Impairment of the Peritoneal Surface as a Decisive Factor for Intestinal Adhesions in Intraperitoneal Onlay Mesh Surgery - Introducing a New Rat Model
| Autor: | Markus Winny, Danny Jonigk, Torsten Lippmann, Daniel Poehnert, LV Grethe, Juergen Klempnauer, Lavinia Maegel |
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| Rok vydání: | 2015 |
| Předmět: |
Enterocutaneous fistula
Hernia mesh repair medicine.medical_specialty Abrasion (medical) Adhesion (medicine) Tissue Adhesions Adhesion formation Polypropylene mesh Polypropylenes Abdominal wall 03 medical and health sciences Cecum 0302 clinical medicine Postoperative Complications Peritoneum medicine Animals Digestive System Surgical Procedures Tissue Adhesion Experimental study business.industry Abdominal Wall General Medicine Surgical Mesh medicine.disease Surgery Rats Intestinal Diseases medicine.anatomical_structure Surgical mesh intraperitoneal onlay mesh surgery 030220 oncology & carcinogenesis 030211 gastroenterology & hepatology Cecal abrasion business Research Paper |
| Zdroj: | International Journal of Medical Sciences |
| ISSN: | 1449-1907 |
| Popis: | Background: Meshes implanted intraperitoneally are known to cause adhesions potentially resulting in complications such as chronic pain, enterocutaneous fistula, or mesh infection. This study introduces a model for investigation of intestine-to-mesh adhesions and evaluates as to whether missing of visceral peritoneum is causative. Methods: In 18 rats, rectangular 1.5 x 2 cm patches of an uncoated polypropylene mesh (Ultrapro®) were sewn to the inner abdominal wall next to the cecum. Additionally, a meso-suture ensured contact between cecum and mesh. Rats were assigned to 2 groups: in 8 rats the peritoneum was left intact, in 10 the cecum was depleted from peritoneum with abrasion. Sacrifice was on day 7. Macroscopic evaluation used two adhesion scores. Specimens were evaluated microscopically, statistical analyses employed student's t-test. Results: On day 7, rats with mesh implantation combined with locally de-peritonealization by cecal abrasion mostly showed severe cecum-to-mesh agglutination (mean Lauder score 92%, mean total Hoffmann score 90%), whereas meshes of most animals without cecal abrasion only had some coverage with intraabdominal fat (33%, 24%; p = 0.0002). Histological work-up showed adequate wall ingrowth of mesh in all rats. In animals with cecal abrasion, meshes were mostly adhesive with cecal wall. However, when the peritoneum of cecum was unimpaired, abdominal wall above the mesh as well as cecum usually revealed sub-peritoneal tissue and a mono-layer cell coverage as seen in normal peritoneum. Conclusion: This study introduces a model mimicking a clinical situation of e.g. hernia repair by intraperitoneally implanted meshes when mesh has contact with normal and with de-peritonealized intestine. The model might be useful for testing mesh types and coatings as well as other devices for their efficacy in adhesion prevention. The high adhesion scores of rats with local de-peritonealization compared with the low scores of animals with intact peritoneum indicate that the integrity of intestinal peritoneum is a decisive factor for adhesion formation. |
| Databáze: | OpenAIRE |
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