title: Impairment of the Peritoneal Surface as a Decisive Factor for Intestinal Adhesions in Intraperitoneal Onlay Mesh Surgery - Introducing a New Rat Model.
abstract: BACKGROUND
  Meshes implanted intraperitoneally are known to cause adhesions potentially resulting in complications such as chronic pain, enterocutaneous fistula, or mesh infection. This study introduces a model for investigation of intestine-to-mesh adhesions and evaluates as to whether missing of visceral peritoneum is causative.
  
  
  METHODS
  In 18 rats, rectangular 1.5 x 2 cm patches of an uncoated polypropylene mesh (Ultrapro(®)) were sewn to the inner abdominal wall next to the cecum. Additionally, a meso-suture ensured contact between cecum and mesh. Rats were assigned to 2 groups: in 8 rats the peritoneum was left intact, in 10 the cecum was depleted from peritoneum with abrasion. Sacrifice was on day 7. Macroscopic evaluation used two adhesion scores. Specimens were evaluated microscopically, statistical analyses employed student's t-test.
  
  
  RESULTS
  On day 7, rats with mesh implantation combined with locally de-peritonealization by cecal abrasion mostly showed severe cecum-to-mesh agglutination (mean Lauder score 92%, mean total Hoffmann score 90%), whereas meshes of most animals without cecal abrasion only had some coverage with intraabdominal fat (33%, 24%; p = 0.0002). Histological work-up showed adequate wall ingrowth of mesh in all rats. In animals with cecal abrasion, meshes were mostly adhesive with cecal wall. However, when the peritoneum of cecum was unimpaired, abdominal wall above the mesh as well as cecum usually revealed sub-peritoneal tissue and a mono-layer cell coverage as seen in normal peritoneum.
  
  
  CONCLUSIONS
  This study introduces a model mimicking a clinical situation of e.g. hernia repair by intraperitoneally implanted meshes when mesh has contact with normal and with de-peritonealized intestine. The model might be useful for testing mesh types and coatings as well as other devices for their efficacy in adhesion prevention. The high adhesion scores of rats with local de-peritonealization compared with the low scores of animals with intact peritoneum indicate that the integrity of intestinal peritoneum is a decisive factor for adhesion formation.
authors.affiliation: 1. Clinic for General, Abdominal and Transplant Surgery, Hannover Medical School, Germany;
authors.forename: M
authors.initials: M
authors.lastname: Winny
authors.affiliation: 1. Clinic for General, Abdominal and Transplant Surgery, Hannover Medical School, Germany;
authors.forename: L
authors.initials: L
authors.lastname: Grethe
authors.affiliation: 2. Institute of Pathology, Hannover Medical School, Germany.
authors.forename: L
authors.initials: L
authors.lastname: Maegel
authors.affiliation: 2. Institute of Pathology, Hannover Medical School, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Jonigk
authors.affiliation: 2. Institute of Pathology, Hannover Medical School, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Lippmann
authors.affiliation: 1. Clinic for General, Abdominal and Transplant Surgery, Hannover Medical School, Germany;
authors.forename: J
authors.initials: J
authors.lastname: Klempnauer
authors.affiliation: 1. Clinic for General, Abdominal and Transplant Surgery, Hannover Medical School, Germany;
authors.forename: D
authors.initials: D
authors.lastname: Poehnert
mesh_terms: D034861:Abdominal Wall / Q000601:surgery; D000818:Animals; D002432:Cecum / Q000473:pathology; D013505:Digestive System Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D007410:Intestinal Diseases / Q000473:pathology*; D010537:Peritoneum / Q000473:pathology* / Q000601:surgery; D011126:Polypropylenes; D011183:Postoperative Complications / Q000473:pathology*; D051381:Rats; D013526:Surgical Mesh; D000267:Tissue Adhesions / Q000473:pathology
chemical_list: D011126:Polypropylenes
keywords: Adhesion formation; Cecal abrasion.; Experimental study; Hernia mesh repair; Polypropylene mesh; intraperitoneal onlay mesh surgery