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Intraabdominal adhesion formation of polypropylene mesh Influence of coverage of omentum and polyglactin

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Abstract

Background

Adhesions after intraabdominal surgical procedures are related to high morbidity and mortality. Biomaterials, particularly those made of polypropylene, in the intraabdominal position have to be considered as pathophysiological cofactor in a multifactorial process of adhesion formation. To investigate the adhesive potential induced by the biomaterial, an animal model was performed. In addition, the influence of coverage by omentum or a polyglactin barrier was investigated.

Methods

In, 18 Chinchilla rabbits the biomaterial was placed laparoscopically using the intraperitoneal onlay mesh technique. Using this model, a polypropylene–polyglactin mesh compound (PPMC) was used with three different implantation techniques: group 1, PPMC implantation without coverage (PPMC): group 2, PPMC implantation with additional omentum coverage (PPMC-O): and group 3, PPMC implantation with coverage of an absorbable polyglactin mesh (PPMC-V). The degree of adhesion formation was measured 90 days after implantation by computer-assisted planimetry. Morphometric examination followed the explantation analyzing the amount of foreign body response.

Results

We found a significant reduction of adhesion formation for the PPMC and PPMC-O groups compared to the PPMC-V group, in which dense adhesions were found. Morphometric investigations of the perifilamental granulomas of the pure (PPMC) group revealed a typical foreign body reaction with a mild to moderate fibrosis around all mesh fibers. However, tissue specimens of the PPMC-O and PPMC-V groups indicated a similar inflammatory reaction but significantly increased connective tissue formation around the polymer fibers compared to the pure PPMC group.

Conclusion

The intraabdominal placement of a pure PPMC shows a neoperitonealization and perifilamental collagenous ingrowth with almost no adhesions. Coverage with omentum (PPMC-O) or polyglactin mesh (PPMC-V) resulted in a significant increase in inflammation and perifilamentary connective tissue formation.

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Acknowledgment

This study was supported by Ethicon, Norderstedt, Germany.

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Authors and Affiliations

  1. Department of Surgery, Rhenish-Westphalian Technical University, Pauwelsstraße 30, Aachen, D-52074, Germany

    J. Conze, K. Junge, U. Klinge & V. Schumpelick

  2. Institute for Medical Statistic, Rhenish-Westphalian Technical University, Paulwelsstraße 30, Aachen, D-52074, Germany

    C. Weiß

  3. Joint Institute for Surgical Research, Russian State University, Moscow, Russia

    M. Polivoda & A. P. Oettinger

Authors
  1. J. Conze
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  2. K. Junge
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  3. U. Klinge
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  4. C. Weiß
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  5. M. Polivoda
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  6. A. P. Oettinger
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  7. V. Schumpelick
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Correspondence to J. Conze.

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Conze, J., Junge, K., Klinge, U. et al. Intraabdominal adhesion formation of polypropylene mesh Influence of coverage of omentum and polyglactin. Surg Endosc 19, 798–803 (2005). https://doi.org/10.1007/s00464-004-2192-5

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  • DOI: https://doi.org/10.1007/s00464-004-2192-5

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