Reynvoet E, Chiers K, Van Overbeke I, Troisi R, Berrevoet F
Department of General and Hepatobiliary Surgery and Liver Transplantation Service, Ghent University Hospital and Medical School, De Pintelaan 185 2K12-IC, 9000, Ghent, Belgium.
Department of Pathology, Bacteriology and Poultry Diseases, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium.
Hernia. 2015 Dec;19(6):955-63. doi: 10.1007/s10029-015-1368-3. Epub 2015 Mar 20.
Although clinical data on long-term efficacy are lacking, the use of self-expanding devices for intraperitoneal placement in the management of small midline hernias has been popularized. In the present experimental study, two different devices were investigated regarding tissue ingrowth, adhesion formation and solid mesh placement.
Two devices of 4.3 cm diameter, one ePTFE-containing small pore polypropylene mesh (PP/ePTFE) and a multi-layered large-pore polypropylene patch with an oxidized cellulose anti-adhesive barrier (PP/ORC), both containing a self-deployment system, were placed intraperitoneally at the linea alba of 24 female pigs. A first laparoscopy was performed to evaluate mesh positioning against the abdominal wall. 1 (n = 6), 2 (n = 6), 4 (n = 6) and 12 weeks (n = 6) later, mesh appearance was inspected and adhesion formation was assessed. All meshes were excised for histological evaluation.
Folding of the patch was more frequently observed at PP/ePTFE, yet no excessive cupping was noticed. Adhesions predominantly presented at short-term evaluation. Overall adhesion formation at all samples was significantly more extensive for PP/ORC (p = 0.048). Massive shrinkage was observed for PP/ORC: after a 12-week period 22% residual surface was preserved, compared to 83% for PP/ePTFE (p < 0.001). While at short-term inflammatory reaction was comparable, at long-term PP/ORC induced a significant more pronounced inflammatory and foreign body reaction.
Although a strong deployment system provides adequate initial placement, shrinkage and excessive adhesion formation are much more prominent in the large-pore multi-layered restorbable devices compared to the ePTFE patch. This might influence long-term clinical outcome and caution seems warranted.
尽管缺乏长期疗效的临床数据，但自膨式装置用于腹膜内放置治疗中线小疝已得到推广。在本实验研究中，对两种不同装置在组织长入、粘连形成和固体补片放置方面进行了研究。
将两个直径4.3厘米的装置，一个含ePTFE的小孔聚丙烯网片（PP/ePTFE）和一个带有氧化纤维素抗粘连屏障的多层大孔聚丙烯补片（PP/ORC），二者均包含自展开系统，放置于24头雌性猪的白线处腹膜内。首次腹腔镜检查用于评估补片相对于腹壁的定位。1周（n = 6）、2周（n = 6）、4周（n = 6）和12周（n = 6）后，检查补片外观并评估粘连形成情况。切除所有补片进行组织学评估。
PP/ePTFE补片更频繁地出现折叠，但未观察到过度凹陷。粘连主要出现在短期评估中。PP/ORC所有样本的总体粘连形成明显更广泛（p = 0.048）。观察到PP/ORC有大量收缩：12周后保留22%的剩余表面，而PP/ePTFE为83%（p < 0.001）。虽然短期炎症反应相当，但长期来看PP/ORC引发的炎症和异物反应明显更显著。
尽管强大的展开系统能提供足够的初始放置，但与ePTFE补片相比，大孔多层可吸收装置中的收缩和过度粘连形成更为突出。这可能影响长期临床结果，似乎有必要谨慎对待。
