Department of Surgery, University of Hong Kong, Hong Kong.
Department of Pathology, Queen Mary Hospital, Hong Kong.
J Pediatr Surg. 2023 Jul;58(7):1301-1305. doi: 10.1016/j.jpedsurg.2023.01.056. Epub 2023 Feb 14.
Laparoscopic inguinal hernia repair is a commonly performed procedure in children. Currently, monofilament polypropylene and braided silk are the two most frequently used materials. Studies have suggested more tissue inflammatory reactions with the use of multifilament non-absorbable sutures. However, little is known about the effects of suture materials on adjacent vas deferens. The aim of this experiment was to compare the effect of non-absorbable monofilament and multifilament sutures on vas deferens in laparoscopic hernia repair.
All animal operations were performed by a single surgeon under aseptic conditions and anaesthesia. Ten male Sprague Dawley rats were divided into two groups. In Group I, "hernia repair" was performed using 5.0 Silk. In Group II, polypropylene sutures (Prolene®; Ethicon, Somerville, N.J., USA) were used. All animals also received sham operations in the left groin as a control. After 14 days, the animals were euthanised and a segment of vas deferens just adjacent to the suture was excised for histological review by an experienced pathologist who was blind to the treatment groups of the respective specimens.
The body sizes of the rats in each group were comparable. Group I had significantly smaller vas deferens than Group II (diameter: 0.2 vs. 0.6 ± 0.2, p = 0.005). Silk sutures appeared to cause more tissue adhesion than Prolene® sutures, as graded by blind assessors (adhesion grade: 2.8 ± 1.3 vs. 1.8 ± 0.8, p = 0.1), although this did not reach statistical significance. There was no significant difference in the histological fibrosis score and inflammation score.
The only effect of non-absorbable sutures on vas deferens in this rat model was the reduced cross-sectional area of vas deferens and increased tissue adhesion when using silk sutures. However, there was no significant histological difference in inflammation or fibrosis caused by either material.
腹腔镜腹股沟疝修补术是儿童中常见的手术。目前，单丝聚丙烯和编织丝是最常使用的两种材料。研究表明，使用多股不可吸收缝线会引起更多的组织炎症反应。然而，对于缝线材料对邻近输精管的影响知之甚少。本实验旨在比较不可吸收单丝和多股缝线对腹腔镜疝修补术中输精管的影响。
所有动物手术均由一名外科医生在无菌条件和麻醉下进行。将 10 只雄性 Sprague Dawley 大鼠分为两组。在第 I 组中，使用 5.0 Silk 进行“疝修补”。在第 II 组中，使用聚丙烯缝线（Prolene®；Ethicon，Somerville，N.J.，USA）。所有动物的左侧腹股沟还接受了假手术作为对照。14 天后，处死动物，切除紧邻缝线的一段输精管，由一位经验丰富的病理学家进行组织学检查，该病理学家对标本的治疗组不知情。
每组大鼠的体型相当。第 I 组的输精管明显小于第 II 组（直径：0.2 ± 0.2 vs. 0.6 ± 0.2，p = 0.005）。盲法评估者认为 Silk 缝线比 Prolene®缝线引起更多的组织粘连（粘连等级：2.8 ± 1.3 vs. 1.8 ± 0.8，p = 0.1），尽管这没有达到统计学意义。两种材料的组织纤维化评分和炎症评分无显著差异。
在这种大鼠模型中，不可吸收缝线对输精管的唯一影响是使用 Silk 缝线时输精管的横截面积减小和组织粘连增加。然而，两种材料引起的炎症或纤维化在组织学上没有显著差异。
