Dogu Dogukan, Akyol Ozge, Sokmensuer Cenk, Yorganci Kaya
Department of General Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Department of Pathology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Sci Rep. 2025 May 23;15(1):17902. doi: 10.1038/s41598-025-02521-x.
Mesh adhesion is an important complication in prosthetic hernia repairs which may lead to intestinal obstruction, enterocutaneous fistula and viscus perforation. Therefore, direct contact between visceral organs and mesh should be avoided. The aim of this study was to investigate the efficacy of platelet rich fibrin (PRF) as an adhesion barrier. Thirty-six Wistar-Albino rats were used in the study. Four rats were used to obtain platelet-rich fibrin. Remaining rats were divided to four separate groups. In sham group, abdominal wall was repaired by suture without mesh following laparotomy. Abdominal walls of remaining rats were excised for about 2 cm in length with margins 2 cm wide. The defect was repaired with polypropylene mesh, Parietex composite mesh, or PRF coated polypropylene mesh in three separate groups. Rats were sacrificed on the 14th postoperative day. Macroscopic Zühlke and Greca adhesion scores, histopathological fibrosis grading and multinucleated giant cells were evaluated. There was statistically significant difference of adhesion scores of Zühlke (p = 0.013) and Greca (p < 0.001) between all groups. It was observed that the adhesion score in the platelet-rich fibrin group was lower than the polypropylene mesh group (p = 0.003), and there was no significant difference between the composite mesh group and the PRF group (p = 0.13). Fibroblast density and degree of fibrosis were higher in the platelet-rich fibrin group than in the polypropylene group (p < 0.001), but there was no significant difference with the composite mesh group. Giant cell formation, an indicator of inflammation, was significantly higher in the platelet-rich fibrin group than in the polypropylene mesh group (p = 0.001), and it was significantly less than in the composite mesh group (p = 0.007). Platelet-rich fibrin significantly reduces the incidence of adhesion to polypropylene meshes in the early postoperative period and enhances fibrosis at the mesh-abdominal wall interface. Acting as a biological barrier, platelet-rich fibrin shows potential as an alternative to composite meshes and antiadhesive barriers.
补片粘连是人工疝修补术中一种重要的并发症，可能导致肠梗阻、肠皮肤瘘和脏器穿孔。因此，应避免内脏器官与补片直接接触。本研究的目的是探讨富血小板纤维蛋白（PRF）作为粘连屏障的疗效。本研究使用了36只Wistar - Albino大鼠。4只大鼠用于获取富血小板纤维蛋白。其余大鼠分为4个独立的组。在假手术组中，剖腹术后通过缝合修复腹壁，不使用补片。其余大鼠的腹壁切除约2厘米长，边缘宽2厘米。在三个独立的组中，分别用聚丙烯补片、Parietex复合补片或PRF涂层聚丙烯补片修复缺损。术后第14天处死大鼠。评估宏观的祖尔克和格雷卡粘连评分、组织病理学纤维化分级和多核巨细胞。所有组之间祖尔克粘连评分（p = 0.013）和格雷卡粘连评分（p < 0.001）存在统计学显著差异。观察到富血小板纤维蛋白组的粘连评分低于聚丙烯补片组（p = 0.003），复合补片组与PRF组之间无显著差异（p = 0.13）。富血小板纤维蛋白组的成纤维细胞密度和纤维化程度高于聚丙烯组（p < 0.001），但与复合补片组无显著差异。作为炎症指标的巨细胞形成在富血小板纤维蛋白组中显著高于聚丙烯补片组（p = 0.001），且显著低于复合补片组（p = 0.007）。富血小板纤维蛋白在术后早期显著降低了与聚丙烯补片粘连的发生率，并增强了补片 - 腹壁界面的纤维化。作为一种生物屏障，富血小板纤维蛋白显示出作为复合补片和抗粘连屏障替代品的潜力。
