Evaluation of Sepramesh Biosurgical Composite in a Rabbit Hernia Repair Model

doi:10.1006/jsre.2000.6020

Journal of Surgical Research

Volume 94, Issue 2, December 2000, Pages 92-98

https://doi.org/10.1006/jsre.2000.6020 Get rights and content

Abstract

Background. In cases such as incisional hernia repair, polypropylene mesh (PPM) can be exposed to the underlying viscera and cause adhesions to the mesh. In this study, a composite prosthesis that was designed to be less susceptible to adhesion formation than PPM was evaluated in a rabbit incisional hernia repair model.

Materials and Methods. A 5 × 7-cm full-thickness defect was created in the abdominal wall of 30 female New Zealand White rabbits. Ten animals each were repaired with PPM, Bard Composix (PP/ePTFE), or Sepramesh biosurgical composite—a polypropylene mesh coated on one side with chemically modified sodium hyaluronate and carboxymethylcellulose (HA/CMC). The animals were sacrificed after 28 days and the overall performance, including adhesion formation and tissue integration by histology and mechanical testing, was evaluated.

Results. In the Sepramesh group, there was a significant reduction in the percentage of surface area covered by adhesions and a significant increase in the percentage of animals with no adhesions compared to standard materials. The tissue integration strength and overall cellular response were similar in all groups. A partially remesothelialized peritoneal surface was often apparent overlying the Sepramesh implant.

Conclusions. Sepramesh biosurgical composite effectively repaired abdominal wall defects in rabbits and reduced adhesion development to the mesh compared to the use of a PPM and a PP/ePTFE composite.

References (24)

J.M. Bellon et al.
Experimental assay of a Dual Mesh PTFE prosthesis (non-porous on one side) in the repair of abdominal wall defects
Biomaterials
(1996)
M.P. Diamond
Reduction of adhesions after uterine myomectomy by Seprafilm membrane (HAL-F): A blinded, prospective, randomized, multicenter, clinical study
Fertil. Steril.
(1996)
G.D. Hooker et al.
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
Surgery
(1999)
J.M. Bellon et al.
Integration of biomaterials implanted into abdominal wall: Process of scar formation and macrophage response
Biomaterials
(1995)
A. Alponat et al.
Effects of physical barriers in prevention of adhesions: An incisional hernia model in rats
J. Surg. Res.
(1997)
M.L. Baptista et al.
Abdominal adhesions to prosthetic mesh evaluated by laparoscopy and electron microscopy
J. Am. Coll. Surg.
(2000)
R. Ross et al.
The biology of platelet-derived growth factor
Cell
(1986)
L.J. DeGuzman et al.
Colocutaneous fistula formation following polypropylene mesh placement for repair of a ventral hernia: Diagnosis by colonoscopy
Endoscopy
(1995)
K.K. Nagy et al.
Experience with three prosthetic materials in temporary abdominal wall closure
Am. Surg.
(1996)
R.J.K. Simmermacher et al.
Reherniation after repair of the abdominal wall with expanded PTFE
J. Am. Coll. Surg.
(1994)

J.M. Becker et al.

Prevention of postoperative abdominal adhesions by a sodium hyaluronate-based bioresorbable membrane: A prospective, randomized, double-blind multicenter study

J. Am. Coll. Surg.

(1996)

Cited by (67)

Design strategies and applications of biomaterials and devices for Hernia repair
2016, Bioactive Materials
Hernia repair is one of the most commonly performed surgical procedures worldwide, with a multi-billion dollar global market. Implant design remains a critical challenge for the successful repair and prevention of recurrent hernias, and despite significant progress, there is no ideal mesh for every surgery. This review summarizes the evolution of prostheses design toward successful hernia repair beginning with a description of the anatomy of the disease and the classifications of hernias. Next, the major milestones in implant design are discussed. Commonly encountered complications and strategies to minimize these adverse effects are described, followed by a thorough description of the implant characteristics necessary for successful repair. Finally, available implants are categorized and their advantages and limitations are elucidated, including non-absorbable and absorbable (synthetic and biologically derived) prostheses, composite prostheses, and coated prostheses. This review not only summarizes the state of the art in hernia repair, but also suggests future research directions toward improved hernia repair utilizing novel materials and fabrication methods.
The effect of methylprednisolone and tenoxicam on the protection of damage of the nerve physiomorphology caused by prolene mesh
2015, International Journal of Surgery
Citation Excerpt :
However, this study demonstrated that it is difficult to make a definitive statement for an ideal mesh. In another study which compares between sodium hyaluronate/carboxymethylselulose PP and polytetraflorethylene (PTFE) mesh determined that PTFE mesh causes adhesion formation more than other [9]. Besim et al. [10] compared between polyester mesh and PTFE.
Aim was to investigate the effect of methylprednisolone and tenoxicam on the protection of damage of the nerve physiomorphology caused by prolene mesh used in hernia repair.
Fifty male Wistar-albino rats weighing 250–350 gr, were randomly divided into 5 groups. Sciatic nerve was dissected in all rats after performing EMG on basal neural transport. In group 1, only sciatic nerve manipulation was performed. Other groups received a monofilament polypropylene cuff around the sciatic nerve. No additional procedure was performed in group 2. In group 3, 2 mg/kg single dose methylprednisolone was injected around the nerve and mesh. In group 4 and 5, 0.5 mg/kg/day methylprednisolone and 1 mg/kg tenoxicam was injected around the nerve and mesh for 4 weeks, respectively. Neural transport was evaluated by electromyography 4 weeks later and compared with pre-procedural values. Then the rats were sacrificed and, sciatic nerves including 1 cm around the mesh were excised. Inflammation and fibrosis were scored histopathologically.
While basal latency was similar, postoperative latency was significantly different among groups. Latency was significantly longer in group 2 than the group 1. It was significantly shorter in group 3 when compared to group 2 (p = 0.007). Preoperative and postoperative amplitudes were similar among groups. Denervation was significantly different among groups (p < 0.05). Denervation was higher in group 2 than group 1. It was similar to group 2 in study groups. Inflammation and fibrosis was significantly different among groups (p < 0.05). Inflammation and fibrosis scores were significantly higher in group 2 than group 1. The highest inflammation and fibrosis scores were detected in repetitive drug administrated groups. Although it wasn't statistically significant, inflammation was lower in single dose steroid administrated group than group 2. Similarly, the highest fibrosis scores were detected in repetitive drug administrated groups. Single dose steroid administration didn't increase fibrosis when compared to group 2.
Prolene mesh used in hernia repair caused increased inflammation and fibrosis and effected latency and denervation negatively. Single dose methylprednisolone administration decreased nerve damage and inflammation. On the other hand, daily administration of methylprednisolone and tenoxicam for 4 weeks caused increased inflammation and fibrosis and wasn't affective on protection of nerve physiomorphology.
Infected animal models for tissue engineering
2015, Methods
Citation Excerpt :
Other studies also examined the ability of meshes to integrate the mesh into the repair site and to minimize foreign body reactions. For example, Greenawalt et al. evaluated adhesion formation, tissue integration, and overall cellular response to an implanted mesh in the cecum wall after 28 days of implantation in a rabbit model [73]. While small animal models have proven useful for evaluating the antimicrobial properties of meshes for use in hernia repair, their ability to model the performance of the material in a surgical setting is limited due to the small size of the animals used.
Infection is one of the most common complications associated with medical interventions and implants. As tissue engineering strategies to replace missing or damaged tissue advance, the focus on prevention and treatment of concomitant infection has also begun to emerge as an important area of research. Because the in vivo environment is a complex interaction between host tissue, implanted materials, and native immune system that cannot be replicated in vitro, animal models of infection are integral in evaluating the safety and efficacy of experimental treatments for infection. In this review, considerations for selecting an animal model, established models of infection, and areas that require further model development are discussed with regard to cutaneous, fascial, and orthopedic infections.
Surgical treatment of large incisional hernias by intraperitoneal insertion of Parietex<sup>¯</sup> composite mesh with an associated aponeurotic graft (280 cases)
2011, Journal of Visceral Surgery
Citation Excerpt :
The kinetics of resorption of the hydrophilic film lead to the development within 1–2 weeks of a hydrogel with a cleavage plane. A recent comparative experimental study showed improved intestinal protection with the absorbable hydrophilic coated prosthesis [20]. Other animal studies comparing different prostheses have shown a decrease in visceral adhesions at D7 and D30 with the Parietex® composite prosthesis [21,22].
To evaluate post-operative complications and the recurrence rate after repair of large ventral incisional hernia with an open technique using intraperitoneal composite mesh and an associated aponeurotic overlay.
This prospective study included a total of 280 patients who underwent repair of large incisional hernia using Parietex^® composite mesh.
The post-operative mortality rate was 0.35%. Six patients (2%) developed subcutaneous surgical site infection without infection of the prosthesis. Six other patients (2%) developed a deep-seated infection; in three cases, the mesh had to be removed. Nine patients (3.2%) developed recurrent incisional hernia.
Large ventral incisional hernias can be effectively treated by the intraperitoneal placement of Parietex^® composite mesh overlaid by an aponeurotic graft; the incidence of complications in this prospective study was very low.
Surgical treatment of large incisional hernias by intraperitoneal insertion of Parietex® composite mesh with an associated aponeurotic graft (280 cases)
2011, Journal de Chirurgie Viscerale
Citation Excerpt :
The kinetics of resorption of the hydrophilic film lead to the development within 1–2 weeks of a hydrogel with a cleavage plane. A recent comparative experimental study showed improved intestinal protection with the absorbable hydrophilic coated prosthesis [20]. Other animal studies comparing different prostheses have shown a decrease in visceral adhesions at D7 and D30 with the Parietex® composite prosthesis [21,22].
To evaluate post-operative complications and the recurrence rate after repair of large ventral incisional hernia with an open technique using intraperitoneal composite mesh and an associated aponeurotic overlay.
This prospective study included a total of 280 patients who underwent repair of large incisional hernia using Parietex^® composite mesh.
The post-operative mortality rate was 0.35%. Six patients (2%) developed subcutaneous surgical site infection without infection of the prosthesis. Six other patients (2%) developed a deep-seated infection; in three cases, the mesh had to be removed. Nine patients (3.2%) developed recurrent incisional hernia.
Large ventral incisional hernias can be effectively treated by the intraperitoneal placement of Parietex^® composite mesh overlaid by an aponeurotic graft; the incidence of complications in this prospective study was very low.
Human Peritoneal Membrane Reduces the Formation of Intra-Abdominal Adhesions in Ventral Hernia Repair: Experimental Study in a Chronic Hernia Rat Model
2009, Journal of Surgical Research
Citation Excerpt :
A number of composite synthetic meshes have been developed in an attempt to address the intra-abdominal adhesion formation. The concept behind each design has been consistent— the presence of a temporary or permanent physical barrier to reduce the propensity for intra-abdominal adhesion formation [4, 21–28]. While such approaches have claimed some success, temporary or permanent physical barriers fall short of providing a template for the re-creation of a truly functional and permanent antiadhesive barrier beyond the advantages of a physical barrier.
Adhesions leading to intestinal obstructions and fistulae are severe complications related to the intraperitoneal placement of synthetic meshes. This study evaluated the efficacy of human peritoneal membrane (HPM) in a chronic hernia repair rat model as an anti-adhesive solution for preventing the development of intra-abdominal adhesions.
The mechanical properties of HPM and human fascia lata (HFL) were evaluated prior to in vivo implantation. Twenty rats underwent midline laparotomy, which led to the development of chronic hernias 28 d later. Then, animals underwent incisional hernia repair in an underlay fashion (n = 5/mesh group) with compressed poly(tetra-fluoro-ethylene) (cPTFE), onto which HPM or HFL were affixed pre-repair, along with two additional controls. The extent and tenacity of intra-abdominal adhesions were determined through qualitative gross evaluations and quantitative tensiometry at 30 d post-repair. The host tissue response was evaluated histologically.
In hydrated state, the elastic properties of HPM were superior to HFL. Repairs with HPM had significantly less surface area covered by adhesions, with significantly lower tenacity compared with all other groups. Furthermore, intra-abdominal adhesions developed in the presence of HPM were associated with omentum only, and were distributed around the perimeter of the exposed cPTFE. HPM served as an active tissue remodeling template, replacing the traditional foreign body encapsulation with an anatomically and physiologically superior outcome.
HPM significantly reduces the extent and tenacity of intra-abdominal adhesion formation, and represents a bioprosthetic template that encourages structural and functional neo peritonealization.

View all citing articles on Scopus

¹: To whom correspondence should be addressed at Genzyme Corporation, One Kendall Square, Cambridge, MA 02139. Fax: 617-374-7225. E-mail: [email protected].

View full text

Regular ArticleEvaluation of Sepramesh Biosurgical Composite in a Rabbit Hernia Repair Model

Abstract

Biomaterials

Fertil. Steril.

Surgery

Biomaterials

J. Surg. Res.

J. Am. Coll. Surg.

Cell

Colocutaneous fistula formation following polypropylene mesh placement for repair of a ventral hernia: Diagnosis by colonoscopy

Endoscopy

Experience with three prosthetic materials in temporary abdominal wall closure

Am. Surg.

Reherniation after repair of the abdominal wall with expanded PTFE

J. Am. Coll. Surg.

Prevention of postoperative abdominal adhesions by a sodium hyaluronate-based bioresorbable membrane: A prospective, randomized, double-blind multicenter study

J. Am. Coll. Surg.

Regular Article
Evaluation of Sepramesh Biosurgical Composite in a Rabbit Hernia Repair Model