Junge Karsten, Binnebösel Marcel, Rosch Raphael, Jansen Marc, Kämmer Daniel, Otto Jens, Schumpelick Volker, Klinge Uwe
Department of Surgery, Technical University of Aachen, Pauwelsstrasse 30, 52057, Aachen, Germany.
Surg Endosc. 2009 Feb;23(2):327-33. doi: 10.1007/s00464-008-9923-y. Epub 2008 Apr 25.
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.
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.
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.
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.
有效的腹腔镜腹疝修补术需要使用腹腔内补片。内脏粘连和补片收缩可能会使修补术变得复杂。本研究的目的是比较一种由聚丙烯（PP）和聚偏二氟乙烯（PVDF）制成的新型双组分单丝网状结构在腹腔内放置后与现有替代材料相比的粘连形成、补片收缩和组织向内生长情况。
本研究使用了40只Sprague-Dawley大鼠。将补片样本仅作为腹腔内补片固定于右侧腹壁。研究组包括：PVDF+PP（聚丙烯在腹壁侧，聚偏二氟乙烯在内脏侧）、PP+Col（带有氧化胶原膜的聚丙烯）、ePTFE（内脏侧为光滑表面，腹壁侧为有纹理表面）以及PP（纯聚丙烯补片作为对照）。30天后取出补片。粘连情况按取出的生物材料受影响表面积的百分比进行评分；计算补片收缩情况。通过研究炎症浸润和纤维化组织形成的量来测量对补片材料的异物反应。
就粘连评分而言，纯PP补片的值最高，其次是ePTFE、PVDF+PP和PP+Col补片。粘连面积的定量评估显示，纯PP补片样本的值（62.0±22.1%）显著高于PP+Col补片（26.8±12.1%）和PVDF+PP补片（34.6±8.2%）。收缩百分比显示，ePTFE补片的值（52.4±13.9%）显著高于所有其他补片变体（PP+Col为19.8±13.9%，PVDF+PP为19.9±7.0%，PP为26.8±9.5%）。与所有其他补片样本相比，PVDF+PP补片组的炎症浸润显著减少。
与用于腹腔内放置的传统补片材料相比，由聚丙烯和聚偏二氟乙烯制成的新型双组分单丝网状结构在粘连形成和补片收缩方面表现良好。
