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Surgical Endoscopy

Published in:

01-11-2011

Impact of pressure and gas type on adhesion formation and biomaterial integration in laparoscopy

Authors: R. Rosch, M. Binnebösel, C. D. Klink, J. Otto, K. Junge, U. P. Neumann

Published in: Surgical Endoscopy | Issue 11/2011

Abstract

Background

Laparoscopic mesh repair of inguinal and incisional hernias has been widely adopted. Nevertheless, knowledge about the impact of pneumoperitoneum on mesh integration is rare. The present study investigates pressure and gas-dependent effects of pneumoperitoneum on adhesion formation and biomaterial integration in a standardized animal model.

Methods

Laparoscopic intraperitoneal onlay mesh implantation (IPOM) was performed in 32 female chinchilla rabbits using CO₂ or helium for pneumoperitoneum. Intra-abdominal pressures were 3 or 6 mmHg. Animals were killed after 21 days, and the abdominal wall was explanted for subsequent histopathological examinations. Adhesions were assessed qualitatively with a scoring system, and the adhesion surface was analyzed semiquantitatively by planimetry. Infiltration of macrophages (CD68), expression of matrix metalloproteinase 13 (MMP-13), and cell proliferation (Ki67) were analyzed at the mesh to host interface by immunohistochemistry. The collagen type I/III ratio was analyzed by cross-polarization microscopy to determine the quality of mesh integration.

Results

After 21 days, perifilamental infiltration with macrophages (CD68) and percentage of proliferating cells (Ki67) were highest after 6 mmHg of CO₂ pneumoperitoneum. The extent of adhesions, as well as the expression of MMP-13 and the collagen type I/III ratio, were similar between groups.

Conclusions

Our experiments showed no pressure or gas-dependent alterations of adhesion formation and only minor effects on biomaterial integration. Altogether, there is no evidence for a clinically negative effect of CO₂ pneumoperitoneum.

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Title: Impact of pressure and gas type on adhesion formation and biomaterial integration in laparoscopy
Authors: R. Rosch
M. Binnebösel
C. D. Klink
J. Otto
K. Junge
U. P. Neumann
Publication date: 01-11-2011
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 11/2011
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-011-1766-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Impact of pressure and gas type on adhesion formation and biomaterial integration in laparoscopy

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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