Surgical Endoscopy

, Volume 25, Issue 7, pp 2125–2131 | Cite as

Human vital amniotic membrane reduces adhesions in experimental intraperitoneal onlay mesh repair

  • A. H. Petter-Puchner
  • R. H. FortelnyEmail author
  • K. Mika
  • S. Hennerbichler
  • H. Redl
  • C. Gabriel



Various antiadhesive coatings have been proposed for intraperitoneal onlay meshes (IPOM). However, adhesions, mesh infections, and impaired integration remain clinically relevant problems. In this experiment, human vital amniotic membrane (AM) was tested as antiadhesive mesh coating. Vital AM complies with clinical standards of product safety.


In this study, 24 rats were randomized to one control or two treatment groups (n = 8). An uncoated polypropylene mesh (Vitamesh) was implanted using open IPOM technique and fixed with four sutures. In the treatment groups, vital AM was attached to Vitamesh by fibrin sealant fixation. The observation period was 7 and 17 days. Vitamesh fixed by suture only served as the control condition (17 days). Adhesion formation, tissue integration, and neovascularization were assessed macroscopically and histologically.


All the meshes in the control group elicited severe adhesions. Vital AM was highly efficient in reducing adhesions to mesh and sutures. No foreign body reaction or unfavorable immunologic response to vital AM occurred. Tissue integration and neovascularization of coated meshes were good. Fibrin sealant yielded a reliable fixation.


Human vital AM was highly effective in reducing adhesions to polypropylene mesh and sutures in experimental IPOM. No adverse effects were detected, and tissue integration of the mesh was good.


Antiadhesives Hernia repair Human amniotic membrane Intraperitoneal mesh placement 



This work was partially supported by a Novosanguis grant. We acknowledge the manufacturers’ support with mesh and fibrin sealant and thank Thomas Benesch, PhD, Nadja Walder, MD, Claudia Keibl, Vet, and Alexandra Meinl for their support.


A. H. Petter-Puchner, R. H Fortelny, K. Mika, S. Hennerbichler, H. Redl, and C. Gabriel have no conflicts of interest or financial ties to disclose.


  1. 1.
    Benhidjeb T, Benecke C, Strik MW (2008) Incisional hernia repair: sublay or intraperitoneal onlay mesh (IPOM)? Zentralbl Chir 133:458–463PubMedCrossRefGoogle Scholar
  2. 2.
    Schug-Pass C, Sommerer F, Tannapfel A, Lippert H, Kockerling F (2009) The use of composite meshes in laparoscopic repair of abdominal wall hernias: are there differences in biocompatibily? Experimental results obtained in a laparoscopic porcine model. Surg Endosc 23:487–495PubMedCrossRefGoogle Scholar
  3. 3.
    Ching SS, Sarela AI, Dexter SP, Hayden JD, McMahon MJ (2008) Comparison of early outcomes for laparoscopic ventral hernia repair between nonobese and morbidly obese patient populations. Surg Endosc 22:2244–2250PubMedCrossRefGoogle Scholar
  4. 4.
    Palanivelu C, Rangarajan M, Jategaonkar PA, Amar V, Gokul KS, Srikanth B (2009) Laparoscopic repair of diastasis recti using the “Venetian blinds” technique of plication with prosthetic reinforcement: a retrospective study. Hernia 13:287–292PubMedCrossRefGoogle Scholar
  5. 5.
    Gananadha S, Samra JS, Smith GS, Smith RC, Leibman S, Hugh TJ (2008) Laparoscopic ePTFE mesh repair of incisional and ventral hernias. ANZ J Surg 78:907–913PubMedCrossRefGoogle Scholar
  6. 6.
    Rauth TP, Poulose BK, Nanney LB, Holzman MD (2007) A comparative analysis of expanded polytetrafluoroethylene and small intestinal submucosa: implications for patch repair in ventral herniorrhaphy. J Surg Res 143:43–49PubMedCrossRefGoogle Scholar
  7. 7.
    Trunzo JA, Ponsky JL, Jin J, Williams CP, Rosen MJ (2009) A novel approach for salvaging infected prosthetic mesh after ventral hernia repair. Hernia (in press)<AQ11>Google Scholar
  8. 8.
    Paton BL, Novitsky YW, Zerey M, Sing RF, Kercher KW, Heniford BT (2007) Management of infections of polytetrafluoroethylene-based mesh. Surg Infect Larchmt 8:337–341PubMedCrossRefGoogle Scholar
  9. 9.
    Di Mugno M, Runfola M, Magalini S, Sermoneta D, Gui D (2006) Rippled mesh: a CT sign of abdominal wall ePTFE prosthesis infection. G Chir 27:384–387PubMedGoogle Scholar
  10. 10.
    Tsimoyiannis EC, Tsimogiannis KE, Pappas-Gogos G, Nikas K, Karfis E, Sioziou H (2008) Seroma and recurrence in laparoscopic ventral hernioplasty. JSLS 12:51–57PubMedGoogle Scholar
  11. 11.
    Burger JW, Halm JA, Wijsmuller AR, ten Raa S, Jeekel J (2006) Evaluation of new prosthetic meshes for ventral hernia repair. Surg Endosc 20:1320–1325PubMedCrossRefGoogle Scholar
  12. 12.
    Olmi S, Scaini A, Erba L, Bertolini A, Croce E (2007) Laparoscopic repair of inguinal hernias using an intraperitoneal onlay mesh technique and a Parietex composite mesh fixed with fibrin glue (Tissucol): personal technique and preliminary results. Surg Endosc 21:1961–1964PubMedCrossRefGoogle Scholar
  13. 13.
    Petter-Puchner AH, Walder N, Redl H, Schwab R, Ohlinger W, Gruber-Blum S et al (2008) Fibrin sealant (Tissucol) enhances tissue integration of condensed polytetrafluoroethylene meshes and reduces early adhesion formation in experimental intraabdominal peritoneal onlay mesh repair. J Surg Res 150:190–195PubMedCrossRefGoogle Scholar
  14. 14.
    Withers L, Rogers A (2006) A spiral tack as a lead point for volvulus. JSLS 10:247–249PubMedGoogle Scholar
  15. 15.
    Karahasanoglu T, Onur E, Baca B, Hamzaoglu I, Pekmezci S, Boler DE et al (2004) Spiral tacks may contribute to intraabdominal adhesion formation. Surg Today 34:860–864PubMedCrossRefGoogle Scholar
  16. 16.
    Szabo A, Haj M, Waxsman I, Eitan A (2000) Evaluation of seprafilm and amniotic membrane as adhesion prophylaxis in mesh repair of abdominal wall hernia in rats. Eur Surg Res 32:125–128PubMedCrossRefGoogle Scholar
  17. 17.
    Hennerbichler S, Reichl B, Pleiner D, Gabriel C, Eibl J, Redl H (2007) The influence of various storage conditions on cell viability in amniotic membrane. Cell Tissue Bank 8:1–8PubMedCrossRefGoogle Scholar
  18. 18.
    Said DG, Nubile M, Alomar T, Hopkinson A, Gray T, Lowe J et al (2009) Histologic features of transplanted amniotic membrane: implications for corneal wound healing. Ophthalmology 116:1287–1295PubMedCrossRefGoogle Scholar
  19. 19.
    Ilancheran S, Moodley Y, Manuelpillai U (2009) Human fetal membranes: a source of stem cells for tissue regeneration and repair? Placenta 30:2–10PubMedCrossRefGoogle Scholar
  20. 20.
    Kesting MR, Wolff KD, Hohlweg-Majert B, Steinstraesser L (2008) The role of allogenic amniotic membrane in burn treatment. J Burn Care Res 29:907–916PubMedCrossRefGoogle Scholar
  21. 21.
    Toda A, Okabe M, Yoshida T, Nikaido T (2007) The potential of amniotic membrane/amnion-derived cells for regeneration of various tissues. J Pharmacol Sci 105:215–228PubMedCrossRefGoogle Scholar
  22. 22.
    Yu SJ, Soncini M, Kaneko Y, Hess DC, Parolini O, Borlongan CV (2009) Amnion: a potent graft source for cell therapy in stroke. Cell Transplant 18:111–118PubMedCrossRefGoogle Scholar
  23. 23.
    Alviano F, Fossati V, Marchionni C, Arpinati M, Bonsi L, Franchina M et al (2007) Term amniotic membrane is a high throughput source for multipotent mesenchymal stem cells with the ability to differentiate into endothelial cells in vitro. BMC Dev Biol 7:11PubMedCrossRefGoogle Scholar
  24. 24.
    Miki T, Mitamura K, Ross MA, Stolz DB, Strom SC (2007) Identification of stem cell marker-positive cells by immunofluorescence in term human amnion. J Reprod Immunol 75:91–96PubMedCrossRefGoogle Scholar
  25. 25.
    Petter-Puchner AH, Fortelny RH, Mittermayr R, Walder N, Ohlinger W, Redl H (2006) Adverse effects of porcine small intestine submucosa implants in experimental ventral hernia repair. Surg Endosc 20:942–946PubMedCrossRefGoogle Scholar
  26. 26.
    Mateijsen MA, van der Wal AC, Hendriks PM, Zweers MM, Mulder J, Struijk DG et al (1999) Vascular and interstitial changes in the peritoneum of CAPD patients with peritoneal sclerosis. Perit Dial Int 19:517–525PubMedGoogle Scholar
  27. 27.
    Voskerician G, Jin J, Hunter SA, Williams CP, White M, Rosen MJ (2009) Human peritoneal membrane reduces the formation of intraabdominal adhesions in ventral hernia repair: experimental study in a chronic hernia rat model. J Surg Res 157:108–114PubMedCrossRefGoogle Scholar
  28. 28.
    Jin J, Voskerician G, Hunter SA, McGee MF, Cavazzola LT, Schomisch S et al (2009) Human peritoneal membrane controls adhesion formation and host tissue response following intraabdominal placement in a porcine model. J Surg Res 156:297–304PubMedCrossRefGoogle Scholar
  29. 29.
    Parolini O, Alviano F, Bagnara GP, Bilic G, Buhring HJ, Evangelista M et al (2008) Concise review: isolation and characterization of cells from human term placenta: outcome of the first international workshop on placenta derived stem cells. Stem Cells 26:300–311PubMedCrossRefGoogle Scholar
  30. 30.
    Wolbank S, Hildner F, Redl H, Van GM, Gabriel C, Hennerbichler S (2009) Impact of human amniotic membrane preparation on release of angiogenic factors. J Tissue Eng Regen Med 3:651–654PubMedCrossRefGoogle Scholar
  31. 31.
    Jain AK, Bansal R, Sukhija J (2008) Human amniotic membrane transplantation with fibrin glue in management of primary pterygia: a new tuck-in technique. Cornea 27:94–99PubMedCrossRefGoogle Scholar
  32. 32.
    Stadler G, Hennerbichler S, Lindenmair A, Peterbauer A, Hofer K, Van GM et al (2008) Phenotypic shift of human amniotic epithelial cells in culture is associated with reduced osteogenic differentiation in vitro. Cytotherapy 10:743–752PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • A. H. Petter-Puchner
    • 1
  • R. H. Fortelny
    • 2
    Email author
  • K. Mika
    • 1
  • S. Hennerbichler
    • 3
  • H. Redl
    • 1
  • C. Gabriel
    • 3
  1. 1.Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Austrian Cluster for Tissue RegenerationViennaAustria
  2. 2.II. Department of SurgeryWilhelminenspitalViennaAustria
  3. 3.Red Cross Blood Transfusion Service of Upper AustriaLinzAustria

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