Comparison of three separate antiadhesive barriers for intraperitoneal onlay mesh hernia repair in an experimental model.
BACKGROUND
Adhesion formation is a common adverse effect in intraperitoneal onlay mesh (IPOM) surgery. Different methods of adhesion prevention have been developed, including coated meshes and separate antiadhesive barriers (SABs). In this study one type of mesh was tested with different SABs, which were fixed to the sutured mesh using fibrin sealant. The primary aim was to compare adhesion prevention between different SABs. Secondary aims were the assessment of tissue integration and evaluation of SAB fixation with fibrin sealant.


METHODS
Thirty-two rats were randomized to one of three treatment groups (SurgiWrap, Prevadh and Seprafilm) or a control group (no SAB). Animals were operated on with an open IPOM technique (8 per group). One macroporous polypropylene mesh per animal (2 × 2 cm) was fixed with four non-absorbable sutures. An antiadhesive barrier of 2·5 × 2·5 cm was fixed with fibrin sealant. After 30 days, adhesion formation, tissue integration, seroma formation, inflammation and vascularization were evaluated macroscopically and by histology.


RESULTS
Prevadh and Seprafilm groups showed a significant reduction in adhesion formation compared with the control group. Tissue integration of the mesh was reduced in these groups. Fibrin sealant fixed the SAB to the mesh securely in all groups.


CONCLUSIONS
Prevadh and Seprafilm are potent materials for the reduction of adhesion formation. A potential relationship between effective adhesion prevention and impaired tissue integration of the implant was observed. Fibrin sealant proved an excellent agent for SAB fixation.
Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.
S
S
Gruber-Blum
A H
AH
Petter-Puchner
J
J
Brand
R H
RH
Fortelny
N
N
Walder
W
W
Oehlinger
F
F
Koenig
H
H
Redl
D000818:Animals; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use; D046449:Hernia, Abdominal / Q000473:pathology / Q000601:surgery*; D011897:Random Allocation; D051381:Rats; D017208:Rats, Wistar; D013526:Surgical Mesh; D000267:Tissue Adhesions / Q000517:prevention & control*; D014014:Tissue Adhesives / Q000627:therapeutic use
D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives