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Remodeling characteristics and collagen distribution in synthetic mesh materials explanted from human subjects after abdominal wall reconstruction: an analysis of remodeling characteristics by patient risk factors and surgical site classifications

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Abstract

Background

The purpose of this study was to evaluate the associations between patient characteristics or surgical site classifications and the histologic remodeling scores of synthetic meshes biopsied from their abdominal wall repair sites in the first attempt to generate a multivariable risk prediction model of non-constructive remodeling.

Methods

Biopsies of the synthetic meshes were obtained from the abdominal wall repair sites of 51 patients during a subsequent abdominal re-exploration. Biopsies were stained with hematoxylin and eosin, and evaluated according to a semi-quantitative scoring system for remodeling characteristics (cell infiltration, cell types, extracellular matrix deposition, inflammation, fibrous encapsulation, and neovascularization) and a mean composite score (CR). Biopsies were also stained with Sirius Red and Fast Green, and analyzed to determine the collagen I:III ratio. Based on univariate analyses between subject clinical characteristics or surgical site classification and the histologic remodeling scores, cohort variables were selected for multivariable regression models using a threshold p value of ≤0.200.

Results

The model selection process for the extracellular matrix score yielded two variables: subject age at time of mesh implantation, and mesh classification (c-statistic = 0.842). For CR score, the model selection process yielded two variables: subject age at time of mesh implantation and mesh classification (r 2 = 0.464). The model selection process for the collagen III area yielded a model with two variables: subject body mass index at time of mesh explantation and pack-year history (r 2 = 0.244).

Conclusion

Host characteristics and surgical site assessments may predict degree of remodeling for synthetic meshes used to reinforce abdominal wall repair sites. These preliminary results constitute the first steps in generating a risk prediction model that predicts the patients and clinical circumstances for which non-constructive remodeling of an abdominal wall repair site with synthetic mesh reinforcement is most likely to occur.

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Acknowledgments

This study utilized the REDCap® application for data maintenance, which is supported at the Washington University, St. Louis, by a Clinical and Translational Science Award (CTSA; UL1TR000448), and a National Cancer Institute (NCI) Cancer Center Support Grant to the Siteman Comprehensive Cancer Center (P30CA091842). Jaime A. Cavallo is supported by a KM1 Comparative Effectiveness Research (CER) Career Development Award (KM1CA156708) through the NCI of the National Institutes of Health (NIH), and the Washington University, St. Louis, CTSA program (UL1TR000448) through the National Center for Advancing Translational Sciences (NCATS) of the NIH. The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official views of the NCI, NCATS, or NIH.

Author contributions

Study conception and design: Jaime A. Cavallo, Brent D. Matthews, and Corey R. Deeken; acquisition of data: Jaime A. Cavallo, Andres A. Roma, Jenny Ousley, Jennifer Creamer, Matthew D. Pichert, Sara Baalman, and Margaret M. Frisella; analysis and interpretation of data: Jaime A. Cavallo, Mateusz S. Jasielec, Brent D. Matthews, and Corey R. Deeken; drafting of manuscript: Jaime A. Cavallo, Mateusz S. Jasielec, Brent D. Matthews, and Corey R. Deeken; critical revision: Jaime A. Cavallo, Andres A. Roma, Mateusz S. Jasielec, Jenny Ousley, Jennifer Creamer, Matthew D. Pichert, Sara Baalman, Margaret M. Frisella, Brent D. Matthews, and Corey R. Deeken.

Disclosure

Dr. Cavallo has received research grant funding for unrelated studies from the NIH, the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), and the American Hernia Society in collaboration with Davol® Incorporated. Ms. Frisella has received funding from Atrium Medical Corporation® and W. L. Gore and Associates® Incorporated for unrelated service contracts, as well as research grant funding for unrelated studies from the Foundation for Barnes-Jewish Hospital. Dr. Matthews has served on advisory boards for the Musculoskeletal Transplant Foundation, Covidien® Incorporated, and Synthes® Incorporated; served as a consultant for Atrium Medical Corporation®; received speaking fees or honoraria from Atrium Medical Corporation®, Davol® Incorporated, Ethicon® Incorporated, and W. L. Gore and Associates® Incorporated; received payments for authorship of an unrelated publication from McMahon Group® Incorporated; received research grant funding for unrelated research studies from Covidien® Incorporated, Ethicon® Incorporated, Karl Storz Endoscopy America® Incorporated, Kensey Nash Corporation®, Musculoskeletal Transplant Foundation, Synovis Surgical Innovations®, SAGES, NIH, and the Foundation for Barnes-Jewish Hospital. Dr. Deeken has served as a consultant for Atrium Medical Corporation® and Davol® Incorporated; received speaking fees or honoraria from Covidien® Incorporated and the Musculoskeletal Transplant Foundation; received research grant funding for unrelated research studies from Atrium Medical Corporation®, Covidien® Incorporated, Ethicon® Incorporated, Kensey Nash Corporation®, Musculoskeletal Transplant Foundation, OBI Biologics Incorporated®, and SAGES. Dr. Roma, Mr. Jasielec, Ms. Ousley, Dr. Creamer, Mr. Pichert, and Ms. Baalman have no conflicts of interest or financial ties to disclose.

Funding

Funding for this project was provided by the Department of Surgery, Washington University School of Medicine.

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Authors and Affiliations

  1. Section of Minimally Invasive Surgery, Department of Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8109, St. Louis, MO, 63110, USA

    Jaime A. Cavallo, Matthew D. Pichert, Sara Baalman, Margaret M. Frisella, Brent D. Matthews & Corey R. Deeken

  2. Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH, USA

    Andres A. Roma

  3. Department of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA

    Mateusz S. Jasielec

  4. Meharry Medical College, Nashville, TN, USA

    Jenny Ousley

  5. William Beaumont Army Medical Center, El Paso, TX, USA

    Jennifer Creamer

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  1. Jaime A. Cavallo
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Correspondence to Corey R. Deeken.

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Cavallo, J.A., Roma, A.A., Jasielec, M.S. et al. Remodeling characteristics and collagen distribution in synthetic mesh materials explanted from human subjects after abdominal wall reconstruction: an analysis of remodeling characteristics by patient risk factors and surgical site classifications. Surg Endosc 28, 1852–1865 (2014). https://doi.org/10.1007/s00464-013-3405-6

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