Abdominal wall healing in incisional hernia using different biomaterials in rabbits

Ana Letícia Gomes Aramayo,Gaspar De Jesus Lopes Filho,Cirênio De Almeida Barbosa,Luciano Assis Costa,Vânia Da Fonseca Amaral

doi:10.1590/s0102-86502013000400011

Abstract

To investigate abdominal wound healing using specific biomaterials in incisional hernias. Incisional hernias were produced in 40 rabbits, after that they were reoperated with or without the use of meshes: PREMILENE® (PPL), ULTRAPRO® (UP), PROCEED® (PCD) or repairing without mesh (TRANSPALB). After 30 days a macroscopic and microscopic study of the part withdrawn from the abdominal wall was performed. Macroscopic: adhesion Area: PPL> UP and PCD (p = 0.031). Vascularization: PPL> UP and PCD (p = 0.001). PPL groups (p = 0.032) and PCD (p <0.001) showed greater meshes shrinkages when compared to UP. Microscopic: neutrophils: PCD> PPL, UP and TRANSPALB (p = 0.010); eosinophils: PPL> UP, and TRANSPALB PCD (p = 0.010); granulation tissue: PPL and PCD> UP and TRANSPALB (p <0.001); macrophages : PPL, UP and PCD> TRANSPALB (p <0.001); lymphocytes: PPL and PCD> UP (p = 0.009) and TRANSPALB (p <0.001); giant cells: PPL, UP and PCD> TRANSPALB (p <0.001); viscera adhered: PPL and UP> PCD and TRANSPALB (p <0.001). All types of meshes caused the formation of adhesions. The UP and PCD groups showed lower area and vascularization of the adhesions. The PPL and PCD groups showed higher meshes shrinkage and there was a predominance of acute inflammatory process in the PCD group.

Highlights

The incisional hernia (IH) has ventral hernia or eventration as synonyms and it consists in the viscera protrusion through orifices or areas of the abdominal wall abnormally weakened by trauma and surgical incisions[1]
31 to 55% repairs made without the use of prostheses may cause recurrence, the positioning of a polypropylene mesh in direct touching with the intraperitoneal viscera is not recommended since this can form adhesions between viscera and fistulas that occurs in 80-90% of patients[4]
This study aims at verifying the healing of the abdominal wall of rabbits concerning incisional hernia repair using specific biomaterials: polypropylene mesh, low-density polypropylene mesh coated with poliglecaprone, low-density polypropylene mesh coated with absorbable polydioxanone and oxidized regenerated cellulose and repair without mesh, using the TRANSPALB technique

Summary

Introduction

The incisional hernia (IH) has ventral hernia or eventration as synonyms and it consists in the viscera protrusion through orifices or areas of the abdominal wall abnormally weakened by trauma and surgical incisions[1]. The IH incidence varies from 10-20% and at least one in ten patients develops ventral hernia after undergoing median laparotomy. One third of these patients presented aesthetic problems, intestinal obstruction or acute strangulation that demand hernia repair[2]. 31 to 55% repairs made without the use of prostheses may cause recurrence, the positioning of a polypropylene mesh in direct touching with the intraperitoneal viscera is not recommended since this can form adhesions between viscera and fistulas that occurs in 80-90% of patients[4]. In the presence of large flaws in the abdominal wall, it is not always possible to separate the viscera from the meshes, so they are placed in the intraperitoneal position[5]

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Conclusion