Human peritoneal membrane controls adhesion formation and host tissue response following intra-abdominal placement in a porcine model.
BACKGROUND
Even with the advent of bioresorbable barriers, complications due to visceral adhesions following surgery continue to occur. The use of a homologous adhesive barrier such as human peritoneal membrane (HPM) could prevent adhesions formation and enhance wound healing. This study evaluates HPM as an effective adhesive barrier in a porcine model simulating a ventral hernia procedure.


METHODS
Through a midline laparotomy, meshes (10 cmx10 cm) were sewn onto the intact peritoneum of a pig, on each side of a midline incision in superior and inferior positions (4 randomized meshes/pig, n=9 pigs). The pigs were survived for 90 d. The meshes used were: HPM, compressed polytetrafluoro-ethylene (cPTFE), cPTFE+HPM, and polyester-collagen composite (PX). Exploratory laparoscopy was performed at 30 and 90 d to evaluate the extent of visceral adhesions. At necropsy, the extent and tenacity of visceral adhesions as well as material-abdominal wall integration were evaluated. Finally, host tissue response was assessed through scoring of inflammation, foreign body reaction, and mesothelialization.


RESULTS
HPM and PX led to the least extent and tenacity of visceral adhesions compared to cPTFE and cPTFE+HPM, but integrated less strongly within the adjacent abdominal wall. PX displayed the most robust foreign body reaction among all prosthetic materials, while HPM scored similarly to the native peritoneum. The extent of mesothelialization was similar throughout the materials tested.


CONCLUSIONS
The HPM barrier which promotes long-term peritoneal remodeling could diminish postsurgical intraperitoneal adhesions following hernia repair.
Jin
Judy
J
Department of Surgery, Case School of Medicine, Case Hernia Institute, University Hospitals Case Medical Center, Cleveland, Ohio, USA.
Voskerician
Gabriela
G
Hunter
Shawn A
SA
McGee
Michael F
MF
Cavazzola
Leandro T
LT
Schomisch
Steve
S
Harth
Karem
K
Rosen
Michael J
MJ
D000818:Animals; D001672:Biocompatible Materials; D003094:Collagen; D004195:Disease Models, Animal; D006555:Hernia, Ventral / Q000601:surgery*; D008566:Membranes; D010537:Peritoneum; D011091:Polyesters; D011138:Polytetrafluoroethylene; D013526:Surgical Mesh; D013552:Swine; D000267:Tissue Adhesions / Q000503:physiopathology* / Q000517:prevention & control*; D014945:Wound Healing / Q000502:physiology*
D001672:Biocompatible Materials; D011091:Polyesters; D011138:Polytetrafluoroethylene; D003094:Collagen