共查询到20条相似文献,搜索用时 31 毫秒
1.
Titanium coating of a polypropylene mesh for hernia repair: Effect on biocompatibilty 总被引:2,自引:0,他引:2
K. Junge R. Rosch U. Klinge M. Saklak B. Klosterhalfen C. Peiper V. Schumpelick 《Hernia》2005,9(2):115-119
Titanium and its alloys are used worldwide in surgery. The favorable characteristics that make this material desirable for implantation are corrosion resistance and biocompatibility. Concerning hernia repair, a mesh modification has been developed using titanium layering of a polypropylene mesh implant, which is said to lead to an improved biocompatibility compared to commercially available mesh materials. To analyze the pure effect of titanium coating, two different mesh structures were studied using a standardized animal model. The titanium-coated monofilamentous, large porous, and lightweight mesh made of polypropylene and coated with titanium (PP+T) was compared to a pure polypropylene mesh manufactured with a similar structure and amount of material serving as a control (PP). In Sprague-Dawley rats, mesh samples were placed in a subcutaneuous position. Then 56, 84, and 182 days after mesh implantation, three animals from each group were sacrificed for morphological observations (amount of inflammatory and connective tissue formation, percentages of proliferating and apoptotic cells, percentage of macrophages). Both mesh modifications investigated showed an overall good biocompatibility. Macroscopic clinical observation after implantation of up to 182 days was uneventful. The tissue response to the PP as well as to the PP+T mesh was characterized by a moderate inflammatory tissue reaction limited to the perifilamentary region as is known for low weight, large porous, and monofilamentous mesh structures. No significant improvement of biocompatibility was found when analyzing the effect of titanium coating compared to the pure polypropylene mesh structure. 相似文献
2.
Rosch R Junge K Quester R Klinge U Klosterhalfen B Schumpelick V 《European surgical research. Europ?ische chirurgische Forschung. Recherches chirurgicales européennes》2003,35(5):445-450
BACKGROUND: To the Vypro II mesh, a large-pore-sized multifilamentous polypropylene mesh for hernia repair, supplementary polyglactin 910 multifilaments were added to improve intraoperative handling. As it has been suggested that polyglactin induces fibroplastic reactions and wound complications, this study was designed to evaluate the long-term tissue reaction to polyglactin in the Vypro II mesh. MATERIALS AND METHODS: Two mesh materials, the Vypro II composite mesh (PP + PG) and the pure polypropylene variant (PP), were compared after inlay implantation in a standardized rodent animal model. After 14, 28, 42, 56, 84 and 112 days of implantation, histological analysis of the inflammatory response was performed: material absorption, inflammatory tissue reaction, fibrosis and granuloma formation were investigated. RESULTS: Total absorption of polyglactin filaments of the Vypro II mesh occurred between 56 and 84 days of implantation. Both the inflammatory and the fibrotic reaction were initially increased in the PP + PG mesh group. These differences disappeared in the following implantation period. After 112 days, inflammation was even less pronounced in the PP + PG mesh group. CONCLUSION: The present data confirm a short-term polyglactin-induced increase in inflammation and fibrosis around implanted Vypro II meshes in rats. With regard to the long-term tissue response, even an anti-inflammatory property of polyglactin multifilaments in low-weight and large-pored polypropylene meshes cannot be ruled out. 相似文献
3.
Rosch R Junge K Schachtrupp A Klinge U Klosterhalfen B Schumpelick V 《European surgical research. Europ?ische chirurgische Forschung. Recherches chirurgicales européennes》2003,35(3):161-166
BACKGROUND: In the reinforcement of the abdominal wall with mesh implants, various complications including hernia recurrence, abdominal pain, seroma formation and infection are discussed to depend on the biocompatibility of the alloplastic prosthesis. Particularly macrophages, T-cells and mast cells have been shown to play a major role in the inflammatory response to biomaterials. To approach biocompatibility of surgical meshes we therefore examined the infiltrate of these cells as well as the proliferation rate in response to different clinically applied materials. MATERIALS AND METHODS: Three mesh materials (polypropylene: PP, Prolene; polyethylene terephthalate: PET, Mersilene, and polypropylene/polyglactin: PP + PG, Vypro) were compared after inlay implantation in a standardized rodent animal model. A suture-closed laparotomy served as control. After 7 and 90 days of implantation, histochemical analysis of the inflammatory response to all biomaterials was performed: macrophages (ED3), T-cells (CD3), proliferating cells (PCNA) and mast cells (Giemsa) were investigated. RESULTS: In all groups a persisting T-cell response was observed. Colonization of the interface with macrophages showed a pronounced reduction in the PP + PG-mesh group. Infiltration of mast cells at the tissue graft interface showed a time-dependent decrease in the PET- and PP + PG-mesh groups, whereas in contrast, index of mast cells increased in the PP-mesh group. At both time points, indices of proliferation were highest in the PP-mesh group. CONCLUSION: The present data confirm the development of a biomaterial-dependent chronic inflammatory response to surgical meshes with macrophages as the predominant cell type. Further research on the recruitment of inflammatory cells and in particular on the role of mast cells and their granular products should be encouraged. 相似文献
4.
Klinge U Klosterhalfen B Birkenhauer V Junge K Conze J Schumpelick V 《The Journal of surgical research》2002,103(2):208-214
BACKGROUND: The surgical therapy of hernias is increasingly based on reinforcement with alloplastic material, in particular surgical meshes. The biological response to these foreign bodies largely depends on the selected material and its structure. In comparison to the physiological scar process following a simple abdominal wall incision, the chronic inflammation at the interface to the polymers lead to specific morphological alterations. MATERIALS AND METHODS: In the present study two meshes with different pore sizes were implanted into rats: a heavy-weight and small-pore-sized mesh (hw-mesh) made of nonabsorbable polypropylene monofilaments and a low-weight large-pore-sized mesh consisting of polypropylene and of absorbable polyglactin multifilaments (lw-mesh). A suture repair of a laparotomy served as control. After 7, 14, 21, and 90 days the mesh area was analyzed with regard to tissue and cellular response. RESULTS: Over the whole observation period morphometric analysis indicated an improved integration of the lw-mesh with reduction of both inflammation and fibrosis, whereas the hw-mesh induced an intense chronic inflammation concomitant with an intensified bridging scar reaction. On the cellular level these findings correspond to an elevated cell turnover, characterized by increased rates of apoptotic and proliferating cells. In contrast, the tissue reaction to the lw-mesh achieved levels almost similar to those of the physiological scaring process in the control group. CONCLUSION: In conclusion, the present data confirm the development of a chronic inflammatory foreign body reaction at the interface to both hw-meshes and lw-meshes; however, the use of lw-meshes showed superior tissue integration. With regard to the quite similar polymer surface the pore size appears to be of major importance in tissue reaction and for the biocompatibility of mesh structures. 相似文献
5.
Junge K Binnebösel M Rosch R Jansen M Kämmer D Otto J Schumpelick V Klinge U 《Surgical endoscopy》2009,23(2):327-333
Background Effective laparoscopic ventral herniorrhaphy mandates the use of an intraperitoneal mesh. Visceral adhesions and shrinkage
of prosthetics may complicate repairs. The aim of this study was to compare adhesion formation, mesh shrinkage and tissue
ingrowth after intra-abdominal placement of a novel two-component monofilament mesh structure made of polypropylene (PP) and
polyvinylidenfluoride (PVDF) with current alternatives.
Materials and methods Forty Sprague-Dawley rats were used in this study. Mesh samples were fixed as intra-abdominal only mesh at the right lateral
abdominal wall. The study groups were: PVDF+PP (polypropylene parietally and polyvinylidenfluoride viscerally), PP+Col (polypropylene
with a collagenoxidized film), ePTFE (smooth surface viscerally and a textured surface parietally), and PP (a pure polypropylene
mesh serving as control). The meshes were explanted after 30 days. Adhesions were scored as a percentage of explanted biomaterials’
affected surface area; prosthetic shrinkage was calculated. Foreign-body reaction to mesh materials was measured by investigating
the amount of inflammatory infiltrate and fibrotic tissue formation.
Results In terms of adhesion score, the pure PP mesh showed the highest values followed by the ePTFE, PVDF+PP, and PP+Col meshes.
Quantitative assessment of adhesion area revealed a significantly higher value of the pure PP mesh sample (62.0 ± 22.1%) compared
with the PP+Col (26.8 ± 12.1%) and the PVDF+PP mesh (34.6 ± 8.2%). Percentage of shrinkage showed a significantly higher value
of the ePTFE mesh (52.4 ± 13.9%) compared with all other mesh modifications (PP+Col 19.8 ± 13.9%, PVDF+PP 19.9 ± 7.0%, and
PP 26.8 ± 9.5%). Inflammatory infiltrate was significantly reduced in the PVDF+PP mesh group compared with all other mesh
samples.
Conclusion The use of the novel two-component monofilament mesh structure made of polypropylene and polyvinylidenfluoride was found to
be favorable regarding adhesion formation and mesh shrinkage compared to conventional mesh materials used for intra-abdominal
placement. 相似文献
6.
Is there a risk of infertility after inguinal mesh repair? Experimental studies in the pig and the rabbit 总被引:4,自引:0,他引:4
Christian Peiper Karsten Junge Uwe Klinge Eva Strehlau A. Öttinger Volker Schumpelick 《Hernia》2006,10(1):7-12
The implantation of a non-absorbable polypropylene mesh during hernia repair causes chronic foreign body reaction involving
the surrounding tissue. In case of inguinal hernia repair using mesh techniques, the spermatic cord is potentially affected
by this chronic inflammatory tissue remodeling. This effect has been investigated using standardized animal models (pig and
rabbit). Fifteen adult male pigs underwent transinguinal preperitoneal implantation of a polypropylene mesh. The contralateral
side with a Shouldice repair served as control. After 7, 14, 21, 28, and 35 days, three animals were sacrificed. The spermatic
cords were resected and analyzed histologically. In a second experiment Lichtenstein repair using the same polypropylene mesh
and Shouldice repair on the contralateral side was done in eight chinchilla rabbits. Three animals served as controls. Three
months after operation, the analysis included testicular size, testicular temperature, and testicular and spermatic cord perfusion.
We added histological evaluation of the foreign body reaction and the spermatogenesis using the Johnsen score. In the pig,
we observed a certain foreign body reaction with diffuse infiltrating inflammatory cells after mesh implantation. Venous thrombosis
of the spermatic veins occurred in five of 15 cases. One animal presented focal fibrinoid necrosis of the deferent duct wall.
The side of Shouldice repair showed only minor postoperative changes. In the rabbit, we also observed a typical foreign body
reaction at the interface between mesh and surrounding tissue, which was not detectable after Shouldice repair. The mesh repair
led to a decrease of arterial perfusion, testicular temperature, and the rate of seminiferus tubules with regular spermatogenesis
classified as Johnsen 10 (Lichtenstein: 48.1%, Shouldice: 63.8%, controls: 65.8%). Testicular volume increased about 10% after
each operation. The implantation of a polypropylene mesh in the inguinal region induces major response of the structures of
the spermatic cord. This may have an influence also on spermatogenesis. Due to this a strict indication for implantation of
a prosthetic mesh during inguinal hernia repair is recommended. 相似文献
7.
Intraabdominal adhesion formation of polypropylene mesh Influence of coverage of omentum and polyglactin 总被引:2,自引:2,他引:0
Conze J Junge K Klinge U Weiss C Polivoda M Oettinger AP Schumpelick V 《Surgical endoscopy》2005,19(6):798-803
Background Adhesions after intraabdominal surgical procedures are related to high morbidity and mortality. Biomaterials, particularly those made of polypropylene, in the intraabdominal position have to be considered as pathophysiological cofactor in a multifactorial process of adhesion formation. To investigate the adhesive potential induced by the biomaterial, an animal model was performed. In addition, the influence of coverage by omentum or a polyglactin barrier was investigated.Methods In, 18 Chinchilla rabbits the biomaterial was placed laparoscopically using the intraperitoneal onlay mesh technique. Using this model, a polypropylene–polyglactin mesh compound (PPMC) was used with three different implantation techniques: group 1, PPMC implantation without coverage (PPMC): group 2, PPMC implantation with additional omentum coverage (PPMC-O): and group 3, PPMC implantation with coverage of an absorbable polyglactin mesh (PPMC-V). The degree of adhesion formation was measured 90 days after implantation by computer-assisted planimetry. Morphometric examination followed the explantation analyzing the amount of foreign body response.Results We found a significant reduction of adhesion formation for the PPMC and PPMC-O groups compared to the PPMC-V group, in which dense adhesions were found. Morphometric investigations of the perifilamental granulomas of the pure (PPMC) group revealed a typical foreign body reaction with a mild to moderate fibrosis around all mesh fibers. However, tissue specimens of the PPMC-O and PPMC-V groups indicated a similar inflammatory reaction but significantly increased connective tissue formation around the polymer fibers compared to the pure PPMC group.Conclusion The intraabdominal placement of a pure PPMC shows a neoperitonealization and perifilamental collagenous ingrowth with almost no adhesions. Coverage with omentum (PPMC-O) or polyglactin mesh (PPMC-V) resulted in a significant increase in inflammation and perifilamentary connective tissue formation. 相似文献
8.
OBJECTIVE: The synthetic implant meshes in clinical use for the treatment of abdominal hernias are generally made of polyester in France and of polypropylene in Germany. Serving as an implant material for the replacement of the cruciate ligament, the Trevira is another polymer of polyester in clinical use with excellent results. This animal trial was performed to ascertain whether it offers any advantages over polypropylene for abdominal incisional hernia repair. MATERIAL [corrected] AND METHODS: In 12 pigs 10 x 10 cm of the abdominal wall preserving the peritoneum was resected and subsequently implanted a 15 x 15 cm synthetic mesh of polyethylene terephthalate (Trevira) in half of them and of polypropylene (Prolene) in the other half using a sublay technique. After two and six month the implant size was measured and the extend of the foreign body reaction determined by the microscopically presence of foreign body giant cells. RESULTS: No significant differences concerning the implant size were shown between the two groups at any of the time periods. The acute inflammatory reaction observed was significantly higher at the polypropylene than at the polyethylene terephthalate implant (number of giant cells after 2 month: Prolene 2.2 +/-0.4, Trevira: 0.8 +/-0.2, after six month: Prolene: 4.6 +/-1.3, Trevira: 1.1 +/-0.5). In contrast to the polyethylene terephthalate all polypropylene samples showed calcification areas after six month. CONCLUSION: In this animal trial Trevira mesh showed a high biocompatibility with a low foreign body reaction. It appears to be a promising new implant for the treatment of hernia. 相似文献
9.
C Langer P Schwartz P Krause H Mohammadi B Kulle A Schaper L Füzesi H Becker 《Der Chirurg》2005,76(9):876-885
BACKGROUND: The biocompatibility of meshes in hernia surgery seems to be influenced markedly by the amount of the selected material and its structure. Fibroblasts play a major key role during the process of mesh incorporation. This study was performed to investigate differences in cell morphology and proliferation of human fibroblasts cultured on different polypropylene meshes. METHODS: In the present in vitro study the cellular response of human fibroblasts was investigated by scanning electron microscopy (SEM), comparing three different polypropylene meshes: a newly constructed low-weight and microporous mesh (NK1), a low-weight and macroporous mesh with absorbable polyglactin filaments (Vypro), and a heavy-weight and microporous mesh (BiomeshP1). Human fibroblasts (1,5.10(5) cells) were incubated with the meshes (each 12 mm(2)) for 6 hours, 5 days, 2, 4, 6, and 12 weeks. Computer-assisted morphometry of the fibroblast/mesh surface ratio served to reflect the biological cell response. RESULTS: The Vypro mesh showed the significantly highest fibroblast density during the first 6 weeks, but cell growth was nearly exclusively limited to the polyglactin filaments. At 3 months, after reabsorption of the polyglactin, the fibroblast-coated polypropylene mesh surface was only 50% compared to NK1 and BiomeshP1. The morphologic aspect of the fibroblasts on the BiomeshP1 mesh was much more degenerative and unphysiological, compared to NK1 and Vypro, with isolated, single cells instead of a broad, connective growth. The BiomeshP1 showed a significantly higher fibroblast proliferation around the nodes of the mesh compared to the straight filaments. On the NK1 mesh fibroblasts exclusively proliferated on the filaments but not on the pressed mesh surface. CONCLUSIONS: The polymer surface and structure appears to be of major importance for the biocompatibility of meshes: human fibroblasts preferably grow on low-weight meshes, thin filaments, and mesh nodes. Heavy-weight meshes induce degenerative cell reactions. Polyglactin seems to further improve cell proliferation whereas a pressed mesh surface without pores hinders fibroblast growth. 相似文献
10.
Background: Polypropylene (PP) meshes are currently being used in millions of operations for hernial repair. We tested several recently modified PP meshes to evaluate them in terms of their biocompatibility and handling characteristics during minimally invasive procedures. Methods: Four different PP meshes (a heavyweight PP, Atrium; a lightweight PP incorporating absorbable polyglactic acid, Vypro II; a lightweight PP, Parietene; and a titanium-coated lightweight PP, Ti-Mesh Extralight), all implanted using the endoscopic total extrapreperitoneal (TEP) technique, were investigated in groups comprising 11 pigs each. After 94 ± 5 days, the animals were autopsied and tissue samples were studied histologically, immunohistochemically, and electron-microscopically. Results: Whereas endoscopic handling of the Vypro II mesh proved difficult, the already good properties of the Atrium mesh were significantly improved on by Parietene and the Ti-Mesh. Clear differences were also found in the shrinkage characteristics of the implant materials. In comparison with Atrium (12%), Vypro II mesh shrinkage was significantly greater (28%), whereas Parietene (7%) and Ti-Mesh (5%) incurred less shrinkage. With regard to the chronic inflammatory reaction, the titanium-coated mesh showed a significantly lower inflammatory activity (13.1% partial volume [%PV] vs 34.1%PV and 29.0%PV) than the lightweight meshes Vypro II and Parietene, but—with the exception of the monocytic (0.2 vs 9.1, 5.1, and 7.9) and B-lymphocytic reaction (1.1 vs 18.0, 11.7, and 12.2)—no significant difference was seen in comparison with Atrium. The various mediators in the extracellular matrix (matrix metalloproteinases 1 [MMP-1 transforming growth factor beta [TGF-], urokinase plasminogen activator [uPA], and type I collagen) tended to show the highest expression with Vypro II (13.6, 113.2, 132.7, and 139.5, respectively) and the lowest expression with Ti-Mesh (11.9, 68.5, 92.8, and 75.0, respectively). With regard to cell proliferation, Parietene and Ti-Mesh appeared to have slight advantages, but no differences were observed in the apoptotic rate. Conclusion: In our opinion, despite a reduction in material, Vipro II, on account of the inflammatory reaction, does not represent a true improvement over the meshes currently used for hernia repair. In comparison, the two lightweight PP patches are characterized by a more favorable foreign body reaction, with the titanium coating of the Ti-Mesh providing an additional advantage in terms of its biocompatibility. 相似文献
11.
Schug-Pass C Sommerer F Tannapfel A Lippert H Köckerling F 《Surgical endoscopy》2008,22(11):2433-2439
Background Intraperitoneal repair of incisional hernias using a mesh makes particular demands on the material used. In addition to good
integration of the mesh on the parietal side, adhesions to the visceral peritoneum must be avoided. Large-pore, light-weight
meshes induce fewer adhesions than heavy-weight polypropylene meshes. Although numerous adhesion-barrier substances for use
in combination with a polypropylene mesh have been tested already, mostly in open small animal models, unequivocal benefits
have been identified to date in only a few of the experiments.
Methods Using the laparoscopic intraperitoneal onlay mesh technique, six pigs were implanted with either a lightweight polypropylene
mesh (TiMesh light) or TiMesh plus an adhesion-barrier film made of polylactide (SurgiWrap). After 3 months, the animals underwent
a postmortem laparoscopy, and specimens were obtained for planimetric and histologic investigations.
Results No adhesions to intestinal structures were found in any of the animals. Adhesions between the greater omentum and the mesh
did not differ significantly between the TiMesh (32%) and SurgiWrap (33.5%) groups. The shrinkage of the mesh’s surface area
was comparable between the two groups (18% vs. 21%). Histology showed pronounced inflammatory reaction and bridging of scar
tissue between the filaments with the use of SurgiWrap versus TiMesh light without film. However, immunohistochemical investigations
examining the partial volume of the inflammatory cells, the proliferation marker Ki67, and the apoptotic index at the interface
of the filaments all failed to show any significant differences.
Conclusion To avoid adhesions, it is essential that the acute and chronic inflammatory reaction to the implanted material be as small
as possible. This requirement is met specifically by the lightweight polypropylene mesh TiMesh light. The additional application
of a slowly absorbable adhesion-barrier film made of polylactide (SurgiWrap) does not appear to confer any further benefit. 相似文献
12.
Wagner Marcondes Fernando A M Herbella Jacques Matone Alexandre N Odashiro Alberto Goldenberg 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2008,12(1):58-61
BACKGROUND: The use of prosthetic materials to reinforce the abdominal wall is associated with a low index of recurrence; however, intraperitoneal placement of a foreign body may lead to adhesions. The present investigation was designed to determine adhesion formation with commercially available meshes implanted laparoscopically in rabbits. METHODS: Three different meshes were implanted laparoscopically in 24 rabbits: polypropylene (mesh A), polypropylene and sodium hyaluronate-carboxymethylcellulose (mesh B), and polypropylene and expanded polytetrafluoroethylene (mesh C). Sites of implantation for each mesh (the left lower quadrant, right lower quadrant, and lower midline) were randomly determined so that every rabbit had all 3 meshes implanted. All animals underwent diagnostic laparoscopy after 28 days to grade adhesions and histological analysis of inflammation. RESULTS: Adhesions were noticed in 46 of the 72 meshes implanted (64%). The number of adhesions was higher for mesh C (87.5%) compared with meshes A (62.5%) and B (41.6%). The severity of adhesions was also higher for mesh C (grade I in 14, II in 6, and III in 1) compared with mesh A (grade I in 10, II in 4, and III in 1 case) and B (all of them grade II). Histological inflammatory reaction was classified as mild in 23 cases of mesh A, 15 of mesh B, and 23 of mesh C. A moderate reaction was found in 1 case of mesh A, 4 cases of mesh B, and 1 case of mesh C. Severe reaction was induced in 5 cases of mesh B. Mesh B induced a higher inflammatory reaction compared with the other meshes. CONCLUSIONS: All meshes induced adhesions of different grades. Mesh B had fewer adhesions and more intense inflammation them did the others. 相似文献
13.
Ronald N. Kaleya 《Hernia》2005,9(3):269-276
An ideal prosthesis for ventral hernia repair should minimize development of postoperative adhesions. This study evaluates
adhesion formation following intraperitoneal implantation of acellular porcine dermal collagen (PDC) and polypropylene (PP)
mesh in 16 rats. Implant placement alternated left/right. Sacrifice (4 or 12 weeks) was randomized. Methods included adhesion
grading (extent, severity, required dissection method) and histological evaluation. At 4 weeks, 7 of 8 PDC specimens and 0
of 8 PP implants were adhesion-free; results were identical at 12 weeks. Four-week adhesions were less developed than 12-week
adhesions. Histology showed mononuclear cell foreign body reaction and disorganized collagen deposition for PPs compared to
infiltration with neovascular channels and qualitatively less intense foreign body reaction for PDCs. PDC exhibits fewer adhesions
and more favorable cellular response than PP in the rat. 相似文献
14.
The use of polypropylene (PP) mesh for pelvic floor repair has been increasing dramatically over the past decade; however, tissue response in humans has not been extensively studied. This review discusses PP mesh and postimplantation host tissue response. Emphasis is placed on studies investigating the relationship between individual mesh properties and specific responses. There is an immediate inflammatory response after PP mesh implantation that lays the framework for tissue ingrowth and subsequent mesh integration. This response varies based on physical properties of individual mesh, such as pore size, weight, coatings, bacterial colonization, and biofilm production. 相似文献
15.
Purpose
As part of the foreign body reaction, mesh filaments are surrounded by an infiltrate of inflammatory cells. Though macrophages are considered as being predominant, little is known about the origin of other cells.Methods
On 55 meshes explanted from humans, we characterised the cells in the inflammatory infiltrate of the granuloma by immunohistochemistry using 10 cellular markers: CD3+ lymphocytes, CD4+ T helper cells, CD8+ cytotoxic T cells, CD20+ B lymphocytes, CD34+ stem cells, CD45R0+ leucocytes, CD68+ macrophages, Mib1 for proliferation, Vimentin for mesenchymal origin, and Desmin for myocytes. Collagen deposits were analysed after staining with Sirius Red.Results
More than 80 % of the cells in the infiltrate showed a positive expression of CD68, CD8, CD45R0 and Vimentin. CD4 and Desmin were seen in 30–80 % of the cells, unaffected by material or time. A score summarising the expression of all markers positively correlated significantly with an increased percentage of collagen type III (green) in the mesh wound. The analysis of collagen deposits was only affected to a small degree by size of area for investigation.Conclusions
At the vicinity of the mesh filaments, the accumulated inflammatory cells represent a mixture of cells of various origins. The high expression of at least four markers requires co-expression of different surface markers and thus confirms the existence of multiple transition forms instead of dominance of just macrophages. This offers new options for interventions to attenuate the inflammatory reaction of mesh implants. 相似文献16.
The influence of inguinal mesh repair on the spermatic cord: a pilot study in the rabbit. 总被引:3,自引:0,他引:3
Christian Peiper Karsten Junge Uwe Klinge Eva Strehlau Carsten Krones A Ottinger Volker Schumpelick 《Journal of investigative surgery》2005,18(5):273-278
The permanent implantation of a polypropylene mesh during inguinal hernia repair causes chronic inflammatory changes in the surrounding tissue. We investigated the effect of this foreign body reaction on the structures of the spermatic cord in the rabbit. Eight Chinchilla rabbits underwent unilateral inguinal hernia repair by the Lichtenstein technique using Marlex (n = 4) or Ultrapro (n = 4) mesh. The contralateral side was operated upon using the Shouldice repair. Three animals served as controls. Three months after operation we analyzed testicular size, testicular temperature, and arterial perfusion by excitation light of a 780-nm laser after injection of 0.5 mg/kg indocyanin green. Histological evaluation included spermatogenesis (Johnsen score) and foreign-body reaction. Testicular volume increased about 10% after each operation. The decrease of arterial perfusion and testicular temperature was more significant after mesh repair than following Shouldice operation. After mesh implantation we found fewer seminiferous tubules classified as Johnsen 10 (Marlex: 51.3%, Ultrapro: 45.0%) than after Shouldice repair (63.8%) or in the controls (65.8%). The spermatic cord showed a typical foreign-body reaction at the interface between mesh and surrounding tissue, which was not detectable after Shouldice repair. Preserved cremasteric muscle fibers protected the structures of the spermatic cord. The inflammatory foreign-body reaction of the surrounding tissue induced by the inguinal prosthetic mesh includes the structures of the spermatic cord. This may have an influence also on spermatogenesis. Therefore, we recommend strict indications for implantation of a prosthetic mesh during inguinal hernia repair. 相似文献
17.
Weyhe D Schmitz I Belyaev O Grabs R Müller KM Uhl W Zumtobel V 《World journal of surgery》2006,30(8):1586-1591
Background Mesh implantation is a standard procedure in hernia repair. It provides low recurrence rate but increases complication rate
due to foreign-body reaction induced by alloplastic materials in surrounding tissues. It is believed that biocompatibility
of meshes may be improved by reducing their weight per meter squared (m2) and altering the implant structure.
Aim The aim of this study was to evaluate the effect of weight and structure as determinants of mesh biocompatibility.
Method Thirty-six Wistar rats were studied. In 12 animals, conventional polypropylene (heavy) meshes (HM) were implanted; in other
12, material-reduced (light) microporous polypropylene meshes (LM); and the remaining 12 served as a sham-operated control
group. Meshes were explanted after 21 and 90 days (6 animals per group). All samples were examined by light and electron microscopies.
Integration of meshes in surrounding tissue, inflammatory response, fibrotic reactions, and structural changes were recorded.
Quantification of the inflammatory response was achieved by CD-68 marking of macrophages and counting their number per surface
unit.
Results After 21 days, there was no significant difference in thickness of surrounding connective tissue between meshes in all groups
studied. After 90 days, thickness of connective tissue decreased in both groups, and fibrotic reaction in the mesh bed was
significantly less in the HM group. Total amount of macrophages per millimeter squared (mm2) decreased with time in HM and LM samples but was significantly lower in the HM group on day 21 (43.5%) and day 90 (46.7%).
Conclusion This study found worse biocompatibility of LM compared with HM. Thus, the amount of implanted mesh was not the main determinant
of biocompatibility (expressed as successful incorporation and diminished foreign-body reaction) but the size of the pores. 相似文献
18.
Priv.-Doz. Dr. C. Langer P. Schwartz P. Krause H. Mohammadi B. Kulle A. Schaper L. Füzesi H. Becker 《Der Chirurg》2005,76(9):876-886
Background
The biocompatibility of meshes in hernia surgery seems to be influenced markedly by the amount of the selected material and its structure. Fibroblasts play a major key role during the process of mesh incorporation. This study was performed to investigate differences in cell morphology and proliferation of human fibroblasts cultured on different polypropylene meshes.Methods
In the present in vitro study the cellular response of human fibroblasts was investigated by scanning electron microscopy (SEM), comparing three different polypropylene meshes: a newly constructed low-weight and microporous mesh (NK1), a low-weight and macroporous mesh with absorbable polyglactin filaments (Vypro), and a heavy-weight and microporous mesh (BiomeshP1). Human fibroblasts (1,5·105 cells) were incubated with the meshes (each 12 mm2) for 6 hours, 5 days, 2, 4, 6, and 12 weeks. Computer-assisted morphometry of the fibroblast/mesh surface ratio served to reflect the biological cell response.Results
The Vypro mesh showed the significantly highest fibroblast density during the first 6 weeks, but cell growth was nearly exclusively limited to the polyglactin filaments. At 3 months, after reabsorption of the polyglactin, the fibroblast-coated polypropylene mesh surface was only 50% compared to NK1 and BiomeshP1. The morphologic aspect of the fibroblasts on the BiomeshP1 mesh was much more degenerative and unphysiological, compared to NK1 and Vypro, with isolated, single cells instead of a broad, connective growth. The BiomeshP1 showed a significantly higher fibroblast proliferation around the nodes of the mesh compared to the straight filaments. On the NK1 mesh fibroblasts exclusively proliferated on the filaments but not on the pressed mesh surface.Conclusions
The polymer surface and structure appears to be of major importance for the biocompatibility of meshes: human fibroblasts preferably grow on low-weight meshes, thin filaments, and mesh nodes. Heavy-weight meshes induce degenerative cell reactions. Polyglactin seems to further improve cell proliferation whereas a pressed mesh surface without pores hinders fibroblast growth. 相似文献19.
BACKGROUND: Despite numerous experimental studies, conducted most often with the open small-animal model, the ideal structure for a mesh with maximum biocompatibility in the intraabdominal region has yet to be found. To date, few experimental models have been concerned with the laparoscopic intraabdominal implantation of meshes. Numerous experimental and clinical studies appear to have identified expanded polytetrafluoroethylene (ePTFE), in the form of DualMesh, as the gold standard. Since publications have reported fistula formation and marked adhesions to be associated with the use of polypropylene meshes, only few studies have investigated meshes made of this material. It is known, however, that a reduction in the amount of material and an increase in pore size results in better mesh biocompatibility. METHODS: Six pigs each underwent laparoscopic intraabdominal placement of either a TiMesh or a DualMesh, both of which were prepared for implantation in standardized fashion. After 87 +/- 2 days, the pigs were killed, and postmortem laparoscopy was performed, followed by the removal of the tissue embedding the mesh for assessment of adhesions and shrinkage, and for histologic workup. The specimens were processed both histologically and immunohistochemically. RESULTS: In all but one case, the greater omentum adhered, usually over discrete areas, to the mesh. In every case the omentum was separable from the mesh surface only by sharp dissection. With the titanium-coated polypropylene meshes, the average total adhesion area was only 0.085, as compared with 0.25 for the GoreTex meshes (p = 0.055). The GoreTex meshes showed an average shrinkage to almost half of the original surface area (median, 0.435). The average shrinkage of the TiMesh, was to 0.18 of the original area (p = 0.006), which thus was significantly smaller. Determination of the partial volume of the inflammatory cells showed significantly lower median figures for the TiMesh (p = 0.009). Measurements of the proliferation marker Ki67 showed significantly higher values for ePTFE than for TiMesh (p = 0.011). The apoptosis index was significantly higher for the ePTFE membranes (p = 0.002). CONCLUSIONS: Titanium-coated polypropylene mesh (TiMesh) is clearly superior to the DualMesh in terms of biocompatibility, and is thus suitable for the laparoscopic intraperitoneal repair of abdominal wall and incisional hernias. 相似文献
20.
Karsten Junge Uwe Klinge Raphael Rosch Bernd Klosterhalfen Volker Schumpelick 《World journal of surgery》2008,26(12):1472
Inguinal hernia repair is one of the most
frequently performed operations. Next to conventional techniques, open
and laparoscopic tension-free methods using mesh implants to reinforce
the abdominal wall are increasingly carried out, even becoming the
standard procedure in many countries. Because of the benefits of
material-reduced meshes for incisional hernia repair, a new mesh
modification for tension-free inguinal hernia repair has been
developed. In the present study this new low-weight mesh (Vypro II)
made of polypropylene and polyglactin multifilaments was compared to a
common heavy-weight polypropylene mesh (Prolene) regarding their
functional consequences and the morphologic tissue response. After
implantation in rats as an inlay, abdominal wall mobility was recorded
by three-dimensional photogrammetry and the tensile strength of the
suture zone and the mesh itself was measured at 3, 21, and 90 days.
Explanted tissue samples have been investigated for their histologic
reaction in regard to the inflammatory infiltrate, vascularization, and
connective and fat tissue ingrowth. Numbers of granulocytes,
macrophages, fibroblasts, lymphocytes, and foreign giant body cells
have been evaluated to reflect the quality of the tissue response. The
cellular response was assessed by measuring DNA strand breaks and
apoptosis (TUNEL), proliferation (Ki67), and cell stress (HSP70). The
results indicated that restriction of abdominal wall mobility was
significantly reduced with Vypro II compared to that seen with
heavy-weight mesh modification, and the inflammatory reaction and
connective tissue formation were markedly diminished. Apoptosis and
cell proliferation showed considerably lowered levels, and expression
of cytoprotective HSP70 was significantly increased. The present study
thus confirms the benefits of material-reduced mesh modifications. The
new low-weight mesh (Vypro II) could be advantageous in inguinal hernia
repair. 相似文献