Abstract
Biological meshes improve the outcome of incisional hernia repairs in infected fields but often lead to recurrence after bridging techniques. Sixty male Wistar rats undergoing the excision of an abdominal wall portion and bridging mesh repair were randomised in two groups: Group A (N = 30) using the uncoated equine pericardium mesh; Group B (N = 30) using the polyethylene oxide (PEO)-coated one. No deaths were observed during treatment. Shrinkage was significantly less common in A than in B (3% vs 53%, P < 0.001). Adhesions were the most common complication and resulted significantly higher after 90 days in B than in A (90% vs 30%, P < 0.01). Microscopic examination revealed significantly (P < 0.05) higher mesh integrity, fibrosis and calcification in B compared to A. The enzymatic degradation, as assessed with Raman spectroscopy and enzyme stability test, affected A more than B. The PEO-coated equine pericardium mesh showed higher resistance to biodegradation compared to the uncoated one. Understanding the changes of these prostheses in a surgical setting may help to optimize the PEO-coating in designing new biomaterials for the bridging repair of the abdominal wall.
Highlights
Biological meshes improve the outcome of incisional hernia repairs in infected fields but often lead to recurrence after bridging techniques
According to the Ventral Hernia Working Group (VHWG), incisional hernias which are at high risk of surgical site occurrences, because of comorbidities or contamination/infection of the operative field, should be treated using biological meshes; this should be recommended in those cases in which the complete rectus closure is not possible and bridging technique is unavoidable[9]
This study aims at investigating if and how much polyethylene oxide (PEO) coating on equine pericardium mesh used as a substitute of the abdominal wall in a rat model can effectively slow down its degradation, possibly opening the route to design and preparation of new biomaterials usable to repair large defects of the abdominal wall, being at the same time resistant to infection and recurrence
Summary
Biological meshes improve the outcome of incisional hernia repairs in infected fields but often lead to recurrence after bridging techniques. Incisional hernia affects 10–20% of laparotomies and represents the most common long-term complication after abdominal surgery[1,2,3] Since their first description by Usher et al in 19854, synthetic prostheses significantly reduced recurrence rate after the first incisional hernia repair, from more than 20% to less than 10%5,6. Albeit the growing interest in the molecular analysis of abdominal wall reconstruction devices[28,29,30,31], no standardised methods are still available for assessing in detail the biochemical changes affecting collagen of the biological meshes once implanted into a living organism In this regard, the advantages and limitations of Raman spectroscopy, in the clinical setting, have been recently reviewed[32]
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