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Abstract
In the definition of the mesh to be used to correct hernias, porosity, amount of absorbable material and polypropylene should be considered in the different stages of healing process. To evaluate the inflammatory reaction in the use of macro and microporous meshes of high and low weight in the repair of defects in the abdominal wall of rats. Ninety Wistar rats (Rattus norvegicus albinus) were used. The animals were submitted to similar surgical procedures, with lesion of the ventral abdominal wall, maintaining the integrity of the parietal peritoneum and correction using the studied meshes (Prolene®, Ultrapro® and Bard Soft®). Euthanasia was performed at 30, 60 and 120 days after surgery. The abdominal wall segments were submitted to histological analysis using H&E, Masson's trichrome, immunohistochemistry, picrosirius red and tensiometric evaluation. On the 120th day, the tensiometric analysis was superior with Ultrapro® macroporous mesh. The inflammatory process score showed a significant prevalence of subacute process at the beginning and at the end of the study. Microporous meshes showed block encapsulation and in macroporous predominance of filamentous encapsulation. The Ultrapro® mesh showed better performance than the others in healing process of the abdominal wall.
Highlights
The standard procedure for surgical correction of incisional hernias is using meshes
The incorporation of biomaterials causes an inflammatory reaction of greater or lesser persistence throughout the life. It has been shown in previous studies that the pore size of surgical meshes impacts the interface of scar formation, and the use of a mesh with reduced material is accompanied by the attenuation of inflammation and fibrosis, and a decrease in the proliferation of apoptotic cells
Greca et al.[9] showed in the comparison of low and high weight polypropylene meshes for the correction of abdominal wall defects in dogs including the peritoneum, incidence of 20% of seroma in both meshes, 5% of infection in high-weight prolene, 9.1% dehiscence in low weight and 4.6% in high weight meshes, and there was no incorporation in 5% of the high weight group
Summary
The standard procedure for surgical correction of incisional hernias is using meshes. The incorporation of biomaterials causes an inflammatory reaction of greater or lesser persistence throughout the life It has been shown in previous studies that the pore size of surgical meshes impacts the interface of scar formation, and the use of a mesh with reduced material is accompanied by the attenuation of inflammation and fibrosis, and a decrease in the proliferation of apoptotic cells. It consists of a monofilament with low weight and large pores - with more than 3 mm - of polypropylene, with the addition of an absorbable Monocryl® component (polyglecaprone 25) that optimize the implant, increase the strength of the wall in the first weeks after the repair It is fully absorbed without increasing cellularity, inflammation and intense fibrotic reaction between 84 and 140 days. The formation of fibrosis bridges is inversely proportional to the pore size[17]
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