Surgical Endoscopy

, 25:3428 | Cite as

Novel technique of overlaying a poly-l-lactic acid nanosheet for adhesion prophylaxis and fixation of intraperitoneal onlay polypropylene mesh in a rabbit model

  • Keiichi FujinoEmail author
  • Manabu Kinoshita
  • Akihiro Saitoh
  • Hidekazu Yano
  • Kahoko Nishikawa
  • Toshinori Fujie
  • Keiichi Iwaya
  • Minoru Kakihara
  • Shinji Takeoka
  • Daizoh Saitoh
  • Yuji Tanaka
Dynamic Manuscript



One problem with polypropylene mesh (PPM) used to repair abdominal wall hernias is dense adhesions to the visceral surface. The authors developed the biocompatible poly-l-lactic acid (PLLA) nanosheet (thickness < 100 nm), which has the unique ability to adhere tightly to tissues but not to opposing tissues. This study investigated the antiadhesive and fixative characteristics of the PLLA nanosheet after placement of intraperitoneal onlay PPM (IPOM) overlaid with a PLLA nanosheet on intact peritoneum.


The PLLA nanosheet was fabricated by the spin-coating method and peeling technique with polyvinyl alcohol (PVA) as a supporting film. Two 1.5-cm-square pieces of mesh were implanted on each peritoneal side of the midline incision. The mesh was fixed to the peritoneum with a suture and then overlaid with a 4-cm-square piece of Seprafilm or nanosheet. To examine the fixative property, mesh was overlaid with Seprafilm or nanosheet without a fixed suture. After 4 weeks, mesh adhesion, inflammatory reaction, fixation, and dislocation of mesh were evaluated.


Nanosheet-overlaid meshes were flexible and fit over the peritoneum. Adhesion was observed in 10% of the nanosheet-overlaid meshes and in 50% of the Seprafilm-overlaid meshes. The adhesion tenacity grade was significantly lower with the nanosheet-overlaid meshes (0.1 ± 0.1) than with the Seprafilm-overlaid meshes (1.0 ± 0.4) (p = 0.029), and the percentage of the adhesion area also was lower with the nanosheet-overlaid meshes (1.0 ± 1.0% vs 8.5 ± 3.2%; p = 0.037). The mean inflammatory cell counts were lower with the nanosheet-overlaid meshes (p = 0.0023). Regarding the fixative property, 37.5% of the nanosheet-overlaid meshes were fixated on the peritoneum, but no Seprafilm-overlaid mesh was fixated.


Overlaying of a PLLA nanosheet was effective for adhesion prophylaxis of intraperitoneal mesh. It also may have a possible beneficial effect on fixation of mesh.


Adhesion, fixation PLLA nanosheet Polymer Polypropylene Pore 



This study was supported by the Adaptable and Seamless Technology Transfer Program through target-driven research and development (R&D) (A-STEP) from JST, Japan and the Japanese Foundation for Research and Promotion of Endoscopy (JFE) Grant (T.F.).


Keiichi Fujino, Manabu Kinoshita, Akihiro Saitoh, Hidekazu Yano, Kahoko Nishikawa, Toshinori Fujie, Keiichi Iwaya, Minoru Kakihara, Shinji Takeoka, Daizoh Saitoh, and Yuji Tanaka have no conflicts of interest or financial ties to disclose.

Supplementary material

464_2011_1745_MOESM1_ESM.pdf (146 kb)
Supplementary material 1 (PDF 146 kb)
464_2011_1745_MOESM2_ESM.pdf (387 kb)
Supplementary material 2 (PDF 388 kb)

Supplementary material 3 (WMV 42920 kb)


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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Keiichi Fujino
    • 1
    Email author
  • Manabu Kinoshita
    • 2
  • Akihiro Saitoh
    • 3
  • Hidekazu Yano
    • 1
  • Kahoko Nishikawa
    • 4
  • Toshinori Fujie
    • 3
  • Keiichi Iwaya
    • 5
  • Minoru Kakihara
    • 6
  • Shinji Takeoka
    • 3
  • Daizoh Saitoh
    • 7
  • Yuji Tanaka
    • 1
  1. 1.Department of General MedicineNational Defense Medical CollegeTokorozawaJapan
  2. 2.Department of Immunology and MicrobiologyNational Defense Medical CollegeTokorozawaJapan
  3. 3.Department of Life Science and Medical Bioscience, Graduate School of Advanced Science and EngineeringWaseda University (TWIns)ShinjukuJapan
  4. 4.Department of Traumatology and Critical Care MedicineNational Defense Medical CollegeTokorozawaJapan
  5. 5.Department of Basic PathologyNational Defense Medical CollegeTokorozawaJapan
  6. 6.Department of SurgeryNational Defense Medical CollegeTokorozawaJapan
  7. 7.Division of TraumatologyNational Defense Medical CollegeTokorozawaJapan

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