title: Adhesion Prevention Efficacy of Composite Meshes Parietex®, Proceed®and 4DryField®PH Covered Polypropylene Meshes in an IPOM Rat Model.
abstract: Background: Adhesions to intraperitoneally implanted meshes (IPOM) are a common problem following hernia surgery and may cause severe complications. Recently, we showed that missing peritoneal coverage of the intestine is a decisive factor for adhesion formation and 4DryField®PH (4DF) gel significantly prevents intestine-to-mesh adhesions even with use of uncoated Ultrapro®polypropylene mesh (UPM). The present study investigates adhesion prevention capability of coated Parietex®mesh (PTM) and Proceed®mesh (PCM) in comparison to 4DF treated UPM.Methods: 20 rats were randomized into two groups. A 1.5 x 2 cm patch of PTM or PCM was attached to the abdominal wall and the cecum was depleted from peritoneum by abrasion. After seven days incidence of intestine-to-mesh adhesions was evaluated using Lauder and Hoffmann adhesion scores. Histological specimens were evaluated; statistics were performed using student's t-test. The data were compared with recently published data of 4DF treated uncoated UPM.Results: Use of PTM or PCM did not significantly diminish development of intestine-to-mesh adhesions (adhesion reduction rate PTM: 29%, p = 0.069 and PCM: 25%, p = 0.078). Histological results confirmed macroscopic finding of agglutination of intestine and abdominal wall with the mesh in between. Compared to these data, the use of UPM combined with 4DF gel reveals significantly better adhesion prevention capability (p < 0.0001) as shown in earlier studies. However, in clinical situation interindividual differences in adhesion induction mechanisms cannot be excluded by this experimental approach as healing responses towards the different materials might vary.Conclusion: This study shows that in case of impaired intestinal peritoneum coated PTM and PCM do not provide significant adhesion prevention. In contrast, use of UPM combined with 4DF gel achieved a significant reduction of adhesions. Hence, in case of injury of the visceral peritoneum, application of a polysaccharide barrier device such as 4DF gel might be considered more effective in reducing intestine-to-mesh adhesions than coated mesh devices.
authors.affiliation: Department of General, Abdominal and Transplantation Surgery, Hannover Medical School, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Winny
authors.affiliation: Institute of Pathology, Hannover Medical School, Germany.
authors.forename: Lavinia
authors.initials: L
authors.lastname: Maegel
authors.affiliation: Department of General, Abdominal and Transplantation Surgery, Hannover Medical School, Germany.
authors.forename: Leonie
authors.initials: L
authors.lastname: Grethe
authors.affiliation: Institute of Pathology, Hannover Medical School, Germany.
authors.forename: Torsten
authors.initials: T
authors.lastname: Lippmann
authors.affiliation: Institute of Pathology, Hannover Medical School, Germany.
authors.forename: Danny
authors.initials: D
authors.lastname: Jonigk
authors.affiliation: Department of General, Abdominal and Transplantation Surgery, Hannover Medical School, Germany.; Core Facility Quality Management & Health Technology Assessment in Transplantation, Integrated Research and Treatment Center-Transplantation (IFB-Tx), Hannover Medical School, Germany.
authors.forename: Harald
authors.initials: H
authors.lastname: Schrem
authors.affiliation: Core Facility Quality Management & Health Technology Assessment in Transplantation, Integrated Research and Treatment Center-Transplantation (IFB-Tx), Hannover Medical School, Germany.; Department of Trauma and Orthopaedic Surgery, Federal Armed Forces Hospital Westerstede, Westerstede, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kaltenborn
authors.affiliation: Department of General, Abdominal and Transplantation Surgery, Hannover Medical School, Germany.
authors.forename: Juergen
authors.initials: J
authors.lastname: Klempnauer
authors.affiliation: Department of General, Abdominal and Transplantation Surgery, Hannover Medical School, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Poehnert
mesh_terms: D034861:Abdominal Wall / Q000601:surgery; D000818:Animals; D006555:Hernia, Ventral / Q000601:surgery; D008297:Male; D011126:Polypropylenes / Q000737:chemistry*; D011183:Postoperative Complications; D051381:Rats; D013526:Surgical Mesh / Q000009:adverse effects*; D000267:Tissue Adhesions / Q000517:prevention & control*
chemical_list: D011126:Polypropylenes
keywords: 4DryField® PH.; Parietex®; Proceed®; adhesion prevention; hernia mesh rat model