title: Biologic hernia implants in experimental intraperitoneal onlay mesh plasty repair: the impact of proprietary collagen processing methods and fibrin sealant application on tissue integration.
abstract: BACKGROUND
  Biologic implants have been recommended for reinforcement in routine and challenging hernia repair. However, experimental and clinical studies have reported adverse effects (e.g., slow implant integration and pronounced foreign body reaction). To evaluate the impact of different material processing methods (cross-linking vs. non-cross-linking of collagen) and implant design, four different biologic hernia implants were compared directly in experimental intraperitoneal onlay mesh plasty (IPOM). Tissue integration, shrinkage, and foreign body reaction were primary outcome parameters.
  
  
  METHODS
  In this study, 48 Sprague-Dawley rats were randomized to four treatment groups. Open IPOM repair was performed. One peritoneal defect per animal was covered with 2 × 2 cm patches of cross-linked or non-cross-linked implants including CollaMend (n = 12), Peripatch (n = 12), Surgisis (n = 12), and Tutomesh (n = 12). In half of the animals, fibrin sealant was applied for additional fixation and to cover sutures. The observation period was 60 days. The primary outcome parameters were implant integration, shrinkage, and foreign body reaction. Macroscopic and histologic assessments were performed.
  
  
  RESULTS
  The integration of implants was insufficient in all the groups. The implants could be detached easily from the underlying tissue, and the penetration of fibroblasts and vessels was limited to the perforations. Foreign body reaction was pronounced with CollaMend and Surgisis, leading to persistent granulomatous inflammation. Shrinkage was excessive with Surgisis, whereas Tutomesh and Peripatch yielded sufficient anti-adhesion and elicited no foreign body reaction.
  
  
  CONCLUSIONS
  At 2 months, cross-linked and non-cross-linked biologic hernia implants were poorly integrated. Cross-linking led to a more pronounced foreign body reaction. Less inflammatory response may reduce local complications, but did not enhance implant integration in this study.
authors.affiliation: Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.
authors.forename: A H
authors.initials: AH
authors.lastname: Petter-Puchner
authors.forename: R H
authors.initials: RH
authors.lastname: Fortelny
authors.forename: K
authors.initials: K
authors.lastname: Silic
authors.forename: J
authors.initials: J
authors.lastname: Brand
authors.forename: S
authors.initials: S
authors.lastname: Gruber-Blum
authors.forename: H
authors.initials: H
authors.lastname: Redl
mesh_terms: D000818:Animals; D001672:Biocompatible Materials / Q000009:adverse effects; D003094:Collagen / Q000009:adverse effects; D003432:Cross-Linking Reagents; D015718:Fibrin Tissue Adhesive / Q000494:pharmacology; D005549:Foreign-Body Reaction / Q000209:etiology; D059685:Herniorrhaphy / Q000295:instrumentation*; D020007:Implants, Experimental; D007421:Intestine, Small; D008297:Male; D010496:Pericardium; D011474:Prosthesis Design; D011897:Random Allocation; D051381:Rats; D017207:Rats, Sprague-Dawley; D018709:Statistics, Nonparametric; D013526:Surgical Mesh / Q000009:adverse effects; D013536:Suture Techniques; D000267:Tissue Adhesions / Q000209:etiology
chemical_list: D001672:Biocompatible Materials; D003432:Cross-Linking Reagents; D015718:Fibrin Tissue Adhesive; D003094:Collagen