Winny Markus, Maegel Lavinia, Grethe Leonie, Lippmann Torsten, Jonigk Danny, Schrem Harald, Kaltenborn Alexander, Klempnauer Juergen, Poehnert Daniel
Department of General, Abdominal and Transplantation Surgery, Hannover Medical School, Germany.
Institute of Pathology, Hannover Medical School, Germany.
Int J Med Sci. 2016 Nov 23;13(12):936-941. doi: 10.7150/ijms.16215. eCollection 2016.
: Adhesions to intraperitoneally implanted meshes (IPOM) are a common problem following hernia surgery and may cause severe complications. Recently, we showed that missing peritoneal coverage of the intestine is a decisive factor for adhesion formation and 4DryField PH (4DF) gel significantly prevents intestine-to-mesh adhesions even with use of uncoated Ultrapro polypropylene mesh (UPM). The present study investigates adhesion prevention capability of coated Parietex mesh (PTM) and Proceed mesh (PCM) in comparison to 4DF treated UPM. : 20 rats were randomized into two groups. A 1.5 x 2 cm patch of PTM or PCM was attached to the abdominal wall and the cecum was depleted from peritoneum by abrasion. After seven days incidence of intestine-to-mesh adhesions was evaluated using Lauder and Hoffmann adhesion scores. Histological specimens were evaluated; statistics were performed using student's t-test. The data were compared with recently published data of 4DF treated uncoated UPM. : Use of PTM or PCM did not significantly diminish development of intestine-to-mesh adhesions (adhesion reduction rate PTM: 29%, p = 0.069 and PCM: 25%, p = 0.078). Histological results confirmed macroscopic finding of agglutination of intestine and abdominal wall with the mesh in between. Compared to these data, the use of UPM combined with 4DF gel reveals significantly better adhesion prevention capability (p < 0.0001) as shown in earlier studies. However, in clinical situation interindividual differences in adhesion induction mechanisms cannot be excluded by this experimental approach as healing responses towards the different materials might vary. : This study shows that in case of impaired intestinal peritoneum coated PTM and PCM do not provide significant adhesion prevention. In contrast, use of UPM combined with 4DF gel achieved a significant reduction of adhesions. Hence, in case of injury of the visceral peritoneum, application of a polysaccharide barrier device such as 4DF gel might be considered more effective in reducing intestine-to-mesh adhesions than coated mesh devices.
腹腔内植入补片（IPOM）后的粘连是疝修补术后常见的问题，可能导致严重并发症。最近，我们发现肠管腹膜覆盖缺失是粘连形成的决定性因素，4DryField PH（4DF）凝胶即使在使用未涂层的Ultrapro聚丙烯补片（UPM）时也能显著预防肠管与补片的粘连。本研究比较了涂层Parietex补片（PTM）和Proceed补片（PCM）与4DF处理的UPM预防粘连的能力。将20只大鼠随机分为两组。将一片1.5×2 cm的PTM或PCM贴于腹壁，通过摩擦去除盲肠的腹膜。7天后，使用劳德和霍夫曼粘连评分评估肠管与补片粘连的发生率。对组织学标本进行评估；采用学生t检验进行统计学分析。将这些数据与最近发表的4DF处理的未涂层UPM的数据进行比较。使用PTM或PCM并没有显著减少肠管与补片粘连的发生（粘连减少率PTM：29%，p = 0.069；PCM：25%，p = 0.078）。组织学结果证实了宏观上肠管与腹壁粘连且中间有补片的发现。与这些数据相比，如早期研究所示，UPM联合4DF凝胶的使用显示出显著更好的预防粘连能力（p < 0.0001）。然而，在临床情况下，这种实验方法无法排除个体间粘连诱导机制的差异，因为对不同材料的愈合反应可能不同。本研究表明，在肠腹膜受损的情况下，涂层PTM和PCM不能提供显著的粘连预防效果。相比之下，UPM联合4DF凝胶的使用显著减少了粘连。因此，在内脏腹膜损伤的情况下，应用多糖屏障装置如4DF凝胶可能比涂层补片装置在减少肠管与补片粘连方面更有效。
