Department of Surgery Innenstadt, Klinikum der Universität München, Nussbaumstrasse 20, 80336, Munich, Germany.
Surg Endosc. 2013 Jun;27(6):1991-6. doi: 10.1007/s00464-012-2699-0. Epub 2013 Jan 9.
In this study, we evaluate a new bioadhesive for intra-abdominal onlay mesh fixation of a polypropylene-polyvinylchloride graft.
Three pieces of a commercially available polypropylene/polyvinylfluoride mesh, each 3 × 3 cm in size, and three pieces of the same mesh coated with a polysaccharide bioadhesive were fixated to the surface of the anterior abdominal wall of 30 New Zealand white rabbits. The fixation was performed either by using four transabdominal Prolene(®) 4/0 sutures, four spiral tacks (Protack 5 mm Tyco), or cyanoacrylate glue (Glubran(®) GEM, Viareggio, Italy). Each mesh position and the according kind of fixation were randomized before implantation. The animals were sacrificed 12 weeks postoperatively. After determining the extent of intra-abdominal adhesions, the meshes were excised en bloc with the anterior abdominal wall for tensile strength measurements and histological analysis.
All meshes coated with the bioadhesive adhered to the intact peritoneum without extra fixation. Irrespective of the fixation technique coated meshes led to more and stronger adhesions. Mesh shrinkage by scarring was increased in coated meshes fixed with glue and low in uncoated meshes fixed with tacks. Testing the tensile strength, coated meshes fixed with transfascial sutures achieved the best results (16.14 ± 6.1 N), whereas coated meshes fixed with glue showed the lowest strength (10.39 ± 4.81 N). The foreign body reaction was considerably more distinctive using coated mesh. The mesh ingrowth was not influenced by this reaction.
All meshes coated with the new bioadhesive were self-adhesive in that way; they stayed in position when attached to the peritoneum. Although this may facilitate intra-operative mesh fixation, the bioadhesive displayed several disadvantages, such as stronger adhesions and an increased shrinkage of the implant. The tensile strength was not influenced by the use of the bioadhesive. At present, we see no major advantage for polysaccharide bioadhesive applied in this study.
本研究评估了一种新型生物黏附剂在聚丙烯-聚氯乙烯移植物腹腔内覆盖固定中的应用。
将 3 块商业上可获得的 3×3cm 大小的聚丙烯/聚氯乙烯网片和 3 块涂有多糖生物黏附剂的相同网片固定在 30 只新西兰白兔的前腹壁表面。采用 4 根经腹 Prolene（®）4/0 缝线、4 个螺旋钉（Protack 5mm Tyco）或氰基丙烯酸酯胶（Glubran（®）GEM，维亚雷焦，意大利）进行固定。每种网片位置和相应的固定方式在植入前均进行随机化。术后 12 周处死动物。确定腹腔内粘连程度后，整块切除带前腹壁的网片，进行拉伸强度测量和组织学分析。
所有涂有生物黏附剂的网片均无需额外固定即可黏附于完整的腹膜上。无论采用何种固定技术，涂有生物黏附剂的网片均导致更多和更强的粘连。涂有生物黏附剂且用胶固定的网片的网片收缩性瘢痕增加，而未涂有生物黏附剂且用螺旋钉固定的网片的网片收缩性瘢痕减少。测试拉伸强度时，经腹缝线固定的涂有生物黏附剂的网片获得最佳结果（16.14±6.1N），而用胶固定的涂有生物黏附剂的网片显示出最低的强度（10.39±4.81N）。使用涂有生物黏附剂的网片时，异物反应明显更为明显。但网片的内生长不受此反应影响。
所有涂有新型生物黏附剂的网片均具有自黏附性，当附着于腹膜时可以保持位置。尽管这可能便于术中固定网片，但生物黏附剂存在几个缺点，如粘连更强和植入物收缩增加。生物黏附剂的使用并未影响拉伸强度。目前，我们在这项研究中没有看到多糖生物黏附剂的主要优势。
