García-Moreno F, Sotomayor S, Pérez-López P, Pérez-Köhler B, Bayon Y, Pascual G, Bellón J M
Department of Surgery, Medical and Social Sciences, Faculty of Medicine, University of Alcalá, Ctra. Madrid-Barcelona, Km 33,600, 28871, Alcalá de Henares, Madrid, Spain.
Surg Endosc. 2014 Dec;28(12):3479-88. doi: 10.1007/s00464-014-3633-4. Epub 2014 Jun 27.
The most common treatment option for ventral and umbilical hernias is the implant of a prosthetic mesh. This study compares the behaviour of a new mesh, Parietex™ Composite Ventral Patch (Ptx), with two commercially available meshes, Ventralex™ ST Hernia Patch and Proceed™ Ventral Patch.
The following meshes were tested in a umbilical-hernia repair model using 54 rabbits: Ventralex™ ST Hernia Patch (Vent) (Bard Davol Inc., USA); Proceed™ Ventral Patch (PVP) (Ethicon, USA) and Ptx (Covidien, Sofradim, France) (n = 18 each). At 3, 7 and 14 days postimplantation, peritoneal behaviour and adhesion formation were assessed by sequential laparoscopy. Adhesions were scored for consistency and quantified by image analysis. The animals were euthanized at 2 (n = 27) and 6 weeks (n = 27) postsurgery. Mesothelial cover of meshes and tissue ingrowth were determined by scanning and light microscopy.
Seroma was observed in 1/18 Vent, 7/18 PVP and 4/18 Ptx, mainly between the implant and subcutaneous tissue. Firm omental adhesions between the mesh and parietal peritoneum were noted in 2/9 Vent, 6/9 PVP and 3/9 Ptx at 2 weeks and in 3/9 Vent, 5/9 PVP and 1/9 Ptx at 6 weeks. Three (out of 9) encapsulated PVP implants showed "tissue-integrated" adhesions affecting the intestinal loops. No differences between implants were detected in the surface area occupied by adhesions at 2 weeks, though at 6 weeks, percentages were significantly higher (p < 0.01; Mann-Whitney U test) for PVP compared to Ptx or Vent. At this time point, Ptx and Vent showed good host tissue incorporation and optimal mesothelialization.
The PVP implants showed greater adhesion formation than the other materials. Postimplantation behaviour was comparable for Ptx and Vent including scarce adhesion formation and optimal mesothelialization. Regarding tissue integration, Ptx showed greater long-term collagenization of the neoformed tissue.
腹疝和脐疝最常见的治疗选择是植入人工合成补片。本研究比较了一种新型补片Parietex™复合腹侧补片（Ptx）与两种市售补片Ventralex™ ST疝修补补片和Proceed™腹侧补片的性能。
使用54只兔子在脐疝修复模型中对以下补片进行测试：Ventralex™ ST疝修补补片（Vent）（美国巴德戴维公司）；Proceed™腹侧补片（PVP）（美国爱惜康公司）和Ptx（法国柯惠医疗旗下索法迪姆公司）（每组n = 18）。在植入后3、7和14天，通过连续腹腔镜检查评估腹膜性能和粘连形成情况。对粘连的稠度进行评分，并通过图像分析进行量化。在术后2周（n = 27）和6周（n = 27）对动物实施安乐死。通过扫描电子显微镜和光学显微镜确定补片的间皮覆盖和组织长入情况。
在Vent组1/18、PVP组7/18和Ptx组4/18中观察到血清肿，主要出现在植入物与皮下组织之间。在2周时，Vent组2/9、PVP组6/9和Ptx组3/9的补片与壁腹膜之间出现牢固的网膜粘连，在6周时，Vent组3/9、PVP组5/9和Ptx组1/9出现此类粘连。9个包裹性PVP植入物中有3个显示“组织整合性”粘连影响肠袢。在2周时，未检测到植入物之间粘连所占表面积的差异，但在6周时，与Ptx或Vent相比，PVP的粘连百分比显著更高（p < 0.01；Mann-Whitney U检验）。此时，Ptx和Vent显示出良好的宿主组织整合和最佳的间皮化。
PVP植入物比其他材料显示出更多的粘连形成。Ptx和Vent的植入后性能相当，包括粘连形成少和间皮化良好。在组织整合方面，Ptx显示新形成组织的长期胶原化程度更高。
