Immunological reaction and oxidative stress after light or heavy polypropylene mesh implantation in inguinal hernioplasty: A CONSORT-prospective, randomized, clinical trial.
The relationship between mesh weight and host tissue reaction has, so far, not been fully investigated. Lightweight meshes (LWM) are thought to give less inflammatory response compared with heavyweight meshes (HWM). The present study is a randomized, controlled, double-blind clinical trial performed in 61 patients who underwent an elective inguinal hernioplasty. The primary outcome of the study was to investigate the relationship between total amount of prosthetic material (polypropylene), immunological reaction, and oxidative stress. The study was double-blinded. Sixty-one patients were recruited for the study and randomly assigned to 2 groups (groups A and B). Levels of inflammation markers (interleukin-6 [IL-6] and tumor necrosis factor-α [TNF-α]) and oxidative stress markers (reduced glutathione [GSH] and lipid hydroperoxides [LOOH]) were determined preoperatively and after undergoing inguinal hernioplasty (after 6, 72, and 288 hours), respectively, with LWM and HWM. There was no significant difference in IL-6 levels between HWM and LWM (P = 0.3, 0.7, 0.8 after 6, 72, and 288 hours, respectively). A statistically significant difference was found after 72 hours for TNF-α (P = 0.01), for GSH after 6 hours (P < 0.01), and after 6 and 72 hours for LOOH (P = 0.05, 0.01, respectively). Oxidative stress occurred at earlier time points and was pore accentuated HWM versus LWM and prodromal to TNF-α increase.Also, in randomized clinical trial, the use of LWM gives advantages in terms of less inflammatory response when compared with HWM. Moreover, there is a significant higher oxidative stress after implantation of HWM. The intensity of oxidative stress seems to be strongly related to the amount of implanted polypropylene. (


BACKGROUND
NCT01090284).
Department of Surgery and Medical-Surgical Specialties, Vittorio-Emanuele University Hospital of Catania, Catania, Italy Department "G.F. Ingrassia," Section of Hygiene and Public Health, University of Catania, Catania, Italy Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy Department of Stress Biology, Epigenetic and Biomarkers, EuroMediterranean Institute of Science and Technology, Palermo, Italy Department of Surgical Sciences, Organ Transplants and New Technologies, General Surgery and Week Hospital Unit, University Hospital of Catania, Catania, Italy.
Marcello
M
Donati
Giovanna
G
Brancato
Giuseppe
G
Grosso
Giovanni
G
Li Volti
Giuseppina
G
La Camera
Francesco
F
Cardì
Francesco
F
Basile
Angelo
A
Donati
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016207:Cytokines / Q000097:blood; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D007249:Inflammation / Q000209:etiology* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D018384:Oxidative Stress; D011126:Polypropylenes / Q000009:adverse effects*; D011183:Postoperative Complications / Q000139:chemically induced* / Q000378:metabolism; D011379:Prognosis; D011446:Prospective Studies; D013526:Surgical Mesh / Q000009:adverse effects*; D013997:Time Factors; D055815:Young Adult
D016207:Cytokines; D011126:Polypropylenes