Surgery Today

, Volume 43, Issue 11, pp 1298–1304 | Cite as

A newly designed bioabsorbable substitute for the treatment of diaphragmatic defects

  • Masayasu Aikawa
  • Mitsuo Miyazawa
  • Kojun Okamoto
  • Yasuko Toshimitsu
  • Katsuya Okada
  • Naoe Akimoto
  • Yosuke Ueno
  • Isamu Koyama
  • Yoshito Ikada
Original Article

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 

References

  1. 1.
    Chao H, Liu C, Chen C, et al. Congenital diaphragmatic hernia in the neonatal period: review of 21 years’ experience. Pediatr Neonatol. 2010;51:97–102.PubMedCrossRefGoogle Scholar
  2. 2.
    Lally P, Paranka MS, Roden J, Georgeson KE, Wilson JM, Lillehei CW, et al. Congenital diaphragmatic hernia. Stabilization and repair on ECMO. Ann Surg. 1992;216:569–73.PubMedCrossRefGoogle Scholar
  3. 3.
    Crandall M, Popowich D, Shapiro M, West M. Posttraumatic hernias: historical overview and review of the literature. Am Surg. 2007;73:845–50.PubMedGoogle Scholar
  4. 4.
    Rocco G, Rendina EA, Meroni A, Venuta F, Della Pona C, De Giacomo T, et al. Prognostic factors after surgical treatment of lung cancer invading the diaphragm. Ann Thorac Surg. 1999;68:2065–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Sugarbaker DJ, Mentzer SJ, Strauss G. Extrapleural pneumonectomy in the treatment of malignant pleural mesothelioma. Ann Thorac Surg. 1992;54:941–6.PubMedCrossRefGoogle Scholar
  6. 6.
    Geisler F, Gotlieb A, Fried D. Agenesis of the right diaphragm: repaired with marlex. J Pediatr Surg. 1977;12:587–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Kuhn R, Schubert D, St, Marusch F, Lippert H, Pross M. Repair of diaphragmatic rupture by laparoscopic implantation of a polytetrafluoroethylene patch. Surg Endosc. 2002;16:1495.Google Scholar
  8. 8.
    Menezes, Chagas, Macedo-Neto, Santos, Rocco, Zin. Suture or prosthetic reconstruction of experimental diaphragmatic defects. Chest. 2000;117:1443–8.Google Scholar
  9. 9.
    Rocco G, Rendina EA. Prosthetic reconstruction of the resected diaphragm: the way to go. Chest. 2001;119:671.PubMedCrossRefGoogle Scholar
  10. 10.
    Lantis JC, Gallivan EK, Hekier R, Connolly R, Schwaitzberg SD, Crombleholme T. A comparison of collagen and PTFE patch repair in a rabbit model of congenital diaphragmatic hernia. J Invest Surg. 2000;13:319–25.PubMedCrossRefGoogle Scholar
  11. 11.
    Tatum RP, Shalhub S, Oelschlager BK, Pellegrini CA. Complications of PTFE mesh at the diaphragmatic hiatus. J Gastrointest Surg. 2008;12:953–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Schneider R, Herrington JL, Granda AM. Marlex mesh in repair of a diaphragmatic defect later eroding into the distal esophagus and stomach. Am Surg. 1979;45:337–9.PubMedGoogle Scholar
  13. 13.
    Barbosa RF, Rodrigues J, Correia-Pinto J, Costa-Ferreira A, Cardoso A, Reis JC, et al. Repair of a large congenital diaphragmatic defect with a reverse latissimus dorsi muscle flap. Microsurgery. 2008;28:85–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Bedini AV, Andreani SM, Muscolino G. Latissimus dorsi reverse flap to substitute the diaphragm after extrapleural pneumonectomy. Ann Thorac Surg. 2000;69:986–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Kageyama Y, Suzuki K, Matsushita K, Takahashi T, Kazui T. Diaphragm reconstruction with autologous fascia lata: report of a case. Surg Today. 1999;29:1285–6.PubMedCrossRefGoogle Scholar
  16. 16.
    Suzuki K, Takahashi T, Itou Y, Asai K, Shimota H, Kazui T. Reconstruction of diaphragm using autologous fascia lata: an experimental study in dogs. Ann Thorac Surg. 2002;74:209–12.PubMedCrossRefGoogle Scholar
  17. 17.
    Sydorak RM, Hoffman W, Lee H, Yingling CD, Longaker M, Chang J, et al. Reversed latissimus dorsi muscle flap for repair of recurrent congenital diaphragmatic hernia. J Pediatr Surg. 2003;38:296–300. (Discussion 296–300).PubMedCrossRefGoogle Scholar
  18. 18.
    Dalla Vecchia L, Engum S, Kogon B, Jensen E, Davis M, Grosfeld J. Evaluation of small intestine submucosa and acellular dermis as diaphragmatic prostheses. J Pediatr Surg. 1999;34:167–71.PubMedCrossRefGoogle Scholar
  19. 19.
    Sandoval JA, Lou D, Engum SA, Fisher LM, Bouchard CM, Davis MM, et al. The whole truth: comparative analysis of diaphragmatic hernia repair using 4-ply vs 8-ply small intestinal submucosa in a growing animal model. J Pediatr Surg. 2006;41:518–23.PubMedCrossRefGoogle Scholar
  20. 20.
    Koot VC, Bergmeijer JH, Molenaar JC. Lyophylized dura patch repair of congenital diaphragmatic hernia: occurrence of relapses. J Pediatr Surg. 1993;28:667–8.PubMedCrossRefGoogle Scholar
  21. 21.
    Fauza DO, Marler JJ, Koka R, Forse RA, Mayer JE, Vacanti JP. Fetal tissue engineering: diaphragmatic replacement. J Pediatr Surg. 2001;36:146–51.PubMedCrossRefGoogle Scholar
  22. 22.
    Kunisaki SM, Fuchs JR, Kaviani A, Oh JT, LaVan DA, Vacanti JP, et al. Diaphragmatic repair through fetal tissue engineering: a comparison between mesenchymal amniocyte- and myoblast-based constructs. J Pediatr Surg. 2006;41:34–9. Discussion 9.PubMedCrossRefGoogle Scholar
  23. 23.
    Toshimitsu Miyazawa. Ikada. Tissue-engineered patch for the reconstruction of inferior vena cava during living-donor liver transplantation. J Gastrointest Surg. 2005;9:789–93.PubMedCrossRefGoogle Scholar
  24. 24.
    Toshimitsu Y, Miyazawa M, Torii T, Koyama I, Ikada Y. Tissue-engineered patch for the reconstruction of inferior vena cava during living-donor liver transplantation. J Gastrointest Surg. 2005;9:789–93.PubMedCrossRefGoogle Scholar
  25. 25.
    Beck DE, Cohen Z, Fleshman JW, Kaufman HS, van Goor H, Wolff BG. A prospective, randomized, multicenter, controlled study of the safety of Seprafilm adhesion barrier in abdominopelvic surgery of the intestine. Dis Colon Rectum. 2003;46:1310–9.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Japan 2012

Authors and Affiliations

  • Masayasu Aikawa
    • 1
  • Mitsuo Miyazawa
    • 1
  • Kojun Okamoto
    • 1
  • Yasuko Toshimitsu
    • 1
  • Katsuya Okada
    • 1
  • Naoe Akimoto
    • 1
  • Yosuke Ueno
    • 1
  • Isamu Koyama
    • 1
  • Yoshito Ikada
    • 2
  1. 1.Department of Surgery, Gastrointestinal CenterSaitama Medical University International Medical CenterHidakaJapan
  2. 2.Division of Life ScienceNara Medical UniversityNaraJapan

Personalised recommendations