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

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.

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Acknowledgments

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.).

Disclosures

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.

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Authors and Affiliations

  1. Department of General Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan

    Keiichi Fujino, Hidekazu Yano & Yuji Tanaka

  2. Department of Immunology and Microbiology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan

    Manabu Kinoshita

  3. Department of Life Science and Medical Bioscience, Graduate School of Advanced Science and Engineering, Waseda University (TWIns), 2-2 Wakamatsu-cho, Shinjuku, Tokyo, 162-8480, Japan

    Akihiro Saitoh, Toshinori Fujie & Shinji Takeoka

  4. Department of Traumatology and Critical Care Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan

    Kahoko Nishikawa

  5. Department of Basic Pathology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan

    Keiichi Iwaya

  6. Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan

    Minoru Kakihara

  7. Division of Traumatology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan

    Daizoh Saitoh

Authors
  1. Keiichi Fujino
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  2. Manabu Kinoshita
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  3. Akihiro Saitoh
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  6. Toshinori Fujie
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  8. Minoru Kakihara
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  9. Shinji Takeoka
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  10. Daizoh Saitoh
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  11. Yuji Tanaka
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Correspondence to Keiichi Fujino.

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Fujino, K., Kinoshita, M., Saitoh, A. et al. Novel technique of overlaying a poly-l-lactic acid nanosheet for adhesion prophylaxis and fixation of intraperitoneal onlay polypropylene mesh in a rabbit model. Surg Endosc 25, 3428–3436 (2011). https://doi.org/10.1007/s00464-011-1745-7

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