Abstract
This study assessed the collagen deposition and correlated it with local inflammatory responses to evaluate the length of time required for fibroplasia when polypropylene meshes are used to repair incisional abdominal wall hernias in rats. Thirty-six male Wistar rats underwent longitudinal resection of a peritoneal and musculoaponeurotic tissue segment (3x2 cm) of the abdominal wall followed by defect reconstruction with polypropylene mesh bridging over aponeurosis. The animals were divided into 6 groups according to the time points for the analysis of fibroplasia: 1, 2, 3, 7, 21 and 30 days post-implantation. Animals were sacrificed at each time point, and the site where the polypropylene mesh was implanted was evaluated histologically to assess inflammatory response and percentage of collagen using computer-assisted videomorphometry. Total collagen was found at the mesh site on the 3rd day post-implantation, and increased progressively on all subsequent days up to the 21st day, when it reached its highest percentage (p<0.001). Type III collagen increased progressively from the 3rd to the 21st days, when it reached its highest percentage (p<0.001); on the 30th day, it decreased significantly (p>0.001). Type I collagen was first found between the 7th and 21st days; it reached its highest percentage on the 21st day and then remained stable until the 30th day. The type I to type III collagen ratio increased significantly and progressively up to the 30th day (p<0.001). Neutrophils were found at the mesh site from the 1st to the 21st day post-implantation. Macrophages, giant cells and lymphocytes were seen on the 2nd day. Thirty days after mesh implantation, neutrophils disappeared, but the percentages of macrophages, giant cells and lymphocytes remained stable (p<0.001). This study showed that total collagen was first seen on the 3rd day post-implantation, with a higher percentage of type I collagen at the last observational time point. The prolonged healing inflammatory response and the persistence of chronic inflammation surrounding to the mesh did not affect the length of time required for fibroplasia.
Highlights
Repair of large abdominal wall hernias has always been a challenge for surgeons
The aim of the present study is to evaluate the length of time required for fibroplasia when polypropylene meshes are used, by determining the amount of total collagen and type I and type III collagen at different times in the process, correlating it with local inflammatory response
Lymphocytes were identified on the polypropylene mesh after the 2nd day, which is inconsistent with the findings of other studies, which indicate that they often appear in the wound on the 5th day after tissue injury[10]
Summary
Repair of large abdominal wall hernias has always been a challenge for surgeons. At the end of the 1950s, the introduction of polypropylene mesh by Usher et al.[1] was a great step forward in the definitive treatment of hernias and led to a significant reduction in the rate of recurrences[2,3]. There are several synthetic materials available, but polypropylene mesh is definitely the most widely used, with the most recorded experience[6,7]. In the literature there are many studies evaluating the reaction of the organism to the presence of the polypropylene screen, which is widely used to correct abdominal wall defects of many different etiologies. Most of these studies seek to determine the rates of recurrence, infection and inflammatory response, and the presence of adhesions associated with the use of different mesh types currently available in the market[7,8,9]
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