title: Collagen/Polypropylene composite mesh biocompatibility in abdominal wall reconstruction.
abstract: BACKGROUND
  Intraperitoneal placement of polypropylene mesh leads to extensive visceral adhesions and is contraindicated. Different coatings are used to improve polypropylene mesh properties. Collagen is a protein with unique biocompatibility and cell ingrowth enhancement potential. A novel acetic acid extracted collagen coating was developed to allow placement of polypropylene mesh in direct contact with viscera. The authors' aim was to evaluate the long-term influence of acetic acid extracted collagen coating on surgical aspects and biomechanical properties of polypropylene mesh implanted in direct contact with viscera, including complications, adhesions with viscera, strength of incorporation, and microscopic inflammatory reaction.
  
  
  METHODS
  Forty adult Wistar rats were divided into two groups: experimental (polypropylene mesh/acetic acid extracted collagen coating) and control (polypropylene mesh only). Astandardized procedure of mesh implantation was performed. Animals were killed 3 months after surgery and analyzed for complications, mesh area covered by adhesions, type of adhesions, strength of incorporation, and intensity of inflammatory response.
  
  
  RESULTS
  The mean adhesion area was lower for polypropylene mesh/acetic acid extracted collagen coating (14.5 percent versus 69.9 percent, p < 0.001). Adhesion severity was decreased in the experimental group: grades 0 and 1 were more frequent (p < 0.04 and p < 0.002, respectively) and grade 3 was less frequent (p < 0.0001). An association between adhesion area and severity was found (p < 0.0001). Complications, strength of incorporation, and intensity of inflammatory response to the mesh were similar.
  
  
  CONCLUSIONS
  Visceral adhesions to polypropylene mesh are significantly reduced because of acetic acid extracted collagen coating. The collagen coating does not increase complications or induce alterations of polypropylene mesh incorporation.
authors: Grudziadz, Torun, and Bydgoszcz, Poland From the Department of Vascular Surgery, Regional Specialist Hospital; the Department of Polymers Chemistry and Photochemistry, Faculty of Chemistry, and Departments of Pathomorphology and Tissue Engineering, Collegium Medicum, Nicolaus Copernicus University; and the Eskulap Surgery Center.
authors: Aleksander
authors: A
authors: Lukasiewicz
authors: Joanna
authors: J
authors: Skopinska-Wisniewska
authors: Andrzej
authors: A
authors: Marszalek
authors: Stanislaw
authors: S
authors: Molski
authors: Tomasz
authors: T
authors: Drewa
mesh_terms: D034861:Abdominal Wall / Q000502:physiology / Q000601:surgery*; D058107:Abdominal Wound Closure Techniques; D000818:Animals; D024042:Collagen Type I / Q000494:pharmacology*; D008297:Male; D008422:Materials Testing; D061646:Operative Time; D011126:Polypropylenes / Q000494:pharmacology*; D051381:Rats; D017208:Rats, Wistar; D019651:Plastic Surgery Procedures / Q000379:methods*; D013526:Surgical Mesh; D013718:Tensile Strength; D000267:Tissue Adhesions / Q000473:pathology / Q000503:physiopathology / Q000517:prevention & control; D014945:Wound Healing
chemical_list: D024042:Collagen Type I; D011126:Polypropylenes
references: Bay-Nielsen M, Kehlet H, Strand L, et al.Danish Hernia Database Collaboration. Quality assessment of 26,304 herniorrhaphies in Denmark: A prospective nationwide study. Lancet. 2001;358:1124–1128
references: Breuing K, Butler CE, et al. Incisional ventral hernias: Review of the literature and recommendations regarding the grading and technique of repair. Surgery. 2010;148:544–558
references: Bringman S, Blomqvist P. Intestinal obstruction after inguinal and femoral hernia repair: A study of 33,275 operations during 1992-2000 in Sweden. Hernia. 2005;9:178–183
references: McGinty JJ, Hogle NJ, McCarthy H, Fowler DL. A comparative study of adhesion formation and abdominal wall ingrowth after laparoscopic ventral hernia repair in a porcine model using multiple types of mesh. Surg Endosc. 2005;19:786–790
references: Shankaran V, Weber DJ, Reed RL II, Luchette FA. A review of available prosthetics for ventral hernia repair. Ann Surg. 2011;253:16–26
references: Jiang ST, Liao KK, Liao MC, Tang MJ. Age effect of type I collagen on morphogenesis of Mardin-Darby canine kidney cells. Kidney Int. 2000;57:1539–1548
references: Blatnik J, Jin J, Rosen M. Abdominal hernia repair with bridging acellular dermal matrix: An expensive hernia sac. Am J Surg. 2008;196:47–50
references: Schuster R, Singh J, Safadi BY, Wren SM. The use of acellular dermal matrix for contaminated abdominal wall defects: Wound status predicts success. Am J Surg. 2006;192:594–597
references: Catena F, Ansaloni L, Gazzotti F, et al. Use of porcine dermal collagen graft (Permacol) for hernia repair in contaminated fields. Hernia. 2007;11:57–60
references: van’t Riet M, de Vos van Steenwijk PJ, Bonjer HJ, Steyerberg EW, Jeekel J. Mesh repair for postoperative wound dehiscence in the presence of infection: Is absorbable mesh safer than non-absorbable mesh?. Hernia. 2007;11:409–413
references: Schreinemacher MH, Emans PJ, Gijbels MJ, Greve JW, Beets GL, Bouvy ND. Degradation of mesh coatings and intraperitoneal adhesion formation in an experimental model. Br J Surg. 2009;96:305–313
references: Schönleben F, Reck T, Tannapfel A, Hohenberger W, Schneider I. Collagen foil (TissuFoil E) reduces the formation of adhesions when using polypropylene mesh for the repair of experimental abdominal wall defects. Int J Colorectal Dis. 2006;21:840–846
references: Łukasiewicz A, Drewa T, Skopińska-Wiśniewska J, Molski S. Abdominal wall reconstruction with collagen membrane in an animal model of abdominal hernia: A preliminary report (in Polish). Polim Med. 2008;38:31–34
references: Jenkins SD, Klamer TW, Parteka JJ, Condon RE. A comparison of prosthetic materials used to repair abdominal wall defects. Surgery. 1983;94:392–398
references: Hooker GD, Taylor BM, Driman DK. Prevention of adhesion formation with use of sodium hyaluronate-based bioresorbable membrane in a rat model of ventral hernia repair with polypropylene mesh: A randomized, controlled study. Surgery. 1999;125:211–216
references: Yung S, Li FK, Chan TM. Peritoneal mesothelial cell culture and biology. Perit Dial Int. 2006;26:162–173
references: van’t Riet M, Burger JW, Bonthuis F, Jeekel J, Bonjer HJ. Prevention of adhesion formation to polypropylene mesh by collagen coating: A randomized controlled study in a rat model of ventral hernia repair. Surg Endosc. 2004;18:681–685
references: Baptista ML, Bonsack ME, Felemovicius I, Delaney JP. Abdominal adhesions to prosthetic mesh evaluated by laparoscopy and electron microscopy. J Am Coll Surg. 2000;190:271–280
references: Falagas ME, Kasiakou SK. Mesh-related infections after hernia repair surgery. Clin Microbiol Infect. 2005;11:3–8
references: Leber GE, Garb JL, Alexander AI, Reed WP. Long-term complications associated with prosthetic repair of incisional hernias. Arch Surg. 1998;133:378–382
references: García-Ureña MA, Vega Ruiz V, Díaz Godoy A, et al. Differences in polypropylene shrinkage depending on mesh position in an experimental study. Am J Surg. 2007;193:538–542
references: Sanchez-Manuel FJ, Lozano-García J, Seco-Gil JL. Antibiotic prophylaxis for hernia repair. Cochrane Database Syst Rev. 2007;3:CD003769
references: Yerdel MA, Akin EB, Dolalan S, et al. Effect of single-dose prophylactic ampicillin and sulbactam on wound infection after tension-free inguinal hernia repair with polypropylene mesh: The randomized, double-blind, prospective trial. Ann Surg. 2001;233:26–33
references: Diener MK, Voss S, Jensen K, Büchler MW, Seiler CM. Elective midline laparotomy closure: The INLINE systematic review and meta-analysis. Ann Surg. 2010;251:843–856