Eickhoff Roman Marius, Kroh Andreas, Eickhoff Simon, Heise Daniel, Helmedag Marius Julian, Tolba Rene H, Klinge Uwe, Neumann Ulf Peter, Klink Christian Daniel, Lambertz Andreas
Department of General, Visceral and Transplant Surgery, RWTH Aachen University Hospital, Aachen, Germany.
Institute of Systems Neuroscience, Heinrich Heine University Düsseldorf, Germany and Institute of Neuroscience and Medicine (INM-7: Brain and Behaviour), Research Centre Jülich, Germany.
J Biomater Appl. 2021 Jan;35(6):732-739. doi: 10.1177/0885328220963918. Epub 2020 Oct 8.
The incidence of incisional hernia is with up to 30% one of the frequent long-term complication after laparotomy. After establishing minimal invasive operations, the laparoscopic intraperitoneal onlay mesh technique (lap. IPOM) was first described in 1993. Little is known about the foreign body reaction of IPOM-meshes, which covered a defect of the parietal peritoneum. This is becoming more important, since IPOM procedure with peritoneal-sac resection and hernia port closing (IPOM plus) is more frequently used.
In 18 female minipigs, two out of three Polyvinylidene-fluoride (PVDF) -meshes (I: standard IPOM; II: IPOM with modified structure [bigger pores]; III: IPOM with the same structure as IPOM II + degradable hydrogel-coating) were placed in a laparoscopic IPOM procedure. Before mesh placement, a 2x2cm peritoneal defect was created. After 30 days, animals were euthanized, adhesions were evaluated by re-laparoscopy and mesh samples were explanted for histological and immunohistochemichal investigations.
All animals recovered after implantation and had no complications during the follow-up period. Analysing foreign body reaction, the IPOM II mesh had a significant smaller inner granuloma, compared to the other meshes (IPOM II: 8.4 µm ± 1.3 vs. IPOM I 9.1 µm ± 1.3, p < 0.001). The degradable hydrogel coating does not prevent adhesions measured by Diamond score (p = 0.46). A peritoneal defect covered by a standard or modified IPOM mesh was a significant factor for increasing foreign body granuloma, the amount of CD3+ lymphocytes, CD68+ macrophages and decrease of pore size.
A peritoneal defect covered by IPOM prostheses leads to an increased foreign body reaction compared to intact peritoneum. Whenever feasible, a peritoneal defect should be closed accurately before placing an IPOM-mesh to avoid an excessive foreign body reaction and therefore inferior biomaterial properties of the prosthesis.
切口疝的发生率高达30%，是剖腹手术后常见的长期并发症之一。在确立微创手术后，腹腔镜腹腔内补片植入修补术（lap. IPOM）于1993年首次被描述。对于覆盖腹膜缺损的IPOM补片的异物反应了解甚少。随着IPOM联合腹膜囊切除及疝口关闭术（IPOM plus）的更频繁应用，这一点变得愈发重要。
在18只雌性小型猪中，通过腹腔镜IPOM手术植入三种聚偏氟乙烯（PVDF）补片中的两种（I：标准IPOM；II：具有改良结构[更大孔隙]的IPOM；III：具有与IPOM II相同结构+可降解水凝胶涂层的IPOM）。在植入补片前，制造一个2×2厘米的腹膜缺损。30天后，对动物实施安乐死，通过再次腹腔镜检查评估粘连情况，并取出补片样本进行组织学和免疫组织化学研究。
所有动物在植入后均恢复，且在随访期间无并发症。分析异物反应时，与其他补片相比，IPOM II补片的内部肉芽肿明显更小（IPOM II：8.4µm±1.3 vs. IPOM I 9.1µm±1.3，p<0.001）。可降解水凝胶涂层并不能防止根据戴蒙德评分法测量的粘连（p = 0.46）。标准或改良IPOM补片覆盖的腹膜缺损是导致异物肉芽肿增加、CD3 +淋巴细胞和CD68 +巨噬细胞数量增加以及孔隙尺寸减小的重要因素。
与完整腹膜相比，IPOM假体覆盖的腹膜缺损会导致异物反应增加。只要可行，在放置IPOM补片前应准确闭合腹膜缺损，以避免过度的异物反应，从而防止假体生物材料性能变差。
