Prevention of adhesions to polypropylene mesh

被引:71
作者
Felemovicius, I [1 ]
Bonsack, ME [1 ]
Hagerman, G [1 ]
Delaney, JP [1 ]
机构
[1] Univ Minnesota, Dept Surg, Minneapolis, MN USA
关键词
D O I
10.1016/j.jamcollsurg.2003.12.004
中图分类号
R61 [外科手术学];
学科分类号
摘要
BACKGROUND: Polypropylene mesh used to repair abdominal wall hernias routinely induces dense adhesions if there is direct contact between the mesh and the viscera. Adhesions may lead later to difficult reoperation, intestinal obstruction, or enteric fistula. STUDY DESIGN: A 2.5-cm square defect was surgically created in the rat abdominal wall and replaced with: 1) polypropylene mesh, 2) Sepramesh (SM), or 3) SM plus Seprafilm. Each group included 20 animals. Adhesion area as a percent of the mesh surface was subjectively quantitated by means of laparoscopy and at sacrifice. Evaluations varied from 7 to 28 days after mesh placement. Tissues were harvested at intervals for scanning electron microscopy. RESULTS: Adhesions were complete by day 7, with no change in area thereafter. Adhesion-free mesh surfaces were found on scanning electron microscopy to be carpeted with mesothelial cells from day 5 on. Polypropylene mesh alone induced adhesions in all rats (20/20). The mean area involved was 92%. With SM, 9 of 20 were adhesion-free. The mean area was 15%. When Seprafilm was added to SM, minimal adhesions developed in 5 of 20 rats, the mean area being 2%. Four of the five were single point omental attachments. CONCLUSIONS: 1) Sepramesh alone reduces polypropylene mesh adhesions by roughly three-quarters. 2) Sepramesh plus Seprafilm nearly eliminates such visceral adhesions. 3) Mesothelial cell coverage of polypropylene mesh confers adhesion resistance. (C) 2004 by the American College of Surgeons.
引用
收藏
页码:543 / 548
页数:6
相关论文
共 18 条
[1]  
Alponat A, 1997, AM SURGEON, V63, P818
[2]   Abdominal adhesions to prosthetic mesh evaluated by laparoscopy and electron microscopy [J].
Baptista, ML ;
Bonsack, ME ;
Felemovicius, I ;
Delaney, JP .
JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS, 2000, 190 (03) :271-280
[3]   Seprafilm reduces adhesions to polypropylene mesh [J].
Baptista, ML ;
Bonsack, ME ;
Delaney, NP .
SURGERY, 2000, 128 (01) :86-92
[4]  
Becker JM, 1996, J AM COLL SURGEONS, V183, P297
[5]  
BENAVID R, 1994, PROSTHESES ABDOMINAL, P116
[6]  
DIAMOND M, 1966, FERTIL STERIL, V66, P904
[7]   Prevention of adhesions to polypropylene mesh in a traumatized bowel model [J].
Dinsmore, RC ;
Calton, WC ;
Harvey, SB ;
Blaney, MW .
JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS, 2000, 191 (02) :131-136
[8]   Evaluation of Sepramesh biosurgical composite in a rabbit hernia repair model [J].
Greenawalt, KE ;
Butler, TJ ;
Rowe, EA ;
Finneral, AC ;
Garlick, DS ;
Burns, JW .
JOURNAL OF SURGICAL RESEARCH, 2000, 94 (02) :92-98
[9]   Effects of five different barrier materials on postsurgical adhesion formation in the rat [J].
Hellebrekers, BWJ ;
Trimbos-Kemper, GCM ;
van Blitterswijk, CA ;
Bakkum, EA ;
Trimbos, JBMZ .
HUMAN REPRODUCTION, 2000, 15 (06) :1358-1363
[10]   Prevention of adhesion formation with use of sodium hyaluronate-based bioresorbable membrane in a rat model of ventral hernia repair with polypropylene mesh - A randomized, controlled study [J].
Hooker, GD ;
Taylor, BM ;
Driman, DK .
SURGERY, 1999, 125 (02) :211-216