Different tissue reaction of oesophagus and diaphragm after mesh hiatoplasty. Results of an animal study.
BACKGROUND
Laparoscopic mesh-reinforcement of the hiatal region in the treatment of gastroesophageal reflux disease (GERD) and paraesophageal hernia (PEH) reduces the risk of recurrence. However, there are still controversies about the technique of mesh placement, shape, structure and material. We therefore compared tissue integration and scar formation after implantation of two different polypropylene-meshes in a rabbit model.


METHODS
A total of 20 female chinchilla rabbits were included in this study. Two different meshes (Polypropylene PP, Polyglecaprone 25 Composite PP-PG) were implanted on the abdominal diaphragm around the oesophagus. After 3 months the implanted meshes were excised en-bloc. Histological and morphological analyses were carried out accordingly proliferation rate, apoptosis and collagen type I/III ratio.


RESULTS
Regarding proliferation rate of oesophagus PP (9.31 +/- 3.4%) and PP-PG (13.26 +/- 2.54%) differ in a significant (p = 0.0097) way. In the diaphragm we found a significant (p = 0.00066) difference between PP (9.43 +/- 1.45%) and PP-PG (18.73 +/- 5.92%) respectively. Comparing oesophagus and diaphragm we could prove a significant difference within PP-PG-group (p = 0.0195). Within PP-group the difference reached no statistical significance (p = 0.88). We found analogous results regarding apoptosis.Furthermore, there is a significant (p = 0.00013) difference of collagen type I/III ratio in PP-PG (12.28 +/- 0.8) compared to PP (8.44 +/- 1,63) in case of oesophageal tissue. Concerning diaphragm we found a significant difference (p = 0.000099) between PP-PG (8.85 +/- 0.81) and PP (6.32 +/- 1.07) as well.


CONCLUSIONS
The histologic and morphologic characteristics after prosthetic enforcement of the hiatus in this animal model show a more distinct tissue integration using PP-PG compared to PP. Additionally, different wound healing and remodelling capability influence tissue integration of the mesh in diaphragm and oesophagus.
Otto
Jens
J
Department of Surgery, University Clinic RWTH Aachen, Pauwelsstrasse 30, 52057 Aachen, Germany. jeotto@ukaachen.de
Kämmer
Daniel
D
Jansen
Petra Lynen
PL
Anurov
Michael
M
Titkova
Svetlana
S
Ottinger
Alexander
A
Rosch
Raphael
R
Schumpelick
Volker
V
Jansen
Marc
M
D000818:Animals; D017209:Apoptosis; D002921:Cicatrix / Q000209:etiology / Q000473:pathology*; D003964:Diaphragm / Q000473:pathology*; D004146:Dioxanes; D004947:Esophagus / Q000473:pathology*; D005260:Female; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006551:Hernia, Hiatal / Q000601:surgery*; D010535:Laparoscopy; D008422:Materials Testing; D011091:Polyesters; D011126:Polypropylenes; D011817:Rabbits; D013526:Surgical Mesh / Q000009:adverse effects*; D014945:Wound Healing
D004146:Dioxanes; D011091:Polyesters; D011126:Polypropylenes; C095495:glycolide E-caprolactone copolymer