title: Comet-tail-like inflammatory infiltrate to polymer filaments develops in tension-free conditions.
abstract: BACKGROUND
  Mesh reinforcement in hiatal hernia repair becomes more frequent but is charged by complications such as erosion or stenosis of the oesophagus. These complications are accompanied by an intense inflammatory infiltrate around the polymer fibres. To characterize this effect, the response to polypropylene fibres in the absence of tension was examined.
  
  
  METHODS
  In rats, polypropylene sutures (USP size 1, 3-0 and 7-0) were placed in the subcutis of the abdominal wall without knot or tension. On postoperative days 3, 7 and 21, specimens were excised. The expressions of c-myc, β-catenin, Notch3, COX-2, CD68 and Ki-67 were measured by immunohistochemistry.
  
  
  RESULTS
  In the absence of tension, sutures were surrounded by a foreign body granuloma with an inflammatory infiltrate not encircling the fibre but forming almost symmetric comet-tail-like infiltrates on opposite sides. The expression of c-myc, β-catenin, Notch3, COX-2, CD68 and Ki-67 was significantly reduced over time in the comet tail, but not in the granuloma.
  
  
  CONCLUSIONS
  Even in tension-free conditions, surgical sutures cause a foreign body response with infiltrates of inflammatory cells. This reaction is shaped like a comet tail, and its extension depends on the diameter of the used fibre. Therefore, for reduction of perifilamental infiltrates, not only absence of tension is required, but also a small-sized fibre textile.
authors.affiliation: Department of Surgery, RWTH Aachen, Aachen, Germany. cklink@ukaachen.de
authors.forename: C D
authors.initials: CD
authors.lastname: Klink
authors.forename: M
authors.initials: M
authors.lastname: Binnebösel
authors.forename: D
authors.initials: D
authors.lastname: Kaemmer
authors.forename: A
authors.initials: A
authors.lastname: Schachtrupp
authors.forename: A
authors.initials: A
authors.lastname: Fiebeler
authors.forename: M
authors.initials: M
authors.lastname: Anurov
authors.forename: V
authors.initials: V
authors.lastname: Schumpelick
authors.forename: U
authors.initials: U
authors.lastname: Klinge
mesh_terms: D000818:Animals; D015703:Antigens, CD / Q000378:metabolism; D015214:Antigens, Differentiation, Myelomonocytic / Q000378:metabolism; D001672:Biocompatible Materials / Q000009:adverse effects; D001696:Biomechanical Phenomena; D049109:Cell Proliferation; D003094:Collagen / Q000378:metabolism; D051546:Cyclooxygenase 2 / Q000378:metabolism; D004195:Disease Models, Animal; D004940:Esophageal Stenosis / Q000209:etiology; D005355:Fibrosis; D005549:Foreign-Body Reaction / Q000209:etiology* / Q000378:metabolism / Q000473:pathology*; D005764:Gastroesophageal Reflux / Q000601:surgery; D006551:Hernia, Hiatal / Q000601:surgery; D006801:Humans; D019394:Ki-67 Antigen / Q000378:metabolism; D008297:Male; D008422:Materials Testing; D011108:Polymers / Q000009:adverse effects; D011183:Postoperative Complications / Q000209:etiology* / Q000378:metabolism / Q000473:pathology*; D051381:Rats; D017207:Rats, Sprague-Dawley; D013526:Surgical Mesh / Q000009:adverse effects; D013537:Sutures / Q000009:adverse effects*; D051176:beta Catenin / Q000378:metabolism; D000097382:CD68 Molecule
chemical_list: D015703:Antigens, CD; D015214:Antigens, Differentiation, Myelomonocytic; D001672:Biocompatible Materials; D003094:Collagen; D051546:Cyclooxygenase 2; D019394:Ki-67 Antigen; D011108:Polymers; D051176:beta Catenin; C539355:CD68 protein, rat; D000097382:CD68 Molecule; C495268:Ctnnb1 protein, rat; C489691:Ptgs2 protein, rat