Original Article

Surgery Today

, Volume 43, Issue 11, pp 1298-1304

First online:

A newly designed bioabsorbable substitute for the treatment of diaphragmatic defects

  • Masayasu AikawaAffiliated withDepartment of Surgery, Gastrointestinal Center, Saitama Medical University International Medical Center
  • , Mitsuo MiyazawaAffiliated withDepartment of Surgery, Gastrointestinal Center, Saitama Medical University International Medical Center Email author 
  • , Kojun OkamotoAffiliated withDepartment of Surgery, Gastrointestinal Center, Saitama Medical University International Medical Center
  • , Yasuko ToshimitsuAffiliated withDepartment of Surgery, Gastrointestinal Center, Saitama Medical University International Medical Center
  • , Katsuya OkadaAffiliated withDepartment of Surgery, Gastrointestinal Center, Saitama Medical University International Medical Center
  • , Naoe AkimotoAffiliated withDepartment of Surgery, Gastrointestinal Center, Saitama Medical University International Medical Center
  • , Yosuke UenoAffiliated withDepartment of Surgery, Gastrointestinal Center, Saitama Medical University International Medical Center
  • , Isamu KoyamaAffiliated withDepartment of Surgery, Gastrointestinal Center, Saitama Medical University International Medical Center
  • , Yoshito IkadaAffiliated withDivision of Life Science, Nara Medical University

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Abstract

Purpose

Earlier studies have investigated the suitability of various materials and autologous grafts for the repair of diaphragmatic defects. Our group investigated the feasibility of using an artificial diaphragm (AD) to repair wide diaphragmatic defects.

Methods

Twelve pigs were laparotomized and, in each pig, a defect was fashioned by resecting a round 8-cm diameter hole in the left diaphragm. Next, the defect was repaired by implanting an AD. The animals were relaparotomized 8 or 24 weeks after implantation for gross, histological and radiological observation of the implanted sites.

Results

All recipient animals survived until killing for evaluation. Chest X-ray examinations showed no differences between the preoperative diaphragms and the grafted diaphragms at 8 and 24 weeks after implantation. At 8 weeks after implantation, the implanted sites exhibited fibrous adhesions to the liver and lungs without deformities or penetrations. Parts of the surface tissue at the graft sites had a varnished appearance similar to those of the native diaphragm. Histology performed at 8 weeks detected no trace of the ADs in the graft sites; however, numerous inflammatory cells and profuse fibrous connective tissue were observed. At 24 weeks after implantation, no differences were found in the thorax between the areas with the grafts and the unaffected areas. Histology of the graft sites in the thorax confirmed growth of mesothelial cells similar to that observed in the native diaphragm.

Conclusions

Artificial diaphragms can be a novel substitute for diaphragmatic repair.

Keywords

Diaphragmatic reconstruction Diaphragmatic defect Bioabsorbable polymer Congenital diaphragmatic hernia Diaphragmatic invasion Post-traumatic diaphragmatic hernia