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Chirurgie 1. Juli 2015

Reduction of adhesions with autogen tissue-covered polypropylene mesh implants for incisional hernia repair: an experimental study

Background: Incisional hernia is a complication that is encountered with a rate of 2–11 % and can lead to morbidity, work loss, and even mortality. Prosthetic materials that are used in hernia repair are still being tested, and the ideal one has not been proposed yet. While the recurrence rates with primary repair are found to be 30–50 %, these rates are decreased to 0–15 % with mesh repair. These rates emphasize the importance of meshes. The most important criteria in their usage are the advantages and disadvantages of types of meshes. Our aim is to cover the mesh with the subject’s own collagen tissue, then to repair the defect with this autogen collagen-covered propylene mesh, and lastly, to prevent or decrease adhesions against the mesh.

Methods: A total of 14 male, healthy, 250–300 g Wistar-Albino rats were included in the study. They were separated into two equal groups as Group A (control group) and Group B (study group). In Group A, full-thickness defects were repaired with polypropylene meshes. In Group B, meshes of the same size were placed under the skins of the rats and excised on the ninth day. After creating a full-thickness defect, it was repaired with the rat’s own mesh. On the 21st day, in both groups, the adhesions between intra-abdominal organs and the mesh were evaluated by two independent observers according to adhesion scoring system. The groups were compared in means of fibrosis and inflammation scores. The pathologist was not informed about which preparate belonged to which group.

Results: In Group A, adhesion area, adhesion strength, inflammation, collagen tissue, and fibroblast activity were significantly higher than Group B.

Conclusions: According to our results, after in-lay placement of autogen tissue-covered polypropylene meshes, adhesions can decrease and complications due to intra-abdominal adhesions can be prevented, and relatively low costs may contribute to health expenditure.

Assoc. Prof. F. Ersoz, M.M. Deniz, Y. Duzkoylu, S. Culcu, Assoc. Prof. S. Sari, M.E. Gunes, A. Ari, K. Buyukasik, E. Pasaoglu, European Surgery 3/2015

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