Advertisement

World Journal of Surgery

, Volume 42, Issue 11, pp 3537–3542 | Cite as

Do Nano-crystalline Silver-Coated Hernia Grafts Reduce Infection?

  • Elif Nergiz Adıgüzel
  • Ebru Esen
  • Gökçe Aylaz
  • Betül Keskinkılıç Yağız
  • Mehmet Kıyan
  • Aydın Doğan
  • Ali Ekrem Ünal
Original Scientific Report

Abstract

Purpose

Inguinal hernia repairs are the most common interventions in adults in general surgery clinics. Depending on the type of mesh and repair, the incidence of mesh-related infection ranges from 0.6 to 8%. Methicillin-resistant Staphylococcus aureus is the most common microorganism causing graft infection. The aim of this study was to investigate the efficacy of nano-crystalline silver-coated polypropylene grafts against graft infection created with MRSA in rats.

Methods

A total of 60 female, Wistar albino rats were used in the study. Polypropylene grafts 1 × 1 cm in size were coated in silver ion-doped, calcium phosphate-based, antibacterial ceramic powder (NS-coated graft) to provide an antimicrobial effect. The MRSA seeding procedure was applied at the same time as surgery. In Group 1, normal graft was applied without MRSA seeding, in Group 2, normal graft with MRSA seeding, in Group 3, NS-coated graft without MRSA seeding, and in Group 4, NS-coated graft with MRSA seeding. For the groups which were to be infected, the bacteria were seeded in the surgical area during the operation. On the 7th day postoperatively, all the animals were killed. The grafts were removed and one from each group was examined under electron microscope and the others were implanted in culture medium and the number of colonies was counted after 24 h.

Results

In Groups 1 and 3, the incision site was seen to have healed on day 3, no clinical surgical area infection was seen during follow-up, and in the exploration made on the 7th day, no findings of infection were observed. In Group 2, hyperemia and collection were seen to have formed on day 3, abscess had started to form in all the rats of this group on day 4, a purulent discharge in the wound site had started in 12 animals on day 5, separation of the wound site was observed in 6 on day 6, and in the exploration on day 7, there was seen to be a fibrin and pus-rich collection around the graft in all cases. In Group 4, there were hyperemia and collection in 6 animals on day 4, and in 3 of these, abscess was seen to have formed on the 5th day. No purulent discharge or wound separation was observed. In the exploration on the 7th day, it was seen that in the animals with abscess development, the formation was of a localized abscess. The results of the cultures of the grafts removed from Groups 1 and 3 showed no production, whereas production was seen in all the grafts removed from Groups 2 and 4. Clinical surgical area infection was seen to have developed in 100% of Group 2 and in 40% of Group 4. In the comparison of the number of colonies, a statistically significantly lower number of bacteria were determined in Group 4 compared to Group 2 (p < 0.05). In the SEM images taken of Group 2, bacteria clusters were seen attached to the graft.

Conclusion

Consistent with previous findings in the literature, the NS-coated polypropylene graft was seen to have a significantly better bactericidal effect than the normal polypropylene graft. Development of NS-coated grafts seems to be a reliable and applicable method to reduce the incidence of postoperative graft infection.

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Dilek ON, Türel KS (2009) Fıtık Tamirinde Mesh Kullanımı ve Komplikasyonları. Cerrahi Sanatlar Dergisi 2(1):1–9Google Scholar
  2. 2.
    Çakmak A (2011) İnguinal Greft İnfeksiyonları. ANKEM Dergisi 25(Ek 2):150–153Google Scholar
  3. 3.
    The EU Hernia Trialists Collaboration (2002) Repair of groin hernia with synthetic mesh. Meta-analysis of randomized controlled trials. Ann Surg 235:322–332CrossRefGoogle Scholar
  4. 4.
    Altun H, Yorganci K, Hamaloglu E (2000) Increasing tendency towards mesh-based herniorrhaphies over last 10 years: analysis of 794 groin hernia repairs. Eurosurgery, Abstract-book, pp 173–174Google Scholar
  5. 5.
    Luijendijk RW, Hop WC, Mp VDT, de Lange DC, Braaksma MM, Ijzermans JN, Boelhouwer RU, de Vries BC, Salu MK, Wereldsma JC, Engl N (2000) A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med 343:392–398CrossRefGoogle Scholar
  6. 6.
    Zhang S, Xu K, Darabi MA, Yuan Q, Xing M (2016) Mussel-inspired alginate gel promoting the osteogenic differentiation of mesenchymal stem cells and anti-infection. Mater Sci Eng C 69:496–504CrossRefGoogle Scholar
  7. 7.
    Zhang S, Wan W, Xu K, Yuan Q, Xing M (2015) Biodegradable materials for bone repair and tissue engineering applications. J Biomater Tissue Eng 4:875–885CrossRefGoogle Scholar
  8. 8.
    Dieudonne G (2001) Plug repair of groin hernias: a 10-year experience. Hernia 5:189–191CrossRefGoogle Scholar
  9. 9.
    Read RC (2004) Milestones in the history of hernia surgery: prosthetic repair. Hernia 8:8–14CrossRefGoogle Scholar
  10. 10.
    Cobb WS, Harris JB, Lokey JS et al (2003) Incisional herniorrhaphy with intraperitoneal composite mesh: a report of 95 cases. Am Surg 69:784–787PubMedGoogle Scholar
  11. 11.
    Edmiston CE, Seabrook GR, Goheen MP, Krepel CJ, Johnson CP, Lewis BD, Brown KR, Towne JB (2006) Bacterial adherence to surgical sutures: can antibacterial-coated sutures reduce the risk of microbial contamination. J Am Coll Surg 203(4):481–489CrossRefGoogle Scholar
  12. 12.
    Darouiche RO, Fowler VG Jr, Adal K, Kielhofner M, Mansouri D, Reller LB (2002) Antimicrobial activity of prosthetic heart valve sewing cuffs coated with minocycline and rifampin. Antimicrob Agents Chemother 46:543–547CrossRefGoogle Scholar
  13. 13.
    Bosetti M, Massè A, Tobin E, Cannas M (2002) Silver coated materials for external fixation devices: in vitro biocompatibility and genotoxicity. Biomaterials 23(3):887–892CrossRefGoogle Scholar
  14. 14.
    Pekşen C (2006) Metal iyon katkılı Kalsiyum fosfat esaslı antibakteriyel seramik tozun karekterizasyonu ve sitotoksiditesinin belirlenmesi. Yüksek lisans tezi. Anadolu Üniversitesi Fen Bilimleri Enstitüsü Seramik Mühendisliği Anabilim Dalı Eskişehir, pp 42–56Google Scholar
  15. 15.
    Miao P, Balachandran W, Xiao P (2002) Formation of ceramic thin films using electrospray in cone-jet mode. IEEE Trans Ind Appl 38(1):50–55CrossRefGoogle Scholar
  16. 16.
    Agalar C, Ozdogan M, Agalar F, Saygun O, Aydinuraz K, Akkus A, Ceken S, Akturk S (2006) A rat model of polypropylene graft infection caused by Staphylococcus epidermidis. ANZ J Surg 76(5):387–391CrossRefGoogle Scholar
  17. 17.
    Ağalar C, Eroğlu E, Yaylı G (2001) Metisilin Dirençli Staphylococcus Aureus İle Deneysel Graft Enfeksiyonu Modelinde İki Farklı Kültür Yönteminin Etkinliğinin Karşılaştırılması. Mikrobiyoloji Bülteni 35:63–67Google Scholar
  18. 18.
    Tomaselli N (2006) The role of topical silver preparations in wound healing. J Wound Ostomy Cont Nurs 33(4):367–378 (quiz 379-80) CrossRefGoogle Scholar
  19. 19.
    Darouiche RO (2004) Current concepts: treatment of infections associated with surgical implants. N Engl J Med 350:1422–1429CrossRefGoogle Scholar
  20. 20.
    Badiou W, Lavigne JP, Bousquet PJ, O’Callaghan D, Marès P, Tayrac R (2011) In vitro and in vivo assessment of silver-coated polypropylene mesh to prevent infection in a rat model. Int Urogynecol J 22:265–272CrossRefGoogle Scholar
  21. 21.
    Cohen MS, Stern JM, Vanni AJ, Kelley RS, Baumgart E, Field D, Libertino JA, Summerhayes IC (2007) In vitro analysis of a nanocrystalline silver-coated surgical mesh. Surg Infect (Larchmt) 8(3):397–403CrossRefGoogle Scholar
  22. 22.
    Hintze J (2011) Pass 11. NCSS LLC, KaysvilleGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  1. 1.Department of General SurgeryLokman Hekim Demet Medical CenterAnkaraTurkey
  2. 2.Department of General SurgeryKonya Training and Research HospitalMeramTurkey
  3. 3.Department of General Surgery, Istanbul Health Practice and Research CenterBaskent UniversityIstanbulTurkey
  4. 4.Department of General SurgeryNumune Training and Research HospitalAnkaraTurkey
  5. 5.Department of Microbiology, Faculty of MedicineAnkara UniversityAnkaraTurkey
  6. 6.Department of Materials Science and Engineering, Faculty of EngineeringAnadolu UniversityEskisehirTurkey
  7. 7.Department of Surgical Oncology, Faculty of MedicineAnkara UniversityAnkaraTurkey

Personalised recommendations