellular dermis grafts (HADM). THA plugs prepared at different cross-linking densities, by varying cross-linking agent concentration (0.0001-0.0075% H2 O2 ), demonstrated varying rates of in vitro degradation (25 U/mL hyaluronidase, 48 h). Based on these results, HADM grafts were coated with THA at three cross-linking densities (0.0001%, 0.00075%, and 0.003% H2 O2 ) and THA coating degradation was evaluated in vitro (25 U/mL hyaluronidase, 48 h) and in vivo (rat intraperitoneal implantation, 1-4 weeks). THA coatings degraded in vitro and in vivo with the lowest cross-linking density (0.0001% H2 O2 ), generally showing greater degradation as evidenced by significant decrease in coating cross-sectional area. However, all three coatings remained partially degraded after 4 weeks of in vivo implantation. Alternate strategies to accelerate in vivo degradation of THA coatings are required to allow investigation of the study hypothesis. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B:2664-2672, 2019.
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Affiliation(s)
- Sambit Sahoo
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jinjin Ma
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Luciano Tastaldi
- Department of General Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Andrew R Baker
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jacki Loftis
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Michael J Rosen
- Department of General Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Kathleen A Derwin
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
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Evaluation of synthetic reticular hybrid meshes designed for intraperitoneal abdominal wall repair: Preclinical and in vitro behavior. PLoS One 2019; 14:e0213005. [PMID: 30811503 PMCID: PMC6392302 DOI: 10.1371/journal.pone.0213005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 02/13/2019] [Indexed: 11/20/2022] Open
Abstract
Introduction Reticular hybrid meshes represent an alternative material for intraperitoneal repair of abdominal hernias. These consist of a reticular mesh coated or interwoven/knitted with inert materials. This study assesses the performance of two reticular polypropylene-containing hybrid meshes, TiMESH (coated with titanium) and DynaMesh (interwoven with polyvinylidene fluoride), in vitro, as well as their efficiency in adhesion prevention and tissue incorporation in an intraperitoneal model. Methods The mesothelialization capacity of TiMESH and DynaMesh was evaluated in vitro and compared to that of Surgipro (reticular bare polypropylene) and Preclude (laminar expanded polytetrafluoroethylene). Mesh fragments were placed on the intact parietal peritoneum of New Zealand white rabbits (n = 24), and laparoscopy performed 7 days post-surgery. Fourteen days post-implantation, adhesions were evaluated and host tissue incorporation, macrophage response, collagen expression (immunohistochemistry/RT-PCR) and neoperitoneum formation assessed. Adhesions and omental tissue were also examined. Results Mesh pores in reticular meshes were devoid of cells in the in vitro study. TiMESH, DynaMesh and Surgipro showed similar adhesion rates at 7/14 days and optimal tissue integration, with significant differences in comparison to Preclude. The greatest presence of macrophages was observed for TiMESH and was significant versus that for Preclude. Hybrid meshes revealed significantly higher collagen 1 mRNA expression in implants, with no differences in the levels of collagen 3. Omental samples from animals with a reticular mesh showed significantly greater collagen 1 mRNA levels. Conclusions The reticular structure of a mesh limits the formation of a continuous mesothelial monolayer in vitro, regardless of its composition. The presence of titanium as a coating or polyvinylidene fluoride interwoven with polypropylene in a reticular structure did not prevent adhesions. The hybrid meshes showed proper integration and an increase in the mRNA Col 1 levels in the implant area compared to Surgipro or Preclude.
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Biomaterial Implants in Abdominal Wall Hernia Repair: A Review on the Importance of the Peritoneal Interface. Processes (Basel) 2019. [DOI: 10.3390/pr7020105] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Biomaterials have long been used to repair defects in the clinical setting, which has led to the development of a wide variety of new materials tailored to specific therapeutic purposes. The efficiency in the repair of the defect and the safety of the different materials employed are determined not only by the nature and structure of their components, but also by the anatomical site where they will be located. Biomaterial implantation into the abdominal cavity in the form of a surgical mesh, such as in the case of abdominal hernia repair, involves the contact between the foreign material and the peritoneum. This review summarizes the different biomaterials currently available in hernia mesh repair and provides insights into a series of peculiarities that must be addressed when designing the optimal mesh to be used in this interface.
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Lutsevich OE, Akimov VP, Shirinsky VG, Bichev AA. [Adhesive disease of the peritoneum: modern view at pathogenesis and treatment]. Khirurgiia (Mosk) 2017:100-108. [PMID: 29076493 DOI: 10.17116/hirurgia201710100-108] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- O E Lutsevich
- Eudokimov's Moscow Medical-Stomatological University, Moscow, Russia
| | - V P Akimov
- Mechnikov's North-West State Medical Unversity, Saint-Petersburg, Russia
| | - V G Shirinsky
- Eudokimov's Moscow Medical-Stomatological University, Moscow, Russia
| | - A A Bichev
- Eudokimov's Moscow Medical-Stomatological University, Moscow, Russia
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Bellón JM, Rodríguez M, Pérez-Köhler B, Pérez-López P, Pascual G. * The New Zealand White Rabbit as a Model for Preclinical Studies Addressing Tissue Repair at the Level of the Abdominal Wall. Tissue Eng Part C Methods 2017; 23:863-880. [PMID: 28756748 DOI: 10.1089/ten.tec.2017.0167] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
In this report, we review the use of the New Zealand White rabbit as the experimental animal for several models of abdominal wall repair. For the repair of an abdominal wall defect, such as a hernia in clinical practice, multiple types of prosthetic material exist. Before their marketing, each of these biomaterials needs to be tested in a preclinical setting to confirm its biocompatibility and appropriate behavior at the different tissue interfaces. For preclinical trials, we have always used the New Zealand White rabbit as the model owing to its ease of handling and suitable size. This size allows for laparoscopic studies designed to follow the behavior in real time of a biomaterial implanted at the peritoneal interface, a delicate interface that often gives rise to complications in human practice. The size of the rabbit also offers a sufficiently large number of implant samples to be harvested for a complete battery of tests at several time points postimplant. In this review, we first describe the models established and then provide the results obtained so far using these models to test the different types of biomaterial. We end our review with a discussion of the clinical implications of these results.
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Affiliation(s)
- Juan M Bellón
- 1 Department of Surgery, Medical, and Social Sciences, University of Alcalá , Alcalá de Henares, Madrid, Spain
| | - Marta Rodríguez
- 1 Department of Surgery, Medical, and Social Sciences, University of Alcalá , Alcalá de Henares, Madrid, Spain
| | - Bárbara Pérez-Köhler
- 1 Department of Surgery, Medical, and Social Sciences, University of Alcalá , Alcalá de Henares, Madrid, Spain
| | - Paloma Pérez-López
- 1 Department of Surgery, Medical, and Social Sciences, University of Alcalá , Alcalá de Henares, Madrid, Spain
| | - Gemma Pascual
- 2 Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, Networking Research Center on Bioengineering, Biomaterials, and Nanomedicine (CIBER-BBN), University of Alcalá , Alcalá de Henares, Madrid, Spain
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Abstract
Postoperative peritoneal adhesions are common sequelae of abdominal surgery. Acute as well as chronic complications, including bowel obstruction, abdominal pain and infertility can arise from adhesion formation. So far, the only reliable treatment is surgical adhesiolysis, which in turn is accompanied by an increased risk of adhesion recurrence. Despite significant progress in modern perioperative medicine, only limited prophylactic approaches are available and atraumatic surgery is still the most important factor.Current research concepts focus on two major antiadhesion strategies: firstly, the intraoperative placement of mechanical barriers and secondly novel immunomodulation concepts. Clinical data about the use of antiadhesive barriers show a heterogeneous outcome. Promising data have arisen from the immunomodulatory approaches and now require a step-up development from experimental to clinical trial level.The present review gives a short overview about the current research on the pathophysiology and prevention of peritoneal adhesions. The promising data are encouraging and require realization of carefully designed prospective clinical trials.
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Gómez-Gil V, Pascual G, Pérez-Köhler B, Cifuentes A, Buján J, Bellón JM. Involvement of transforming growth factor-β3 and betaglycan in the cytoarchitecture of postoperative omental adhesions. J Surg Res 2013; 187:699-711. [PMID: 24332552 DOI: 10.1016/j.jss.2013.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 11/06/2013] [Accepted: 11/07/2013] [Indexed: 01/03/2023]
Abstract
BACKGROUND Adhesions commonly appear in patients after abdominal surgery, with considerable individual variation in adhesion composition and severity of the repair process. Here, we address the influence of transforming growth factor (TGF)-β3 and betaglycan in this response, in relation to TGF-β1, in an adhesiogenic rabbit model. MATERIALS AND METHODS Omental adhesions were recovered 3, 7, 14, and 90 d after the implantation of a polypropylene mesh on the parietal peritoneum in New Zealand White rabbits. Omentum from nonoperated animals served as control. Tissue specimens were examined for TGF-β3 and TGF-β1 (Western blotting, reverse transcription-polymerase chain reaction), and TGF-β1:TGF-β3 messenger RNA and protein expression ratios were analyzed. Immunohistochemical detection of TGF-β3 and betaglycan was performed. RESULTS Injury to the omentum led to mobilization of TGF-β3 and betaglycan-expressing cells from milky spots. Fibrous zones in adhesions were simultaneous to the presence of TGF-β1 and the membrane-bound form of betaglycan (7-d adhesions), whereas soluble betaglycan appeared in TGF-β1-positive areas showing limited fibrosis (3-d adhesions). The elevated expression of TGF-β3 concurrent with the presence of membrane-bound form of betaglycan was observed in zones of adipose regeneration (14-d adhesions), whereas zones of fibrous consistency were negative for TGF-β3. CONCLUSIONS Milky spots on the omentum contain inflammatory/immune cells positive for TGF-β3, TGF-β1, and betaglycan, playing a role in the damaged omentum repair. Our observations support the contribution of TGF-β3 to tissue repair through adipose tissue regeneration and the profibrotic role of TGF-β1 and suggest that these effects on the local wound repair response could be driven by the expression of betaglycan in its soluble or membrane-bound form.
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Affiliation(s)
- Verónica Gómez-Gil
- Department of Medicine and Medical Specialties, Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - Gemma Pascual
- Department of Medicine and Medical Specialties, Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - Bárbara Pérez-Köhler
- Department of Surgery, Medical and Social Sciences, Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - Alberto Cifuentes
- Department of Medicine and Medical Specialties, Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - Julia Buján
- Department of Medicine and Medical Specialties, Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - Juan M Bellón
- Department of Surgery, Medical and Social Sciences, Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain.
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Kutuk MS, Ozgun MT, Batukan C, Ozcelik B, Basbug M, Ozturk A. Oral tadalafil reduces intra-abdominal adhesion reformation in rats. Hum Reprod 2012; 27:733-7. [PMID: 22215626 DOI: 10.1093/humrep/der439] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Currently, there is no ideal agent to prevent adhesion formation. We have shown that sildenafil, a phosphodiesterase-5 (PDE-5) inhibitor, reduces post-operative adhesion formation by vasodilatation and increases fibrinolytic activity. Here, we evaluated whether tadalafil, a long-acting PDE-5 inhibitor, decreases post-operative adhesion reformation in rats. MATERIALS AND METHODS Standardized lesions were created in Wistar albino rats by cauterization of uterine horns and abrasion of adjacent peritonium. The extent and severity of adhesions were scored on the 14th post-operative day and adhesiolysis was performed at the second laparotomy. Animals were then assigned randomly into two groups. The study group (n = 11) received 10 mg/kg oral tadalafil by gavage 60 min before the second laparotomy and daily for 14 days afterwards. Controls (n = 11) received the same volume of tap water for 14 days by gavage. Animals were killed 15 days after adhesiolysis and adhesions were scored blind during the third laparotomy. RESULTS Basal adhesion scores at the time of the second laparotomy were comparable in the study and control groups. Scores for the extent of adhesion reformation in the study and control groups did not differ [median 1 (range 0-3) versus median 2 (range 1-3); P: 0.81] but tadalafil reduced the respective severity scores [median 0.5 (range 0-1) versus median 1 (range 0.5-1); P: 0.02] and total scores [median 2 (range 0-4) versus median 2.5 (range 1.5-4); P: 0.042]. CONCLUSIONS Oral administration of tadalafil during the perioperative period reduces intra-abdominal adhesion reformation in rats.
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Affiliation(s)
- Mehmet Serdar Kutuk
- Department of Obstetrics and Gynecology, Faculty of Medicine, Erciyes University, Gevher Nesibe Hospital, 38039 Kayseri, Turkey.
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Fujino K, Kinoshita M, Saitoh A, Yano H, Nishikawa K, Fujie T, Iwaya K, Kakihara M, Takeoka S, Saitoh D, Tanaka Y. Novel technique of overlaying a poly-L: -lactic acid nanosheet for adhesion prophylaxis and fixation of intraperitoneal onlay polypropylene mesh in a rabbit model. Surg Endosc 2011; 25:3428-36. [PMID: 21638189 DOI: 10.1007/s00464-011-1745-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2011] [Accepted: 04/16/2011] [Indexed: 01/29/2023]
Abstract
BACKGROUND One problem with polypropylene mesh (PPM) used to repair abdominal wall hernias is dense adhesions to the visceral surface. The authors developed the biocompatible poly-L: -lactic acid (PLLA) nanosheet (thickness < 100 nm), which has the unique ability to adhere tightly to tissues but not to opposing tissues. This study investigated the antiadhesive and fixative characteristics of the PLLA nanosheet after placement of intraperitoneal onlay PPM (IPOM) overlaid with a PLLA nanosheet on intact peritoneum. METHODS The PLLA nanosheet was fabricated by the spin-coating method and peeling technique with polyvinyl alcohol (PVA) as a supporting film. Two 1.5-cm-square pieces of mesh were implanted on each peritoneal side of the midline incision. The mesh was fixed to the peritoneum with a suture and then overlaid with a 4-cm-square piece of Seprafilm or nanosheet. To examine the fixative property, mesh was overlaid with Seprafilm or nanosheet without a fixed suture. After 4 weeks, mesh adhesion, inflammatory reaction, fixation, and dislocation of mesh were evaluated. RESULTS Nanosheet-overlaid meshes were flexible and fit over the peritoneum. Adhesion was observed in 10% of the nanosheet-overlaid meshes and in 50% of the Seprafilm-overlaid meshes. The adhesion tenacity grade was significantly lower with the nanosheet-overlaid meshes (0.1 ± 0.1) than with the Seprafilm-overlaid meshes (1.0 ± 0.4) (p = 0.029), and the percentage of the adhesion area also was lower with the nanosheet-overlaid meshes (1.0 ± 1.0% vs 8.5 ± 3.2%; p = 0.037). The mean inflammatory cell counts were lower with the nanosheet-overlaid meshes (p = 0.0023). Regarding the fixative property, 37.5% of the nanosheet-overlaid meshes were fixated on the peritoneum, but no Seprafilm-overlaid mesh was fixated. CONCLUSION Overlaying of a PLLA nanosheet was effective for adhesion prophylaxis of intraperitoneal mesh. It also may have a possible beneficial effect on fixation of mesh.
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Affiliation(s)
- Keiichi Fujino
- Department of General Medicine, National Defense Medical College, Saitama, Japan.
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Rodríguez M, Pascual G, Sotomayor S, Pérez-Köhler B, Cifuentes A, Bellón JM. Chemical Adhesion Barriers: Do They Affect the Intraperitoneal Behavior of a Composite Mesh? J INVEST SURG 2011; 24:115-22. [DOI: 10.3109/08941939.2011.555059] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Bellón JM. Letter 1: Adverse effects of polyvinylidene fluoride-coated polypropylene mesh used for laparoscopic intraperitoneal onlay repair of incisional hernia (Br J Surg 2010; 97: 1140-1145). Br J Surg 2010; 98:158-9; author reply 160. [PMID: 21136573 DOI: 10.1002/bjs.7326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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