Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box #8109, St. Louis, MO 63110, USA.
Hernia. 2011 Dec;15(6):677-84. doi: 10.1007/s10029-011-0834-9. Epub 2011 May 24.
The purpose of this study is to evaluate the histologic response to fibrin sealant (FS) as an alternative fixation method for laparoscopic ventral hernia repair.
One non-absorbable barrier mesh (Composix™) and three absorbable barrier meshes (Sepramesh™, Proceed™, and Parietex™ Composite) were used for the study, with uncoated macroporous polypropylene mesh (ProLite Ultra™) as the control. Three methods of fixation were used: #0-polypropylene suture + FS (ARTISS™, Baxter Healthcare Corp.), FS alone (ARTISS™), or tacks alone (n = 10 for each group). Two pieces of mesh (of dimensions 4 × 4-cm) were secured intraperitoneally in 75 New Zealand white rabbits. After 8 weeks, hematoxylin and eosin (H&E)-stained specimens were evaluated for host tissue response. Statistical significance (P < 0.05) was determined using a one-way analysis of variance (ANOVA) with Fisher's least significant difference (LSD) post hoc test.
Composix™ with FS only showed significantly greater cellular infiltration than with suture + FS (P = 0.0007), Proceed™ with FS only had significantly greater neovascularization than with suture + FS (P = 0.0172), and ProLite Ultra™ with suture + FS had significantly greater neovascularization than with tacks only (P = 0.046). Differences due to mesh type showed that Composix™ exhibited less extensive cellular infiltration (P ≤ 0.0032), extracellular matrix (ECM) deposition, and neovascularization, and demonstrated less inflammatory cells and more fibroblasts compared to the other meshes (P < 0.05).
FS did not have a significant histologic effect compared to tacks when utilized for the fixation of mesh to the peritoneum of New Zealand White rabbits. However, the mesh type did have a significant histologic effect. The permanent barrier mesh (Composix™) was associated with less histologic incorporation than absorbable barrier and macroporous meshes, as evidenced by lower levels of cellular infiltration, ECM deposition, and neovascularization, independent of the fixation method used.
本研究旨在评估纤维蛋白密封剂（FS）作为腹腔镜腹疝修补术替代固定方法的组织学反应。
本研究使用了一种不可吸收的屏障网（Composix™）和三种可吸收的屏障网（Sepramesh™、Proceed™和 Parietex™Composite），并将未涂层的大孔聚丙烯网（ProLite Ultra™）作为对照。使用了三种固定方法：#0 聚丙烯缝线+FS（ARTISS™，Baxter Healthcare Corp.）、FS 单独使用（ARTISS™）或单独使用钉（每组 10 个）。将两块尺寸为 4×4cm 的网片在 75 只新西兰白兔的腹腔内固定。8 周后，用苏木精和伊红（H&E）染色标本评估宿主组织反应。采用单因素方差分析（ANOVA）和 Fisher 最小显著差异（LSD）事后检验确定统计学意义（P<0.05）。
仅用 FS 的 Composix™显示出比缝线+FS 显著更高的细胞浸润（P=0.0007），仅用 FS 的 Proceed™显示出比缝线+FS 显著更高的新生血管形成（P=0.0172），而缝线+FS 的 ProLite Ultra™比仅用钉固定具有显著更高的新生血管形成（P=0.046）。由于网片类型的差异，Composix™显示出较低的细胞浸润（P≤0.0032）、细胞外基质（ECM）沉积和新生血管形成，与其他网片相比，表现出较少的炎性细胞和更多的成纤维细胞（P<0.05）。
与钉固定相比，FS 用于固定新西兰白兔腹膜上的网片时，组织学效果并不显著。然而，网片类型确实有显著的组织学影响。永久性屏障网（Composix™）与可吸收屏障和大孔网相比，组织学整合程度较低，表现为细胞浸润、ECM 沉积和新生血管形成水平较低，这与使用的固定方法无关。
