丝素蛋白降低聚丙烯补片表面粘连的研究

目的 观察聚丙烯补片经丝素蛋白涂覆后,其表面粘连程度的变化,并探讨其作用机制.方法 将40只Sprague-Dawle大鼠随机分为两组,每组各20只.按组于腹腔内分别植入丝素蛋白涂覆聚丙烯材料(丝素面朝向腹腔,聚丙烯面朝向腹壁)和聚丙烯补片,于术后3、7、14、90 d分批处死大鼠,比较植入补片表面粘连程度及粘连面积,并行病理及扫描电镜检查.结果 丝素蛋白涂覆聚丙烯材料组,术后3、7、14、90d检查基本无腹腔内粘连形成,补片表面粘连面积占总面积的(6.04±4.78)%,粘连程度为(0.8±0.4);单纯聚丙烯组全部大鼠术后并发腹腔内粘连面积占总面积的(86.61±12.25)%,粘连程度为(3.4±0.6),有5只(5/20,25.0%)大鼠分别于术后2～9d因肠管与聚丙烯粘连引起肠梗阻或肠瘘死亡,两组的术后腹腔内粘连面积和粘连程度差异均存在统计学意义(P均<0.05).结论 丝素材料能促进腹膜间皮细胞长入,于聚丙烯补片表面腹膜化,形成新的间皮细胞层,可有效降低聚丙烯补片与腹腔内器官发生粘连的程度及范围.     

防粘连细菌纤维素复合补片动物模型的建立及实验研究

目的将防粘连细菌纤维素复合补片应用于大鼠实验中,进一步探索并验证该补片腹腔内的防粘连效果,为新型补片的研发提供理论基础。方法采用随机数字表法将48只成年Wistar大鼠平均分成2组(每组24例),分别为聚丙烯组(PP组)、防粘连复合补片组(PP/BC组)。每组再随机平均分成2个亚组(每组12例),即短期组(10 d)和长期组(60 d),分别予植入后10 d和60 d肉眼观察补片粘连情况,并取补片及其周围腹壁组织进行组织学观察,比较及评价各组补片的抗粘连效果。结果术后第10天,细菌纤维素复合补片防粘连评分明显优于聚丙烯补片(P0.05)。复合补片周围新生细胞外沉积较多(P0.05),腹腔侧有更明显的纤维结缔组织覆盖,较少的炎细胞浸润(P0.05)。术后第60天,细菌纤维素复合补片粘连评分与聚丙烯补片相比,差异无统计学意义(P0.05),炎细胞浸润较多、多核巨细胞浸润较少(P0.05)。结论细菌纤维素复合补片腹腔内修补的防粘连效果较佳,是一种潜在的腹腔内防粘连疝补片,但能否临床转化仍需进一步研究。     

复合型疝补片抗粘连动物实验研究

目的评价复合型疝补片在动物模型中的抗粘连作用。方法选用24头实验动物猪,通过腹腔镜在健康家猪腹壁上植入补片,其中12头植入复合型疝补片(研究组),12头植入普通聚丙烯补片(对照组),在术后1个月和3个月两次随访并统计分析补片粘连面积和粘连等级。结果术后1个月和3个月,复合型疝补片的粘连面积和等级均低于普通聚丙烯补片(P0.05)。复合型疝补片术后1个月和3个月的粘连面积和等级差异无统计学意义(P0.05)。结论实验动物模型表明,复合型疝补片抗粘连效果肯定。     

不同材质补片固定大鼠膈肌后的炎症反应、粘连及补片皱缩情况对比研究

背景与目的：食管裂孔疝是外科常见病症，临床上多采用补片以无张力修补的方式进行治疗。食管裂孔疝的补片修补中补片的选择及其应用效果方面的实验数据仍相对缺乏。因此，本研究通过在大鼠食道裂孔处膈肌组织上分别固定聚丙烯补片和复合补片，比较两种材质补片对周围组织的影响，以及自身皱缩情况，为临床食管裂孔疝补片的选择提供参考。方法：雄性SD大鼠在分离胃部与肝脏相连接组织显露胃食道裂孔后，分别用单丝缝线将轻量聚丙烯补片（聚丙烯补片组）或复合补片（复合补片组）固定于食道裂孔处膈肌组织，或不进行补片固定（假手术组）。分别在术后7、15、30 d时记录每组每只大鼠的体质量和饮食量。观察30 d后处死大鼠，分析补片皱缩程度、粘连强度以及膈肌组织的病理学变化。结果：各组大鼠手术前后的体质量及每天进食量均无明显的变化（均P>0.05）。复合补片组膈肌组织与补片的粘连范围及粘连程度分值均明显低于聚丙烯补片组（均P<0.05）；两组补片均出现皱缩，但复合补片组术后补片面积明显大于聚丙烯补片组，皱缩率明显低于聚丙烯补片组（均P<0.05）；与假手术组比较，聚丙烯补片组和复合补片组膈肌组织出现局部肌纤维萎...     

对腹腔内置疝修补补片动物实验的评价探讨

该文结合国家食品药品监督管理总局(CFDA)对腹腔内置疝修补补片的监管要求,对评价补片与腔内组织的粘连情况、新生腹膜情况的动物实验要素进行了阐述分析,为补片制造商、从事临床前动物实验的研究人员或医生提供了参考。     

三种新型复合材料修补大鼠腹壁缺损的研究

目的观察三种新型国产复合补片修补腹壁缺损的效果,客观评价三种补片的防粘连效果。方法 Wistar大鼠120只,采用完全随机方法随机分为4组:①聚丙烯(PP)+聚丙交己内酯(PLC)组;②PP+透明质酸(HA)/PLC组;③PP+胶原/PLC组;④PP+膨体聚四氟乙烯(e-PTFE)组,每组30只。切除直径约1cm的大鼠全层腹壁,以直径1.5cm的补片进行修补,分别于术后30、60、90及180d处死,每次处死5只,根据Nair评分标准进行粘连评分,并进行组织学检查。结果术后各组大鼠均未出现死亡,在各时间点均出现腹腔粘连,主要为网膜、肠管。术后各时间点,PP+胶原/PLC组粘连评分均低于PP+e-PTFE组(P<0.05)。PP+HA/PLC组和PP+PLC组粘连评分与PP+e-PTFE组相比差异无统计学意义(P>0.05)。组织学检查显示,术后各时间点,各组补片周围均有炎性细胞浸润和成纤维细胞出现及胶原分泌,随时间推移炎症细胞逐渐减少,成纤维细胞逐渐增多,胶原分泌增多。术后30d胶原及HA层消失,PLC层出现断裂,在术后180dPLC层尚未被完全吸收,在4种补片腹腔面均有细胞或组织覆盖,将补片与腹腔内容物隔离,胶原/PLC复合补片的隔离层的连续性最好。结论 PLC、HA/PLC和胶原/PLC三种国产复合补片在动物实验中均具有良好的防粘连效果,其中胶原/PLC复合补片的防粘连效果最佳,且价格低廉,适于大众普遍使用,临床应用前景良好。     

载有纳米银新型复合补片在污染条件下大鼠腹壁缺损修补中的运用

目的观察载有纳米银新型复合补片在污染条件下对大鼠腹壁缺损修补的应用效果,对其耐受感染和防粘连效果进行评价,进而探讨新型补片在感染条件下腹壁缺损一期修复中应用的可行性。方法成年雄性SD大鼠60只,体重200~280 g,随机分为普通聚丙烯补片组(A组)和新型纳米银复合补片组(B组),制备污染条件下大鼠腹壁缺损模型(缺损面积2 cm×2 cm),分别使用以上两种补片完成一期修复,术后对比观察两组大鼠一般情况及伤口愈合情况,术后30 d处死大鼠观察腹腔脏器粘连情况,同时切取补片及其周围组织进行病理学观察。结果术后30 d内共4只大鼠死亡,其中A组3只,B组1只,死亡原因与补片修补无关。切口愈合情况B组优于A组(P0.05),术后30 d二组均见腹腔脏器与补片粘连,主要为肠管、网膜,B组轻于A组,按照修正的Katada粘连评分方法,差异有统计学意义(P0.05);组织学观察,术后30 d,光镜下聚丙烯补片组依然有大量炎细胞浸润,可见毛细血管生长,成纤维细胞开始大量增生,胶原分泌增多,局部肉芽组织形成。新型纳米银复合补片组创面可见少量炎细胞浸润,成纤维细胞增生,胶原纤维和毛细血管大量增多,肉芽组织结构致密,成熟度高。结论新型纳米银复合补片在污染条件下腹壁缺损的一期修复中,具有更好的耐受感染、抗腹腔粘连特性,具有较好的临床应用前景,但其远期效果及生物安全性尚需进一步研究和评价。     

用于腹腔内疝修补术的复合补片:作用原理与产品综述

对腹壁疝进行腹腔内修补术时,需要补片贴近内脏的一侧具有降低粘连的功能,而贴近腹壁侧具有优异的组织长入性能。聚丙烯等经典疝修补材料具有优异的组织长入性能,在此类材料一侧复合隔离层用于降低与脏器的粘连,即为复合补片。早期的隔离层材料多为不可吸收材料,如膨体聚四氟乙烯。随着材料科学和临床技术的进步,可吸收材料的隔离层被广泛应用。本文回顾了粘连的发生机制、腹膜的修复机制和粘连的预防原理,介绍了目前已在我国批准上市的各种腹腔内置复合补片产品,供广大临床医生及研究者参考。     

部分可吸收腹壁疝修补材料的研究

目的 对聚丙烯网（polypropylene mesh，PPM）＋壳聚糖膜部分可吸收复合材料修补大鼠腹壁缺损的效果进行研究。方法 S-D大鼠80只，随机分为单纯PPM修补组（Ⅰ组），PPM＋壳聚糖膜复合材料修补组（Ⅱ组）和商品化防粘连复合补片组（Ⅲ组）。手术造成腹壁缺损，分别采用上述三种补片修补，术后分期进行腹腔内粘连评分，组织学检查及抗张强度的测定。结果 Ⅰ组大鼠术后各期腹腔粘连明显高于Ⅱ组及Ⅲ组（分别P〈0．05），而Ⅱ组及Ⅲ组之间差异无统计学意义（P〉0．05）。电镜下，术后90d观察，Ⅰ组网片表面新腹膜的生长不规则，Ⅱ组网片表面有光滑、完整的新腹膜间皮细胞形成，Ⅲ组网片表面则没有新腹膜形成，而是形成纤维素性包裹层。术后60、90d，三组网片修复腹壁缺损后的抗拉强度差异无统计学意义（P〉0．05）。结论 本研究中利用PPM与壳聚糖膜这两种廉价材料组合后设计的部分可吸收复合网片，可安全放置腹腔，能有效的防止术后的粘连，并维持良好的修复强度，值得进一步研究和开发。     

三种复合补片在污染环境下修补大鼠腹壁缺损的比较研究

目的观察聚丙交己内酯(polylactide-co-caprolactone,PLC)、透明质酸(hyaluronic acid,HA)、胶原蛋白与聚丙烯(polypropylene,PP)网片复合,在污染环境下修补大鼠腹壁缺损后粘连情况和修补效果,比较3种复合补片特点及一期修补可行性。方法成年雄性Wistar大鼠93只,体重150～250 g,随机分为3组(n=31):PP/PLC复合补片组(A组),PP/HA/PLC复合补片组(B组),PP/胶原蛋白/PLC复合补片组(C组)。各组取1只大鼠小肠制备污染源匀浆。其余大鼠制备直径约1 cm的腹壁疝模型后,根据分组将直径1.5 cm的复合补片缝合于腹壁缺损处。术后观察大鼠一般情况;于术后30、60、90 d处死大鼠,大体观察腹腔脏器粘连情况;切取补片及其周围组织进行组织学观察。结果术后10～70 d共6只大鼠死亡,其中A组2只,B组3只,C组1只;死亡原因均与补片修补无关。术后各时间点各组均见腹腔脏器与补片粘连,主要为肠管、网膜、肝。按照修正的Katada粘连评分方法,术后30、60 d各组间粘连评分比较,差异均无统计学意义(P>0.05);90 d时C组粘连评分显著低于A、B组(P<0.05)。组织学观察,术后30 d各组补片周围可见炎性细胞浸润,成纤维细胞出现且胶原分泌增加,可吸收材料残留;60 d时补片周围炎性细胞较前减少,成纤维细胞数量及胶原分泌较前增加,各组仅见PLC残留;90 d时成纤维细胞日趋成熟,可见胶原充填,腹腔面可见间皮层逐渐形成,各组残留PLC较前减少。结论 在污染环境下,PP/胶原蛋白/PLC复合补片在腹腔粘连及局部组织反应方面均优于PP/PLC及PP/HA/PLC复合补片,更适于一期修补大鼠腹壁缺损,但其远期效果及安全性仍待进一步确定。     

Prevention of adhesion to prosthetic mesh: comparison of different barriers using an incisional hernia model

OBJECTIVE: To assess whether use of antiadhesive liquids or coatings could prevent adhesion formation to prosthetic mesh. SUMMARY BACKGROUND DATA: Incisional hernia repair frequently involves the use of prosthetic mesh. However, concern exists about development of adhesions between viscera and the mesh, predisposing to intestinal obstruction or enterocutaneous fistulas. METHODS: In 91 rats, a defect in the muscular abdominal wall was created, and mesh was fixed intraperitoneally to cover the defect. Rats were divided in five groups: polypropylene mesh only (control group), addition of Sepracoat or Icodextrin solution to polypropylene mesh, Sepramesh (polypropylene mesh with Seprafilm coating), and Parietex composite mesh (polyester mesh with collagen coating). Seven and 30 days postoperatively, adhesions were assessed and wound healing was studied by microscopy. RESULTS: Intraperitoneal placement of polypropylene mesh was followed by bowel adhesions to the mesh in 50% of the cases. A mean of 74% of the mesh surface was covered by adhesions after 7 days, and 48% after 30 days. Administration of Sepracoat or Icodextrin solution had no influence on adhesion formation. Coated meshes (Sepramesh and Parietex composite mesh) had no bowel adhesions. Sepramesh was associated with a significant reduction of the mesh surface covered by adhesions after 7 and 30 days. Infection was more prevalent with Parietex composite mesh, with concurrent increased mesh surface covered by adhesions after 30 days (78%). CONCLUSIONS: Sepramesh significantly reduced mesh surface covered by adhesions and prevented bowel adhesion to the mesh. Parietex composite mesh prevented bowel adhesions as well but increased infection rates in the current model.     

Evaluation of seprafilm and amniotic membrane as adhesion prophylaxis in mesh repair of abdominal wall hernia in rats

INTRODUCTION: Adhesion formation following abdominal wall hernia repair with prosthetic mesh may lead to intestinal obstruction and enterocutaneous fistula. Physical barriers, namely, human amniotic membrane (HAM) or Seprafilm (Genzyme, Cambridge, Mass., USA), a bio-absorbable, translucent membrane composed of carboxymethylcellulose and hyaluronic acid, have been reported to prevent postsurgical intra-abdominal adhesions. OBJECTIVE: Evaluating the effect of HAM and Seprafilm in preventing adhesion formation in the rat model of ventral hernia repair with polypropylene mesh (PPM). MATERIAL AND METHODS: Sixty female Sprague-Dawley rats were divided into three groups. A full-thickness abdominal wall defect was created in each animal. Control animals had the PPM sutured into the defect, whereas in the other two groups, either HAM or Seprafilm were laid over the abdominal viscera before the repair with PPM. Half of the animals in each group were sacrificed on the 21st postoperative day. The remaining rats of the same group were re-operated on the 42nd day for investigation and measurement of the adhesion area in relation to the graft area. RESULTS: Direct mesh repair showed 52.8 and 56% area adhesion formation 3 and 6 weeks postoperatively, respectively. The HAM barrier covered with mesh repair demonstrated 0 and 0.96% area adhesion formation, and the Seprafilm-covered mesh repair showed 0 and 0% area adhesion formation 3 and 6 weeks postoperatively, respectively. Uncovered mesh showed a significantly larger adhesion area than both covered mesh (p = 0.001 and 0.001). Both HAM and Seprafilm were equally effective in preventing postoperative adhesions. CONCLUSIONS: HAM and Seprafilm proved to be an effective antiadhesive barrier in PPM repair of abdominal wall hernia.     

Fibrin glue reduces intra-abdominal adhesions to synthetic mesh in a rat ventral hernia model

Postoperative intra-abdominal adhesions are associated with significant morbidity and mortality. In this study, the effect of topical fibrin glue (FG) on adhesion formation in a rat model was investigated. Forty Sprague-Dawley male rats underwent midline laparotomy. Bilateral peritoneal-muscular abdominal wall defects were created and then replaced with premeasured soft tissue Goretex patches. Rats were randomized to FG sprayed over the patches or to a control group. Two observers blinded to the randomization assessed the severity of adhesions to the patch by scoring the density of adhesions (grades 0-3) and the percentage of the patch area covered by adhesions (0-100%). The mean percentage of the patch covered by adhesions was 32.8 +/- 6.1 per cent for the FG group versus 57.9 +/- 6.7 per cent for the control group (P < 0.01). The mean density of adhesions for the FG group was 0.95 (+/-0.17) versus 2.0 (+/-0.21) for the control group (P = 0.001). Topical FG reduces the severity and density of intra-abdominal adhesions in a rat model.     

Seprafilm reduces adhesions to polypropylene mesh

BACKGROUND: Adhesions to polypropylene mesh used for abdominal wall hernia repair may eventuate in intestinal obstruction or enterocutaneous fistula. A Seprafilm Bioresorbable Membrane translucent adhesion barrier has been shown to inhibit adhesions. This investigation was designed to determine if Seprafilm alters abdominal visceral adhesions to polypropylene mesh. METHODS: A 2.5-cm square abdominal muscle peritoneal defect was created and corrected with polypropylene mesh. Mesh alone was used in 17 rats. In another 17, the Seprafilm membrane was applied between the viscera and the mesh. Five animals had the bioresorbable membrane placed in the subcutaneous space and between the mesh and the viscera. Laparoscopy was performed 7, 14, and 28 days later to evaluate adhesions as a percentage of mesh surface involved. RESULTS: Polypropylene mesh alone was associated with adhesions in every rat. The average area involved was 90%, the minimum was 75%. Adhesions were present within 24 hours and progressed up to 7 days with no change thereafter. When the Seprafilm barrier was used, the mean area involved was 50%. In 16 such rats, the area involved was smaller than any control animal. No adhesions formed in 5 animals. Scanning electron microscopy demonstrated a mesothelial cell layer covering the mesh after 4 weeks. CONCLUSIONS: The use of the Seprafilm adhesion barrier resulted in a significant reduction of adhesion formation to polypropylene mesh (P <.001).     

Evaluation of sepramesh biosurgical composite in a rabbit hernia repair model

BACKGROUND: In cases such as incisional hernia repair, polypropylene mesh (PPM) can be exposed to the underlying viscera and cause adhesions to the mesh. In this study, a composite prosthesis that was designed to be less susceptible to adhesion formation than PPM was evaluated in a rabbit incisional hernia repair model. MATERIALS AND METHODS: A 5 x 7-cm full-thickness defect was created in the abdominal wall of 30 female New Zealand White rabbits. Ten animals each were repaired with PPM, Bard Composix (PP/ePTFE), or Sepramesh biosurgical composite-a polypropylene mesh coated on one side with chemically modified sodium hyaluronate and carboxymethylcellulose (HA/CMC). The animals were sacrificed after 28 days and the overall performance, including adhesion formation and tissue integration by histology and mechanical testing, was evaluated. RESULTS: In the Sepramesh group, there was a significant reduction in the percentage of surface area covered by adhesions and a significant increase in the percentage of animals with no adhesions compared to standard materials. The tissue integration strength and overall cellular response were similar in all groups. A partially remesothelialized peritoneal surface was often apparent overlying the Sepramesh implant. CONCLUSIONS: Sepramesh biosurgical composite effectively repaired abdominal wall defects in rabbits and reduced adhesion development to the mesh compared to the use of a PPM and a PP/ePTFE composite.     

Seprafilm reduces adhesions to polypropylene mesh and increases peritoneal hydroxyproline

Polypropylene mesh is an effective and widely used material in repairing abdominal wall defects, but it causes dense adhesions when in contact with abdominal viscera directly. As a consequence of this process intestinal obstruction and enterocutaneous fistula may develop. The purpose of the present study was to determine whether Seprafilm, a bioresorbable translucent membrane, reduces abdominal visceral adhesions to polypropylene mesh and whether Seprafilm has any effects on peritoneal tissue hydroxyproline levels. Twenty-six adult Wistar rats were used. A full-thickness abdominal wall defect was created and cecal abrasions were created to induce adhesion formation in each animal. All of the abdominal defects were repaired with polypropylene mesh. In addition a Seprafilm membrane was laid over the abdominal viscera in the Seprafilm group (n = 13). The abdominal cavity was evaluated for adhesion formation, and peritoneal biopsies were taken for the measurement of tissue hydroxyproline levels at the 14th day. The use of Seprafilm resulted in significant reduction in the adhesion formation (P = 0.002) and a significant increase in peritoneal hydroxyproline level (P < 0.0001). These findings demonstrate that the increase of peritoneal hydroxyproline levels caused by Seprafilm might play a role on the antiadhesive effects of Seprafilm.     

Peritoneal regeneration induced by an acellular bovine pericardial patch in the repair of abdominal wall defects

BACKGROUND: This study was to evaluate the feasibility of using an acellular bovine pericardium fixed with genipin (AGP) to repair an abdominal wall defect created in a rat model. MATERIALS AND METHODS: The glutaraldehyde-fixed acellular pericardium (AGA), the genipin-fixed cellular pericardium (GP), and a commercially available polypropylene mesh were used as controls. RESULTS: Gross examination at 3-month post-operatively revealed that dense adhesions to the visceral organs were observed for the polypropylene mesh and the AGA patch, while a filmy to dense adhesion was seen for the GP patch. In contrast, no adhesion to the visceral organs was observed for the AGP patch. Histologically, inflammatory cells were found mainly surrounding the GP patch. In contrast, host cells (inflammatory cells, fibroblasts, and neo-capillaries) were able to infiltrate into the AGA and AGP patches. Unlike the AGA patch, the AGP patch retrieved at 1-month post-operatively became well integrated with the host tissue near the suture line. Additionally, there were some mesothelial cells, identified by the van Gieson stain, observed on the AGP patch. At 3-month post-operatively, a neo-peritoneum was observed on the AGP patch. The neo-peritoneum consisted of organized vascularized connective tissues covered by an intact layer of mesothelial cells. The calcium contents of the polypropylene mesh and the AGA patch increased significantly at 3-month post-operatively, while those of the GP and AGP patches stayed minimal throughout the entire course of the study. CONCLUSIONS: The results obtained in the study revealed that the AGP patch effectively repaired abdominal wall defects in rats and successfully prevented the formation of post-surgical abdominal adhesions.     

Abdominal adhesions to prosthetic mesh evaluated by laparoscopy and electron microscopy

BACKGROUND: Most adhesion experiments involve observations at a single time point. We developed a method to evaluate abdominal adhesions to surgical mesh by sequential laparoscopy. STUDY DESIGN: An abdominal wall defect was created in rats and repaired with polypropylene mesh. Sequential laparoscopic evaluation of adhesion formation was performed in each animal. The percentage of mesh area involved was scored (0% to 100%). At various time intervals animals were sacrificed and samples were obtained for light and scanning electron microscopy. RESULTS: Adhesions were already present on day 1, increased by day 7, and did not progress thereafter. Mesh surfaces free of adhesions were covered with a confluent mesothelial cell layer, first seen by scanning electron microscopy on day 5 and complete by day 7. CONCLUSIONS: Intraabdominal adhesions are best studied by sequential laparoscopy. Adhesions develop within 1 day of prosthesis placement. Adhesion-free surfaces are carpeted with mesothelial cells by day 7 and remain free thereafter, for duration of study.     

Fibrin glue reduces the severity of intra-abdominal adhesions in a rat model

BACKGROUND: The purpose of this study was to determine whether fibrin glue inhibits intra-abdominal adhesions. METHODS: Twenty rats underwent midline laparotomy. To maximize adhesions, bilateral peritoneal muscular defects were created and covered with polypropylene mesh sewn with a braided suture. The bowel was abraded with dry gauze. Rats were randomized to either fibrin glue (FG) sprayed over the mesh or to control (no further treatment) groups. At 1 week, the adhesion density (graded 0 to 3), the percentage of the patch covered by adhesion (0% to 100%), and adhesion type were recorded. RESULTS: The mean adhesion density was 1.45+/-0.33 for FG versus 2.8+/-0.11 for controls (P = 0.001). The mean percentage of adhesions was 36+/-9.9 for the FG group and 94+/-3.7 for controls (P = 0.0002). Bowel or solid organs were adherent to the patch in 6 of 20 (30%) in the FG group versus 12 of 20 (70%) in controls (P = 0.057). CONCLUSIONS: Topical fibrin glue reduces the density and severity of intra-abdominal adhesions in a rat model.     

Prevention of adhesion formation to polypropylene mesh by collagen coating: A randomized controlled study in a rat model of ventral hernia repair

Introduction In laparoscopic incisional hernia repair with intraperitoneal mesh, concern exists about the development of adhesions between bowel and mesh, predisposing to intestinal obstruction and enterocutaneous fistulas. The aim of this study was to assess whether the addition of a collagen coating on the visceral side of a polypropylene mesh can prevent adhesion formation to the mesh.Method In 58 rats, a defect in the muscular abdominal wall was created, and a mesh was fixed intraperitoneally to cover the defect. Rats were divided in two groups; polypropylene mesh (control group) and polypropylene mesh with collagen coating (Parieten mesh). Seven and 30 days postoperatively, adhesions and amount and strength of mesh incorporation were assessed. Wound healing was studied by microscopy.Results With Parieten mesh, the mesh surface covered by adhesions was reduced after 30 days (42% vs 69%, p = 0.01), but infection rate was increased after both 7 (p = 0.001) and 30 days (p = 0.03), compared to the polypropylene group with no mesh infections. If animals with mesh infection were excluded in the analysis, the mesh surface covered by adhesions was reduced after 7 days (21% vs 76%, p = 0.02), as well as after 30 days (21 vs 69%, p < 0.001). Percentage of mesh incorporation was comparable in both groups. Mean tensile strength of mesh incorporation after 30 days was higher with Parieten mesh.Conclusion Although the coated Parieten mesh was more susceptible to mesh infection in the current model, a significant reduction of adhesion formation was still seen with the Parieten mesh after 30 days, with comparable mesh incorporation in the abdominal wall.