Prevention of adhesions to polypropylene mesh in a traumatized bowel model.
BACKGROUND
Polypropylene mesh (PPM) is an effective material for the repair of abdominal wall defects, but has a tendency to induce dense adhesions when in contact with viscera. Seprafilm (Genzyme Corp, Cambridge, MA), a bioresorbable membrane, has been shown to reduce adhesion formation after midline closures in humans and to PPM in animals. Given the increased inflammatory response expected with surgical trauma, its efficacy under surgical conditions has been questioned.


METHODS
A prospective, randomized, blinded study was conducted using a rabbit model. Standardized abdominal wall defects were created in three groups of New Zealand white rabbits. The cecum was deserosalized to simulate the effects of trauma. The abdominal defect was then repaired with PPM. In the control group, no Seprafilm was used. In the first experimental group Seprafilm was placed between the mesh and the abdominal viscera. In the second experimental group Seprafilm was placed over the deserosalized area and between the mesh and abdominal viscera. Animals were sacrificed at 30 days and adhesions were categorized and quantified using digital image analysis of inked specimens. The strength of incorporation was also determined.


RESULTS
The formation of adhesions between the viscera and mesh repair was dramatically reduced in both experimental groups compared with the control group. The incidence of visceral adhesions was reduced by 80% in the single film group (p = 0.0004) and 90% in the double film group (p = 0.00008). The reduction in surface area of adhesions was 96.4% in the single film group (p = 0.000019) and 99.4% in the double film group (p = 0.00002). Omental adhesions were reduced by 30% but this did not achieve statistical significance. Strength of incorporation was not adversely affected in either group.


CONCLUSIONS
Seprafilm is highly effective in preventing adhesions to PPM. This effect was not diminished by the presence of visceral trauma and its resultant inflammatory response. The use of Seprafilm does not adversely affect tissue incorporation. Clinical trials are warranted to determine if the protective effects of Seprafilm demonstrated in this study are applicable in the clinical setting.
Dinsmore
R C
RC
Eisenhower Army Medical Center, Department of Surgery, Ft. Gordon, GA 30905, USA.
Calton
W C
WC
Harvey
S B
SB
Blaney
M W
MW
D000009:Abdominal Muscles / Q000601:surgery*; D020341:Absorbable Implants; D000704:Analysis of Variance; D000818:Animals; D001672:Biocompatible Materials / Q000737:chemistry; D002432:Cecum / Q000293:injuries* / Q000601:surgery; D016009:Chi-Square Distribution; D004195:Disease Models, Animal; D006820:Hyaluronic Acid; D007091:Image Processing, Computer-Assisted; D015994:Incidence; D007410:Intestinal Diseases / Q000517:prevention & control*; D008107:Liver Diseases / Q000517:prevention & control; D008567:Membranes, Artificial; D009852:Omentum / Q000473:pathology; D010532:Peritoneal Diseases / Q000517:prevention & control; D011126:Polypropylenes / Q000009:adverse effects* / Q000737:chemistry; D011446:Prospective Studies; D011817:Rabbits; D011897:Random Allocation; D016037:Single-Blind Method; D013499:Surface Properties; D013526:Surgical Mesh / Q000009:adverse effects*; D000267:Tissue Adhesions / Q000517:prevention & control; D014945:Wound Healing
D001672:Biocompatible Materials; D008567:Membranes, Artificial; D011126:Polypropylenes; C118198:Seprafilm; D006820:Hyaluronic Acid