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Published in: Surgical Endoscopy 2/2009

01-02-2009

Adhesion formation of a polyvinylidenfluoride/polypropylene mesh for intra-abdominal placement in a rodent animal model

Authors: Karsten Junge, Marcel Binnebösel, Raphael Rosch, Marc Jansen, Daniel Kämmer, Jens Otto, Volker Schumpelick, Uwe Klinge

Published in: Surgical Endoscopy | Issue 2/2009

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Abstract

Background

Effective laparoscopic ventral herniorrhaphy mandates the use of an intraperitoneal mesh. Visceral adhesions and shrinkage of prosthetics may complicate repairs. The aim of this study was to compare adhesion formation, mesh shrinkage and tissue ingrowth after intra-abdominal placement of a novel two-component monofilament mesh structure made of polypropylene (PP) and polyvinylidenfluoride (PVDF) with current alternatives.

Materials and methods

Forty Sprague-Dawley rats were used in this study. Mesh samples were fixed as intra-abdominal only mesh at the right lateral abdominal wall. The study groups were: PVDF+PP (polypropylene parietally and polyvinylidenfluoride viscerally), PP+Col (polypropylene with a collagenoxidized film), ePTFE (smooth surface viscerally and a textured surface parietally), and PP (a pure polypropylene mesh serving as control). The meshes were explanted after 30 days. Adhesions were scored as a percentage of explanted biomaterials’ affected surface area; prosthetic shrinkage was calculated. Foreign-body reaction to mesh materials was measured by investigating the amount of inflammatory infiltrate and fibrotic tissue formation.

Results

In terms of adhesion score, the pure PP mesh showed the highest values followed by the ePTFE, PVDF+PP, and PP+Col meshes. Quantitative assessment of adhesion area revealed a significantly higher value of the pure PP mesh sample (62.0 ± 22.1%) compared with the PP+Col (26.8 ± 12.1%) and the PVDF+PP mesh (34.6 ± 8.2%). Percentage of shrinkage showed a significantly higher value of the ePTFE mesh (52.4 ± 13.9%) compared with all other mesh modifications (PP+Col 19.8 ± 13.9%, PVDF+PP 19.9 ± 7.0%, and PP 26.8 ± 9.5%). Inflammatory infiltrate was significantly reduced in the PVDF+PP mesh group compared with all other mesh samples.

Conclusion

The use of the novel two-component monofilament mesh structure made of polypropylene and polyvinylidenfluoride was found to be favorable regarding adhesion formation and mesh shrinkage compared to conventional mesh materials used for intra-abdominal placement.
Literature
1.
go back to reference Rudmik LR, Schieman C, Dixon E, Debru E (2006) Laparoscopic incisional hernia repair: a review of the literature. Hernia 10(2):110–119PubMedCrossRef Rudmik LR, Schieman C, Dixon E, Debru E (2006) Laparoscopic incisional hernia repair: a review of the literature. Hernia 10(2):110–119PubMedCrossRef
2.
go back to reference Fourtanier G, Muscari F, Duffas JP, Suc B (2006) Laparocopic repair of incisional hernias: a gold standard? Ann Chir 131(4):233–235PubMedCrossRef Fourtanier G, Muscari F, Duffas JP, Suc B (2006) Laparocopic repair of incisional hernias: a gold standard? Ann Chir 131(4):233–235PubMedCrossRef
5.
go back to reference LeBlanc KA (2005) Incisional hernia repair: laparoscopic techniques. World J Surg 29(8):1073–1079PubMedCrossRef LeBlanc KA (2005) Incisional hernia repair: laparoscopic techniques. World J Surg 29(8):1073–1079PubMedCrossRef
6.
go back to reference Novitsky YW, Harrell AG, Cristiano JA, Paton BL, Norton HJ, Peindl RD et al (2007) Comparative evaluation of adhesion formation, strength of ingrowth, and textile properties of prosthetic meshes after long-term intra-abdominal implantation in a rabbit. J Surg Res 140(1):6–11PubMedCrossRef Novitsky YW, Harrell AG, Cristiano JA, Paton BL, Norton HJ, Peindl RD et al (2007) Comparative evaluation of adhesion formation, strength of ingrowth, and textile properties of prosthetic meshes after long-term intra-abdominal implantation in a rabbit. J Surg Res 140(1):6–11PubMedCrossRef
7.
go back to reference Jacob BP, Hogle NJ, Durak E, Kim T, Fowler DL (2007) Tissue ingrowth and bowel adhesion formation in an animal comparative study: polypropylene versus Proceed versus Parietex Composite. Surg Endosc 21(4):629–633PubMedCrossRef Jacob BP, Hogle NJ, Durak E, Kim T, Fowler DL (2007) Tissue ingrowth and bowel adhesion formation in an animal comparative study: polypropylene versus Proceed versus Parietex Composite. Surg Endosc 21(4):629–633PubMedCrossRef
8.
go back to reference Urban E, King MW, Guidoin R, Laroche G, Marois Y, Martin L et al (1994) Why make monofilament sutures out of polyvinylidene fluoride? ASAIO J 40(2):145–156PubMed Urban E, King MW, Guidoin R, Laroche G, Marois Y, Martin L et al (1994) Why make monofilament sutures out of polyvinylidene fluoride? ASAIO J 40(2):145–156PubMed
9.
go back to reference Klinge U, Klosterhalfen B, Ottinger AP, Junge K, Schumpelick V (2002) PVDF as a new polymer for the construction of surgical meshes. Biomaterials 23(16):3487–3493PubMedCrossRef Klinge U, Klosterhalfen B, Ottinger AP, Junge K, Schumpelick V (2002) PVDF as a new polymer for the construction of surgical meshes. Biomaterials 23(16):3487–3493PubMedCrossRef
10.
go back to reference The Surgical Membrane Study Group (1992) Prophylaxis of pelvic sidewall adhesions with Gore-Tex surgical membrane: a multicenter clinical investigation. Fertil Steril 57(4):921–923 The Surgical Membrane Study Group (1992) Prophylaxis of pelvic sidewall adhesions with Gore-Tex surgical membrane: a multicenter clinical investigation. Fertil Steril 57(4):921–923
11.
go back to reference Eriksen JR, Gogenur I, Rosenberg J (2007) Choice of mesh for laparoscopic ventral hernia repair. Hernia 11(6):481–492 Eriksen JR, Gogenur I, Rosenberg J (2007) Choice of mesh for laparoscopic ventral hernia repair. Hernia 11(6):481–492
12.
go back to reference McGinty JJ, Hogle NJ, McCarthy H, Fowler DL (2005) A comparative study of adhesion formation and abdominal wall ingrowth after laparoscopic ventral hernia repair in a porcine model using multiple types of mesh. Surg Endosc 19(6):786–790PubMedCrossRef McGinty JJ, Hogle NJ, McCarthy H, Fowler DL (2005) A comparative study of adhesion formation and abdominal wall ingrowth after laparoscopic ventral hernia repair in a porcine model using multiple types of mesh. Surg Endosc 19(6):786–790PubMedCrossRef
13.
go back to reference Schug-Pass C, Tamme C, Tannapfel A, Kockerling F (2006) A lightweight polypropylene mesh (TiMesh) for laparoscopic intraperitoneal repair of abdominal wall hernias: comparison of biocompatibility with the DualMesh in an experimental study using the porcine model. Surg Endosc 20(3):402–409PubMedCrossRef Schug-Pass C, Tamme C, Tannapfel A, Kockerling F (2006) A lightweight polypropylene mesh (TiMesh) for laparoscopic intraperitoneal repair of abdominal wall hernias: comparison of biocompatibility with the DualMesh in an experimental study using the porcine model. Surg Endosc 20(3):402–409PubMedCrossRef
14.
go back to reference Fischer T, Ladurner R, Gangkofer A, Mussack T, Reiser M, Lienemann A (2007) Functional cine MRI of the abdomen for the assessment of implanted synthetic mesh in patients after incisional hernia repair: initial results. Eur Radiol 17(12):3123–3129PubMedCrossRef Fischer T, Ladurner R, Gangkofer A, Mussack T, Reiser M, Lienemann A (2007) Functional cine MRI of the abdomen for the assessment of implanted synthetic mesh in patients after incisional hernia repair: initial results. Eur Radiol 17(12):3123–3129PubMedCrossRef
15.
go back to reference Mussack T, Fischer T, Ladurner R, Gangkofer A, Bensler S, Hallfeldt KK et al (2005) Cine magnetic resonance imaging vs high-resolution ultrasonography for detection of adhesions after laparoscopic and open incisional hernia repair: a matched pair pilot analysis. Surg Endosc 19(12):1538–1543PubMedCrossRef Mussack T, Fischer T, Ladurner R, Gangkofer A, Bensler S, Hallfeldt KK et al (2005) Cine magnetic resonance imaging vs high-resolution ultrasonography for detection of adhesions after laparoscopic and open incisional hernia repair: a matched pair pilot analysis. Surg Endosc 19(12):1538–1543PubMedCrossRef
16.
go back to reference Urban E, King MW, Guidoin R, Laroche G, Marois Y, Martin L et al (1994) Why make monofilament sutures out of polyvinylidene fluoride? Asaio J 40(2):145–156PubMed Urban E, King MW, Guidoin R, Laroche G, Marois Y, Martin L et al (1994) Why make monofilament sutures out of polyvinylidene fluoride? Asaio J 40(2):145–156PubMed
17.
go back to reference Laroche G, Marois Y, Guidoin R, King MW, Martin L, How T et al (1995) Polyvinylidene fluoride (PVDF) as a biomaterial: from polymeric raw material to monofilament vascular suture. J Biomed Mater Res 29(12):1525–1536PubMedCrossRef Laroche G, Marois Y, Guidoin R, King MW, Martin L, How T et al (1995) Polyvinylidene fluoride (PVDF) as a biomaterial: from polymeric raw material to monofilament vascular suture. J Biomed Mater Res 29(12):1525–1536PubMedCrossRef
18.
go back to reference Bellon JM, Garcia-Carranza A, Jurado F, Garcia-Honduvilla N, Carrera-San Martin A, Bujan J (2001) Peritoneal regeneration after implant of a composite prosthesis in the abdominal wall. World J Surg 25(2):147–152PubMedCrossRef Bellon JM, Garcia-Carranza A, Jurado F, Garcia-Honduvilla N, Carrera-San Martin A, Bujan J (2001) Peritoneal regeneration after implant of a composite prosthesis in the abdominal wall. World J Surg 25(2):147–152PubMedCrossRef
19.
go back to reference Conze J, Rosch R, Klinge U, Weiss C, Anurov M, Titkowa S et al (2004) Polypropylene in the intra-abdominal position: influence of pore size and surface area. Hernia 8(4):365–372PubMedCrossRef Conze J, Rosch R, Klinge U, Weiss C, Anurov M, Titkowa S et al (2004) Polypropylene in the intra-abdominal position: influence of pore size and surface area. Hernia 8(4):365–372PubMedCrossRef
20.
go back to reference Burger JW, Halm JA, Wijsmuller AR, ten Raa S, Jeekel J (2006) Evaluation of new prosthetic meshes for ventral hernia repair. Surg Endosc 20(8):1320–1325PubMedCrossRef Burger JW, Halm JA, Wijsmuller AR, ten Raa S, Jeekel J (2006) Evaluation of new prosthetic meshes for ventral hernia repair. Surg Endosc 20(8):1320–1325PubMedCrossRef
21.
go back to reference Johnson EK, Hoyt CH, Dinsmore RC (2004) Abdominal wall hernia repair: a long-term comparison of Sepramesh and Dualmesh in a rabbit hernia model. Am Surg 70(8):657–661PubMed Johnson EK, Hoyt CH, Dinsmore RC (2004) Abdominal wall hernia repair: a long-term comparison of Sepramesh and Dualmesh in a rabbit hernia model. Am Surg 70(8):657–661PubMed
22.
go back to reference Harrell AG, Novitsky YW, Peindl RD, Cobb WS, Austin CE, Cristiano JA et al (2006) Prospective evaluation of adhesion formation and shrinkage of intra-abdominal prosthetics in a rabbit model. Am Surg 72(9):808–813PubMed Harrell AG, Novitsky YW, Peindl RD, Cobb WS, Austin CE, Cristiano JA et al (2006) Prospective evaluation of adhesion formation and shrinkage of intra-abdominal prosthetics in a rabbit model. Am Surg 72(9):808–813PubMed
23.
go back to reference Conze J, Krones CJ, Schumpelick V, Klinge U (2007) Incisional hernia: challenge of re-operations after mesh repair. Langenbecks Arch Surg 392(4):453–457PubMedCrossRef Conze J, Krones CJ, Schumpelick V, Klinge U (2007) Incisional hernia: challenge of re-operations after mesh repair. Langenbecks Arch Surg 392(4):453–457PubMedCrossRef
24.
go back to reference Klinge U, Klosterhalfen B, Muller M, Ottinger AP, Schumpelick V (1998) Shrinking of polypropylene mesh in vivo: an experimental study in dogs. Eur J Surg 164(12):965–969PubMedCrossRef Klinge U, Klosterhalfen B, Muller M, Ottinger AP, Schumpelick V (1998) Shrinking of polypropylene mesh in vivo: an experimental study in dogs. Eur J Surg 164(12):965–969PubMedCrossRef
Metadata
Title
Adhesion formation of a polyvinylidenfluoride/polypropylene mesh for intra-abdominal placement in a rodent animal model
Authors
Karsten Junge
Marcel Binnebösel
Raphael Rosch
Marc Jansen
Daniel Kämmer
Jens Otto
Volker Schumpelick
Uwe Klinge
Publication date
01-02-2009
Publisher
Springer-Verlag
Published in
Surgical Endoscopy / Issue 2/2009
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-008-9923-y

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