Duffy A J, Hogle N J, LaPerle K M, Fowler D L
Minimal Access Surgery Center Department of Surgery, Weill Medical College of Cornell University, New York, NY, USA.
Hernia. 2004 Dec;8(4):358-64. doi: 10.1007/s10029-004-0258-x.
Laparoscopic ventral hernia repair uses tacks to secure mesh. The mesh is designed to maximize tissue ingrowth while minimizing adhesions. We hypothesized: (1) a collagen-coated polyester mesh (PCO) will form fewer adhesions than an ePTFE-polypropylene composite (BC) and (2) absorbable tacks are equivalent to metal tacks.
In a porcine model of adhesion formation, three pieces of 10x15-cm mesh were placed on the anterior abdominal wall. PCO was secured with absorbable (PLA) or metal tacks (PT), BC with PT. At 28 days, adhesion formation, abdominal-wall adherence, and tissue ingrowth were analyzed.
PCO induced fewer adhesions (14.5% vs 53.4%, P = 0.007). On an adhesion scale (0 5), BC scored 3.6 vs 1.75 for PCO (P < 0.03). There was no difference in adhesion strength, tack adhesions, or abdominal-wall peel force. Histology showed equal ingrowth.
PCO induces fewer adhesions than BC. There is no difference in the ingrowth of the two mesh types. The PLA achieves equivalent mesh incorporation to the PT.
腹腔镜腹疝修补术使用钉合器固定补片。补片的设计旨在使组织向内生长最大化，同时使粘连最小化。我们假设：（1）胶原涂层聚酯补片（PCO）形成的粘连比ePTFE-聚丙烯复合材料（BC）少；（2）可吸收钉合器与金属钉合器等效。
在猪粘连形成模型中，将三块10×15厘米的补片放置在前腹壁上。PCO用可吸收（聚乳酸）或金属钉合器（PT）固定，BC用PT固定。在28天时，分析粘连形成、腹壁粘连和组织向内生长情况。
PCO诱导的粘连较少（14.5%对53.4%，P = 0.007）。在粘连评分量表（0至5）上，BC评分为3.6，而PCO为1.75（P < 0.03）。粘连强度、钉合器粘连或腹壁剥离力无差异。组织学显示向内生长情况相同。
PCO诱导的粘连比BC少。两种补片类型的向内生长无差异。聚乳酸钉合器在补片固定方面与金属钉合器等效。
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