Date Published: August 19, 2019
Publisher: Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia
Author(s): Waston Gonçalves Ribeiro, Diego Vinnicyus Santos Rodrigues, Francisco Felipe Moreira Atta, Izabelle Smith Frazão Ramos, Fabiola Nassar Sousa Frazão, Orlando Jorge Martins Torres, Marcos Bettini Pitombo.
To Compare the extent and intensity of adhesions formed between the intra-abdominal organs and the intraperitoneal implants of polypropylene mesh versus polypropylene/polyglecaprone versus polyester/porcine collagen used for correction of abdominal wall defect in rats.
After the defect in the abdominal wall, thirty Wistar rats were placed in three groups (ten animals each) for intraperitoneal mesh implant: polypropylene group, polypropylene/polyglecaprone group, and polyester/porcine collagen group. The macroscopic evaluation of the extent and intensity of adhesions was performed 21 days after the implant.
The polypropylene group had a higher statistically significant impairment due to visceral adhesions (p value = 0.002) and a higher degree of intense adherence in relation to polypropylene/polyglecaprone and polyester/porcine collagen groups (p value<0.001). The polyester/porcine collagen group showed more intense adhesions than the polypropylene/polyglecaprone group (p value=0.035). The intraperitoneal implantation of polypropylene meshes to correct defects of the abdominal wall caused the appearance of extensive and firm adhesions to intra-abdominal structures. The use of polypropylene/polyglecaprone or polyester/porcine collagen tissue-separating meshes reduces the number and degree of adhesions formed.
The incisional abdominal hernia can be defined as a hernia protrusion that develops in the topography of a previous surgical incision or a traumatic injury to the abdominal wall. It is one of the most frequent complications after elective or emergency abdominal surgeries. The incidence is 10-20%, reaching a higher rate (30-40%) in patients with associated risk factors1-2. In the United States of America, approximately four to five million abdominal surgeries are performed annually, resulting in an approximate incidence of 500.000 new cases of incisional hernias1-3. About 365.000 incisional hernioplasties were performed in the US in 2006 at a cost of $ 3.2 billion4. Due to the increase in the survival of patients with traumatic and infectious abdominal catastrophes, the number of large incisional hernias has increased, as well as the complexity of their surgical management1,2-5. The repair of large abdominal wall hernias is technically challenging. It is associated with a long hospitalization, difficulties and complications in the healing process, intra-abdominal hypertension, high rate of re-operations, readmissions and hernia recurrences, with a consequent increase in overall costs of treatment1,6-7.
The study respected the Brazilian legislation on the use of experimental animals (Lei Arouca no. 11.794/2008) and the standards of the Brazilian College of Animal Experimentation (COBEA). It was analyzed and approved by the Ethics Committee on the Use of Animals (CEUA) of Universidade Federal do Maranhão, registration no. 23115.011726/2016-51.
There were no statistically significant differences in initial (D1) and final (D21) weight of the animals among the three groups according to the ANOVA test (p value=0.652 for the initial weight, and p value=0.736 for the final weight). However, in all groups, there was a significant increase in the weight of the animals at the end of the study (D21) compared to the weight of the animals at the beginning (D1), according to the ANOVA test (p value<0.0001). The mean initial weight of the animals was 307 ± 33 g, and the mean final weight of the animals was 349 ± 35 g. All meshes showed some degree of adhesion in all experiments. However, the tissue separating meshes composed of polypropylene/polyglecaprone and polyester/porcine collagen presented a statistically significant lower impairment (p value=0.002) of their visceral surface by adhesions with intra-abdominal organs and structures compared to the polypropylene mesh. Ditzel et al.18, in a study with rats with implants of five different types of meshes, among which polypropylene and polyester collagen meshes, concluded that the polyester composite mesh with collagen showed a significantly small surface of adherence compared to the polypropylene mesh. Lamber et al.16 developed a similar study with an intraperitoneal mesh implant of polypropylene and polyester with collagen in rats, and concluded that the polypropylene mesh showed a significantly greater adhesion compromise than the polyester mesh with collagen. Similar results were found by Garcia et al.19 in an experimental study with rabbits with polypropylene mesh versus polypropylene with bovine collagen, where animals with only a polypropylene mesh presented a greater surface area of adhesion compromise with intra-abdominal viscera compared to the double-sided mesh. However, the result of the present study differs from the study by Biondo-Simões et al.20, in which there was no significant difference in the surface compromised by adherences between the meshes after intraperitoneal implantation of the polypropylene and polyester meshes with collagen in rats. The intraperitoneal implantation exclusively of polypropylene meshes to correct defects of the abdominal wall causes the appearance of extensive and firm adhesions with the intra-abdominal structures. The use of polypropylene/polyglecaprone or polyester/porcine collagen tissue-separating meshes reduces the number and degree of adhesions formed. Source: http://doi.org/10.1590/s0102-865020190060000003