Adverse effects of porcine small intestine submucosa implants in experimental ventral hernia repair.
BACKGROUND
Biomeshes made of porcine small intestine submucosa (SIS) have recently been suggested for repair of ventral hernia. A fully biodegradable combination of implant and fibrin sealant fixation was assessed in a new rat model with sutures serving as control.


METHODS
In 10 Sprague-Dawley rats, two defects per animal were created in the abdominal wall left and right of the linea alba (1 cm in diameter), and the peritoneum was spared. The lesions were left untreated for 10 days to achieve a chronic condition and were then covered with SIS (2 x 2 cm), sealed or sutured (n = 10 per group). Randomization allowed sealant and sutures in one animal. Animals were killed on postoperative day 17, and implant sites were analyzed macroscopically, histologically, and microbiologically.


RESULTS
Abscedation, encapsulation, and putrid seroma were observed in all samples, regardless of fixation technique. Histology revealed lytic necrosis and extensive inflammatory response of the surrounding tissue. Tissue samples obtained from three implant sites were positive for beta-hemolytic Streptococcus. SIS was not detectable after 17 days.


CONCLUSIONS
Adverse effects were observed using SIS in an experimental model of ventral hernia and were not linked to fixation method or study design. Further experimental investigations on SIS are necessary before its clinical use in hernia repair.
Petter-Puchner
A H
AH
Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Research Center for Traumatology of AUVA, Donaueschingenstrasse 13, A-1200, Vienna, Austria. alexander.petter@lbitrauma.org
Fortelny
R H
RH
Mittermayr
R
R
Walder
N
N
Ohlinger
W
W
Redl
H
H
D000818:Animals; D001705:Bioprosthesis / Q000009:adverse effects; D004322:Drainage; D006555:Hernia, Ventral / Q000382:microbiology / Q000473:pathology / Q000601:surgery*; D007249:Inflammation; D007413:Intestinal Mucosa / Q000637:transplantation*; D007421:Intestine, Small / Q000637:transplantation*; D009336:Necrosis; D051381:Rats; D017207:Rats, Sprague-Dawley; D049291:Seroma / Q000209:etiology / Q000382:microbiology / Q000473:pathology / Q000601:surgery; D013291:Streptococcus / Q000302:isolation & purification; D013552:Swine