Fixation of light-weight polypropylene mesh with cyanoacrylate-derived glues in a rat experimental model: histopathologic immunohistochemical and morphometric study
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The use of cyanoacrylate (CA)-based tissue adhesives for mesh fixation in abdominal hernia repair is increasing due to the fast action and bond strength of these glues. The aim of the present study was to assess tissue changes induced by different CA glues used for mesh fixation in an animal model.
Parietal defects were induced in the abdominal wall of 60 rats and repaired by polyvinylidene fluoride (PVDF) mesh fixation using different CA glues. At 1, 7, 15, and 30 days post-surgery, macroscopic and histopathological studies were performed to evaluate mesh adhesion, the presence of complications and the tissue response.
All meshes were successfully fixed without signs of inflammatory reaction, displacement or detachment. In areas where CA adhesives were applied, the acute tissue response was limited and transient. At 7 days post-surgery, collagen fibril production around prosthetic materials was observed, and collagen maturation was achieved at 30 days post-surgery. Good mesh incorporation was detected with all three glues, but the application of Glubran-2 was associated with an early macrophagic response and the early production and maturation of collagen fibrils.
Our study confirmed that CA tissue adhesives induced the good incorporation of prosthetic mesh within host tissue with a low incidence of complications and reduced acute tissue reaction. At 30 days post-surgery no signs of mesh disinsertion or migration were observed, the prosthetic mesh adhesion was due to the presence of a dense mature connective tissue rich in type I collagen fibres.
KeywordsHernia repair Tissue adhesives Cyanoacrylate glue Cellular response Collagen production
Restricted grant provided by GEM Srl for data analysis.
Compliance with ethical standards
Conflict of interest
The authors declare no conflicts of interest.
Human and animal rights
All procedures performed in studies involving animals were in accordance with the international ethical standards. This article does not contain any studies with human participants performed by any of the authors.
Permission to conduct this experimental study (Authorization n. 755/2015-PR) was granted by the Italian Ministry of Health, in accordance with Italian Laws DL.gs 26/2014 and Directive 2010/63/EU on the protection of animals used for scientific purposes.
No informed consent was necessary for the study.
- 1.Luijendijk RW, Hop WC, van den Tol MP, de Lange DC, Braaksma MM, Ijzermans JN, Boelhouwer RU, de Vries BC, Salu MK, Wereldsma JC, Bruijninckx CM, Jeekel J (2000) A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med 343:392–398. https://doi.org/10.1056/nejm200008103430603 CrossRefPubMedGoogle Scholar
- 4.Ladurner R, Drosse I, Bürklein D, Plitz W, Barbaryka G, Kirchhoff C, Kirchhoff S, Mutschler W, Schieker M, Mussack T (2011) Cyanoacrylate glue for intra-abdominal mesh fixation of polypropylene-polyvinylidene fluoride meshes in a rabbit model. J Surg Res 167(2):e157–e162. https://doi.org/10.1016/j.jss.2009.11.710 CrossRefPubMedGoogle Scholar
- 5.Bellón JM, Fernández-Gutiérrez M, Rodríguez M, Sotomayor S, Pérez-Köhler B, Kuhnhardt A, Pascual G, San Román J (2017) Bioassay of cyanoacrylate tissue adhesives used for intraperitoneal mesh fixation. J Biomed Mater Res B Appl Biomater 105(2):312–319. https://doi.org/10.1002/jbm.b.33558 CrossRefPubMedGoogle Scholar
- 6.Gruber-Blum S, Petter-Puchner AH, Brand J, Fortelny RH, Walder N, Oehlinger W, Koenig F, Redl H (2011) Comparison of three separate antiadhesive barriers for intraperitoneal onlay mesh hernia repair in an experimental model. Br J Surg 98:442–449. https://doi.org/10.1002/bjs.7334 CrossRefPubMedGoogle Scholar
- 7.Hollinsky C, Kolbe T, Walter I, Joachim A, Sandberg S, Koch T, Rulicke T, Tuchmann A (2010) Tensile strength and adhesion formation of mesh fixation systems used in laparoscopic incisional hernia repair. Surg Endosc 24:1318–1324. https://doi.org/10.1007/s00464-009-0767-x CrossRefPubMedGoogle Scholar
- 8.Bellon JM, Fernandez-Gutierrez M, Rodriguez M, Perez-Lopez P, Perez-Kohler B, Kuhnhardt A, Pascual G, Roman JS (2017) Behavior of a new long-chain cyanoacrylate tissue adhesive used for mesh fixation in hernia repair. J Surg Res 208:68–83. https://doi.org/10.1016/j.jss.2016.09.021 CrossRefPubMedGoogle Scholar
- 9.Koehler RH, Begos D, Berger D, Carey S, LeBlanc K, Park A, Ramshaw B, Smoot R, Voeller G (2003) Minimal adhesions to ePTFE mesh after laparoscopic ventral incisional hernia repair: reoperative findings in 65 cases. JSLS 7:335–340. https://doi.org/10.1055/s-2003-41365 CrossRefPubMedPubMedCentralGoogle Scholar
- 10.Suarez-Grau JM, Morales-Conde S, Martin-Cartes JA, Chaves CR, Jimenez MB, Ramirez FP, Docobo-Durantez F, Mendez SM (2009) Mesh fixation with sutures versus fibrin sealant in hernioplasty with re-absorbable prosthesis (polyglycolic acid and trimethylene carbonate). Experimental study in animals. Cir Esp 86:242–248. https://doi.org/10.1016/j.ciresp.2009.05.004 CrossRefPubMedGoogle Scholar
- 13.Kongyuan W, Cuncun L, Long G, Bei P, Huan Y, Jinhui T, Nong C (2018) Different types of mesh fixation for laparoscopic repair of inguinal hernia: a protocol for systematic review and network meta-analysis with randomized controlled trials. Medicine (Baltimore) 97:e0423. https://doi.org/10.1097/md.0000000000010423 CrossRefGoogle Scholar
- 16.Pascual G, Rodriguez M, Perez-Kohler B, Mesa-Ciller C, Fernandez-Gutierrez M, Roman JS, Bellon JM (2017) Host tissue response by the expression of collagen to cyanoacrylate adhesives used in implant fixation for abdominal hernia repair. J Mater Sci Mater Med 28:58. https://doi.org/10.1007/s10856-017-5869-8 CrossRefPubMedGoogle Scholar
- 20.Fernandez-Gutierrez M, Rodriguez-Mancheno M, Perez-Kohler B, Pascual G, Bellon JM, Roman JS (2016) Structural analysis and application of n-alkyl cyanoacrylate surgical adhesives to the fixation of meshes for hernia repair. Macromol Biosci 16:1803–1814. https://doi.org/10.1002/mabi.201600246 CrossRefPubMedGoogle Scholar
- 23.Garcia-Vallejo L, Couto-Gonzalez I, Concheiro-Coello P, Brea-Garcia B, Taboada-Suarez A (2014) Cyanoacrylate surgical glue for mesh fixation in laparoscopic total extraperitoneal hernia repair. Surg Laparosc Endosc Percutan Tech 24:240–243. https://doi.org/10.1097/SLE.0b013e3182a2f008 CrossRefPubMedGoogle Scholar