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Autologous augmentation of hiatal hernia repair with filtered platelet concentrate improves tissue remodeling in a swine model

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Abstract

Introduction

Autologus augmentation of wound remodeling with platelet concentrate is a burgeoning field with promising results. We hypothesized that the addition of filtered platelet concentrate (fPC) to an acellular biologic graft would improve crural healing and tissue integrity in hiatal hernia repair.

Methods

Sixteen healthy Yorkshire female pigs were divided into three groups: hiatus repair (HR) (n = 7), HR with biologic graft (HRM; n = 8, and HR with biologic graft and fPC (fPC; n = 9). Surgeries were performed by a single surgeon. Animals were euthanized at 8 weeks, and the distal esophagus with hiatus was harvested en-block. Tissue was graded by a histopathologist on collagen deposition, vascularization, and inflammation at the graft–hiatal interface. Tensile strength testing was performed using the Teststar IIs (MTS), coupled with a strain extensometer (Epsilon). Samples of equal dimensions were preloaded to 1 N and deformed at a constant rate of 0.2 mm/s. Statistical analysis was performed via Kruskal–Wallis one-way analysis of variance.

Results

Aspirate analysis revealed a mean platelet count of 3 million platelets/1 mL of aspirate. Animals in the fPC group had significantly increased mean chronic inflammation (3.1 ± 1.1 vs. 1.8 ± 1.6, 1.2 ± 1.2, p = 0.04) compared to HR alone and HR + biologic graft. Vascular deposition did not differ between groups (p = 0.8). A trend toward increased collagen deposition was demonstrated for the fPC group (1.4 ± 1.1 vs. 2.0 ± 0.6 in HR group and 3.0 ± 1.2 in HRM group, p = 0.06). There was a statistically significant increase in tensile strength, yield force, and Young’s modulus in the fPC group compared with HR and HR + biologic mesh (p < 0.01).

Conclusion

A trend toward increased collagen deposition and vascularity of the fPC group was demonstrated. In addition, there was an increase in tensile strength and yield force in the fPC group. Use of autologous fPC appears a safe and promising adjunct to wound remodeling and healing in a swine model.

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Acknowledgments

A research grant from COOK® Medical (Award Number 1105172-1-62176) was used to fund this study, in addition to providing Cook Biodesign® mesh. We would like to thank the Foundation for Surgical Fellows for their support of our fellowship program. We also would like to thank Christina Preece for her help with histology.

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Correspondence to Dana A. Telem.

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Dr. Maria S. Altieri, Dr. Gabriel Pagnotti, Dr. Angelique Corthals, Dr. Kenneth Shroyer, and Dr. Mark Talamini have no disclosures. Dr. Aurora Pryor serves as a consultant for Apollo, Intuitive and Freehold Medical, in an investigator with Baronova and Obalon, and serves as a speaker for Ethicon and Gore. Dr. Dana Telem serves as a consultant for Medtronic, Gore and Ethicon and receives research support from Cook and Surgiquest.

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Altieri, M.S., Pagnotti, G., Corthals, A. et al. Autologous augmentation of hiatal hernia repair with filtered platelet concentrate improves tissue remodeling in a swine model. Surg Endosc 31, 1591–1598 (2017). https://doi.org/10.1007/s00464-016-5145-x

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  • DOI: https://doi.org/10.1007/s00464-016-5145-x

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