Department of Surgery, Erasmus MC, Rotterdam, The Netherlands.
Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
Br J Surg. 2017 Dec;104(13):1884-1893. doi: 10.1002/bjs.10635. Epub 2017 Sep 13.
The use of synthetic mesh to repair a potentially contaminated incisional hernia may lead to higher failure rates. A biological mesh might be considered, but little is known about long-term results. Both biological and synthetic meshes were investigated in an experimental model of peritonitis to assess their characteristics in vivo.
Male Wistar rats were randomized into five groups and peritonitis was induced. A mesh was implanted after 24 h. Five meshes were investigated: Permacol™ (cross-linked collagen), Strattice™ (non-cross-linked collagen), XCM Biologic (non-cross-linked collagen), Omyra Mesh (condensed polytetrafluoroethylene) and Parietene™ (polypropylene). The rats were killed after either 30, 90 or 180 days. Incorporation and shrinkage of the mesh, adhesion coverage, strength of adhesions and histology were analysed.
Of 135 rats randomized, 18 died from peritonitis. Some 180 days after implantation, both XCM Biologic and Permacol™ had significantly better incorporation than Strattice™ (P = 0·003 and P = 0·009 respectively). Strattice™ had significantly fewer adhesions than XCM Biologic (P = 0·001) and Permacol™ (P = 0·020). Thirty days after implantation, Permacol™ had significantly stronger adhesions than Strattice™ (P < 0·001). Shrinkage was most prominent in XCM Biologic , but no significant difference was found compared with the other meshes. Histological analysis revealed marked differences in foreign body response among all meshes.
This experimental study suggested that XCM Biologic was superior in terms of incorporation, macroscopic mesh infection, and histological parameters such as collagen deposition and neovascularization. There must be sufficient overlap of mesh during placement, as XCM Biologic showed a high rate of shrinkage. Surgical relevance The use of synthetic mesh to repair a potentially contaminated incisional hernia is not supported unequivocally, and may lead to a higher failure rate. A biological mesh might be considered as an alternative. There are few long-term studies, as these meshes are expensive and rarely used. This study evaluated the use of biological mesh in a contaminated environment, and investigated whether there is an ideal mesh. A new non-cross-linked biological mesh (XCM Biologic ) was evaluated in this experiment. The new non-cross-linked biological mesh XCM Biologic performed best and may be useful in patients with a potentially contaminated incisional hernia.
使用合成网片修复潜在污染的切口疝可能会导致更高的失败率。生物网片可能是一种考虑，但对长期结果知之甚少。本实验模型采用生物和合成网片来评估腹膜炎患者体内的特征。
雄性 Wistar 大鼠随机分为五组，并诱导腹膜炎。24 小时后植入网片。研究了 5 种网片：PermacolTM（交联胶原）、StratticeTM（非交联胶原）、XCM Biologic（非交联胶原）、Omyra Mesh（浓缩聚四氟乙烯）和 ParieteneTM（聚丙烯）。大鼠分别在 30、90 或 180 天后处死。分析网片的融合和收缩、粘连覆盖、粘连强度和组织学。
在 135 只随机分组的大鼠中，18 只死于腹膜炎。植入后 180 天，XCM Biologic 和 PermacolTM 的融合明显优于 StratticeTM（P=0·003 和 P=0·009）。StratticeTM 的粘连明显少于 XCM Biologic（P=0·001）和 PermacolTM（P=0·020）。植入后 30 天，PermacolTM 的粘连强度明显大于 StratticeTM（P<0·001）。XCM Biologic 的收缩最为明显，但与其他网片相比无显著差异。组织学分析显示，所有网片的异物反应均有明显差异。
本实验研究表明，XCM Biologic 在融合、宏观网片感染以及胶原沉积和新生血管形成等组织学参数方面具有优势。在放置网片时必须有足够的重叠，因为 XCM Biologic 收缩率很高。
使用合成网片修复潜在污染的切口疝并不明确，且可能导致更高的失败率。可考虑使用生物网片。这些网片昂贵且很少使用，因此长期研究较少。本研究评估了生物网片在污染环境中的应用，并研究了是否存在理想的网片。本实验评估了新型非交联生物网片（XCM Biologic）的应用。新型非交联生物网片 XCM Biologic 性能最佳，可能对潜在污染的切口疝患者有用。
