Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA.
Surg Endosc. 2011 Oct;25(10):3405-13. doi: 10.1007/s00464-011-1741-y. Epub 2011 May 19.
The objective of this study was to determine the acute and chronic fixation strengths achieved by fibrin or polyethylene glycol (PEG) sealants to secure biologic mesh at the esophageal hiatus in a porcine model.
For this study, 32 female domestic pigs were divided into four groups of 8 each. The four groups respectively received acute fibrin sealant, acute PEG sealant, chronic fibrin sealant, and chronic PEG sealant. Laparoscopically, a 5.5 × 8.5-cm piece of Biodesign Surgisis Hiatal Hernia Graft (porcine small intestine submucosa) was oriented with the U-shaped cutout around the gastroesophageal junction and the short axis in the craniocaudal direction to simulate hiatal reinforcement with a biologic mesh. The mesh then was secured with 2 ml of either fibrin sealant or PEG sealant. The pigs in the acute groups were maintained alive for 2 h to allow for complete polymerization of the sealants, and the pigs in the chronic group were maintained alive for 14 days. After the pigs were euthanized, specimens of the mesh-tissue interface were subjected to lap shear testing to determine fixation strength, and hematoxylin and eosin (H&E) stained slides were evaluated for evidence of remodeling.
No significant differences were observed between the acute and chronic fixation strengths or the remodeling characteristics of the two sealants. However, fixation strength increased significantly over time for both types of sealant. Evidence of remodeling also was significantly more pronounced in the chronic specimens than in the acute specimens.
This study demonstrated the feasibility of using fibrin or PEG sealants to secure biologic mesh at the hiatus in a porcine model.
本研究旨在确定纤维蛋白或聚乙二醇（PEG）密封剂在猪模型中固定生物网于食管裂孔的急性和慢性固定强度。
在这项研究中，将 32 只雌性家猪分为四组，每组 8 只。四组分别接受急性纤维蛋白密封剂、急性 PEG 密封剂、慢性纤维蛋白密封剂和慢性 PEG 密封剂。腹腔镜下，将一块 5.5×8.5cm 的 Biodesign Surgisis 食管裂孔疝补片（猪小肠黏膜下层）定向放置，U 形切口环绕胃食管交界处，短轴沿头侧至尾侧方向，模拟生物网增强食管裂孔。然后用 2ml 纤维蛋白密封剂或 PEG 密封剂固定网。急性组的猪存活 2 小时，以使密封剂完全聚合，慢性组的猪存活 14 天。猪被安乐死后，取网-组织界面标本进行搭接剪切试验，以确定固定强度，并对苏木精和伊红（H&E）染色切片进行评价，以评估重塑的证据。
两种密封剂的急性和慢性固定强度或重塑特征之间无显著差异。然而，两种类型的密封剂的固定强度随时间显著增加。慢性标本中的重塑证据也明显比急性标本更明显。
本研究证明了使用纤维蛋白或 PEG 密封剂在猪模型中固定生物网于食管裂孔的可行性。
