orabase and Hernia--Ventral

This study compared Parietex composite mesh (PCM) with Sepramesh (SM) in terms of strength of tissue incorporation, adhesion formation, and mesh shrinkage, using an animal model.. A two-phase, prospective, randomized study using 44 New Zealand white rabbits. Each animal underwent creation of a standardized ventral hernia defect, followed by repair using either SM or PCM. Half of each group was sacrificed and examined at 1 month, and the remainder at 5 months. Outcomes measurements were strength of incorporation (SOI), type and area of adhesions (AA), and mesh shrinkage.. SOI for PCM was much greater than for SM, both at 1 month (60.8 N versus 42.6 N) and 5 months (70.9 N versus 31.5 N). The incidence of bowel adhesions was lower with PCM than SM, both at 1 month (1 versus 6) and at 5 months (0 versus 4). At 5 months, PCM demonstrated lower AA, both as a percentage of the mesh (5.6% versus 12.8%) and in terms of absolute area involved (321 mm(2) versus 840 mm(2)). PCM underwent considerably more shrinkage than SM, at both 1 month (38.2% versus 18.1%) and 5 months (17.4% versus 6.1%).. PCM demonstrated a substantially stronger SOI, which improved over time, and SOI of SM decreased. PCM was also superior in terms of adhesion prevention, but underwent considerably more shrinkage in this experimental model.

Topics: Abdominal Wall; Animals; Carboxymethylcellulose Sodium; Collagen; Disease Models, Animal; Equipment Design; Hernia, Ventral; Hyaluronic Acid; Hydrogel, Polyethylene Glycol Dimethacrylate; Intestinal Diseases; Omentum; Peritoneal Diseases; Polyesters; Polypropylenes; Prospective Studies; Rabbits; Random Allocation; Surface Properties; Surgical Mesh; Time Factors; Tissue Adhesions

The purpose of this study was to compare the intra-abdominal adhesion formation following ventral hernia repair by using oxidized regenerated cellulose (ORC) as a barrier underneath polypropylene mesh (PPM), and sodium hyaluronate/carboxymethylcellulose (HA/CMC)-coated PPM.. A ventral abdominal defect was created in each of 30 male rats which were divided into three groups. In group 1 (control) the defect was repaired with PPM; in group 2 ORC was laid over the viscera and the defect was repaired with PPM, and in group 3 HA/CMC-coated PPM was used for the repairing procedure. On the 28th postoperative day all the rats were sacrificed and adhesions were evaluated by laparoscopic exploration followed by histopathological examination.. Animals treated with ORC and PPM, and HA/CMC-coated PPM showed significantly less adhesions than the control group (p = 0.026) and the intra-abdominal adhesions of the rats in these two groups were significantly easier to release than in the control group (p = 0.001). There was no significant difference between the ORC and HA/CMC groups.. ORC used together with PPM is as effective as HA/CMC-coated PPM and ORC can be used as an adhesion barrier in intra-abdominal hernia repair.

Topics: Adjuvants, Immunologic; Animals; Carboxymethylcellulose Sodium; Cellulose, Oxidized; Disease Models, Animal; Hemostatics; Hernia, Ventral; Hyaluronic Acid; Laparoscopy; Male; Rats; Rats, Sprague-Dawley; Surgical Mesh; Tissue Adhesions

Intraperitoneal placement of prosthetic mesh causes adhesion formation after laparoscopic incisional hernia repair. A prosthesis that prevents or reduces adhesion formation is desirable. In this study, 21 pigs were randomized to receive laparoscopic placement of plain polypropylene mesh (PPM), expanded polytetrafluoroethylene (ePTFE), or polypropylene coated on one side with a bioresorbable adhesion barrier (PPM/HA/CMC). The animals were sacrificed after 28 days and evaluated for adhesion formation. Mean area of adhesion formation was 14% (SD+/-15) in the PPM/HA/CMC group, 40% (SD+/-17) in the PPM group, and 41% (SD+/-39) in the ePTFE group. The difference between PPM/HA/CMC and PPM was significant ( P=0.013). A new visceral layer of mesothelium was present in seven out of seven PPM/HA/CMC cases, six out of seven PPM cases, and two out of seven ePTFE cases. Thus, laparoscopic placement of PPM/HA/CMC reduces adhesion formation compared to other mesh types used for laparoscopic ventral hernia repairs.

Topics: Abdominal Wall; Animals; Biocompatible Materials; Carboxymethylcellulose Sodium; Coated Materials, Biocompatible; Female; Hernia, Ventral; Hyaluronic Acid; Intestines; Laparoscopy; Peritoneal Diseases; Polypropylenes; Polytetrafluoroethylene; Surgical Mesh; Swine; Tissue Adhesions

Adhesions between viscera and mesh may result in intestinal obstruction and fistulae formation. Fewer adhesions with sodium carboxymethylcellulose (SCMC)-coated polypropylene mesh (PM) has been reported, but impaired wound healing was the major concern. We investigated the adhesion-prevention effect of SCMC in different concentrations, as coating only on visceral face of PM and its effects on wound healing. A full-thickness abdominal wall defect was created in 28 rats, which were then divided into three groups. In Group I (control), the defect was repaired with PM only; in Group II and Group III, the defects were repaired with 1% and 1.6% SCMC-coated-PM, respectively. All animals were sacrificed at day 30, and histological evaluation and adhesion scoring were done. Animals in the group in which 1.6% SCMC-coated PM was used developed significantly fewer adhesions compared with other animals (P=0.04). Histological evaluation using a semiquantitative scoring system showed no difference between the groups in fibrosis and inflammation scores (P=0.9 and P=0.3, respectively), and thickness of fibrosis on mesh was also similar (P=0.5). SCMC in 1.6% concentration as coating only on the visceral face of PM reduced the incidence and severity of adhesions without impairing wound healing.

Topics: Animals; Carboxymethylcellulose Sodium; Coated Materials, Biocompatible; Disease Models, Animal; Female; Hernia, Ventral; Laparotomy; Male; Polypropylenes; Postoperative Complications; Probability; Rats; Rats, Sprague-Dawley; Reference Values; Sensitivity and Specificity; Surgical Mesh; Tissue Adhesions; Wound Healing

Hyaluronate sodium in the form of a bioresorbant membrane reduces the development of intra-abdominal adhesions frequently found after implantation of synthetic mesh in the context of surgical hernia repair.. The effect of hyaluronate on the formation of adhesions was evaluated when applied laparoscopically as a bioresorbant membrane to protect the peritoneal surface of a synthetic mesh.. Experimental animal model.. A peritoneal defect 5 cm in diameter was bilaterally created in the abdominal wall of each of 9 pigs by laparoscopy. A polypropylene mesh was fixed with clips onto these defects on both sides. In each of the animals, only on one side, the synthetic mesh was also covered by a hyaluronate membrane.. The incidence and severity of adhesions (grade 0-4, where 0 indicates no adhesion; 1, filmy avascular adhesions; 2, vascular adhesions; 3, cordlike fibrous adhesions; and 4, plain fibrous adhesions) were determined after 45 days, comparing treated and untreated sides by autopsy results and histological features.. Adhesions, mainly grades 3 and 4, occurred in 7 of the 9 animals in those meshes not covered by hyaluronate; 2 untreated animals did not develop adhesions. On the other hand, only 1 of the 9 animals developed adhesions (grade 2) at the mesh concealed by the hyaluronate membrane.. The bioresorbant hyaluronate membrane significantly reduced the formation of peritoneal adhesions (1-sided sign test, P<.05) induced by the insertion of a polypropylene mesh, when compared with the contralateral implants not protected by hyaluronate. Thus, hyaluronate membranes are efficient for reducing the incidence of peritoneal adhesions.

Topics: Animals; Biocompatible Materials; Carboxymethylcellulose Sodium; Disease Models, Animal; Hernia, Ventral; Hyaluronic Acid; Incidence; Laparoscopy; Membranes, Artificial; Polypropylenes; Postoperative Complications; Severity of Illness Index; Surgical Mesh; Swine; Tissue Adhesions