Schreinemacher Marc H F, van Barneveld Kevin W Y, Dikmans Rieky E G, Gijbels Marion J J, Greve Jan-Willem M, Bouvy Nicole D
Department of General Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands,
Surg Endosc. 2013 Nov;27(11):4202-9. doi: 10.1007/s00464-013-3021-5. Epub 2013 Jun 8.
Laparoscopic incisional hernia repair with intraperitoneal mesh is associated with a certain degree of adhesion formation to the mesh. This experimental study examined the efficacy of several coated meshes for adhesion reduction.
Five commercially available meshes with a layered coating were placed intraperitoneally in rats and followed up for 90 days: polypropylene and polyester meshes, both coated with absorbable collagen (Parietene Composite and Parietex Composite, respectively), and three polypropylene meshes respectively coated with absorbable omega-3 fatty acids (C-Qur Edge), absorbable cellulose (Sepramesh IP), and nonabsorbable expanded polytetrafluoroethylene (Intramesh T1). Uncoated polypropylene and collagen meshs (Parietene and Permacol, respectively) served as the control condition. Adhesions, incorporation, and tissue reaction were evaluated macro- and microscopically. Additionally, the development of the neoperitoneum was examined.
All the coated meshes performed equally well in terms of adhesion reduction. The collagen mesh performed comparably, but the uncoated polypropylene mesh performed significantly worse. The different coatings led to very differing degrees of inflammation. Ingrowth was observed only at the place of suture but was comparable for all the meshes except C-Qur Edge, which showed the weakest incorporation. Development of a neoperitoneum on the mesh surface occurred independently of whether an absorbable or nonabsorbable coating or no coating at all was present.
Commercially available meshes with a layered coating deliver comparable adhesion reduction. The physical presence of a layered coating between the intraperitoneal content and the abdominal wall seems to be more important than the chemical properties of the coating in adhesion formation.
腹腔镜切口疝修补术中使用腹膜内补片会导致补片形成一定程度的粘连。本实验研究旨在探讨几种涂层补片在减少粘连方面的效果。
将五种具有分层涂层的市售补片置于大鼠腹腔内，并随访90天：聚丙烯和聚酯补片，分别涂有可吸收胶原蛋白（分别为Parietene Composite和Parietex Composite），以及三种聚丙烯补片，分别涂有可吸收的ω-3脂肪酸（C-Qur Edge）、可吸收纤维素（Sepramesh IP）和不可吸收的膨化聚四氟乙烯（Intramesh T1）。未涂层的聚丙烯和胶原蛋白补片（分别为Parietene和Permacol）作为对照。通过宏观和微观评估粘连、补片整合及组织反应。此外，还检查了新腹膜的形成情况。
在减少粘连方面，所有涂层补片的表现相当。胶原蛋白补片表现类似，但未涂层的聚丙烯补片表现明显较差。不同涂层导致的炎症程度差异很大。仅在缝合处观察到补片长入，除C-Qur Edge（其补片整合最弱）外，所有补片的长入情况相当。补片表面新腹膜的形成与是否存在可吸收或不可吸收涂层或无涂层无关。
具有分层涂层的市售补片在减少粘连方面效果相当。腹膜内容物与腹壁之间分层涂层的物理存在似乎比涂层的化学性质在粘连形成中更重要。
