Evaluation of seprafilm and amniotic membrane as adhesion prophylaxis in mesh repair of abdominal wall hernia in rats.
BACKGROUND
Adhesion formation following abdominal wall hernia repair with prosthetic mesh may lead to intestinal obstruction and enterocutaneous fistula. Physical barriers, namely, human amniotic membrane (HAM) or Seprafilm (Genzyme, Cambridge, Mass., USA), a bio-absorbable, translucent membrane composed of carboxymethylcellulose and hyaluronic acid, have been reported to prevent postsurgical intra-abdominal adhesions.


OBJECTIVE
Evaluating the effect of HAM and Seprafilm in preventing adhesion formation in the rat model of ventral hernia repair with polypropylene mesh (PPM).


METHODS
Sixty female Sprague-Dawley rats were divided into three groups. A full-thickness abdominal wall defect was created in each animal. Control animals had the PPM sutured into the defect, whereas in the other two groups, either HAM or Seprafilm were laid over the abdominal viscera before the repair with PPM. Half of the animals in each group were sacrificed on the 21st postoperative day. The remaining rats of the same group were re-operated on the 42nd day for investigation and measurement of the adhesion area in relation to the graft area.


RESULTS
Direct mesh repair showed 52.8 and 56% area adhesion formation 3 and 6 weeks postoperatively, respectively. The HAM barrier covered with mesh repair demonstrated 0 and 0.96% area adhesion formation, and the Seprafilm-covered mesh repair showed 0 and 0% area adhesion formation 3 and 6 weeks postoperatively, respectively. Uncovered mesh showed a significantly larger adhesion area than both covered mesh (p = 0.001 and 0.001). Both HAM and Seprafilm were equally effective in preventing postoperative adhesions.


CONCLUSIONS
HAM and Seprafilm proved to be an effective antiadhesive barrier in PPM repair of abdominal wall hernia.
Szabo
A
A
Department of Surgery, Western Galilee Hospital, Nahariya, Israel.
Haj
M
M
Waxsman
I
I
Eitan
A
A
D000005:Abdomen; D000650:Amnion / Q000637:transplantation*; D000818:Animals; D001672:Biocompatible Materials / Q000008:administration & dosage / Q000627:therapeutic use*; D005069:Evaluation Studies as Topic; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D006801:Humans; D006820:Hyaluronic Acid; D011126:Polypropylenes; D011183:Postoperative Complications / Q000517:prevention & control*; D051381:Rats; D017207:Rats, Sprague-Dawley; D013526:Surgical Mesh; D013997:Time Factors; D000267:Tissue Adhesions / Q000473:pathology / Q000517:prevention & control*
D001672:Biocompatible Materials; D011126:Polypropylenes; C118198:Seprafilm; D006820:Hyaluronic Acid