title: Treatment of de-peritonealized intestine with 4DryField®PH prevents adhesions between non-resorbable intra-peritoneal hernia mesh and bowel.
abstract: BACKGROUND
  Intraperitoneal onlay meshes (IPOM) can be associated with intestine-to-mesh adhesion formation, implementing risks like pain, enterocutaneous fistula, infection, and female infertility. This study investigates, whether a treatment of impaired intestinum with the anti-adhesive and hemostyptic agent 4DryField®PH prevents adhesion formation.
  
  
  METHODS
  In 20 male LEWIS rats uncoated polypropylene meshes were sewn to the inner abdominal wall and the cecum of the respective animal was de-peritonealized by peritoneal abrasion by a gauze swap, and meso-sutures ensured a constant contact of injured areas. Rats were treated with 4DryField®PH gel either premixed or applied as a powder with in-situ transformation (100 mg powder plus 0.4 ml 0.9% saline solution). One week postoperatively, the extent of intestine-to-mesh adhesions and the quality of mesh ingrowth were evaluated macroscopically by two independent investigators using two scoring systems. Furthermore, specimens were analysed microscopically. All data were compared with control animals without 4DryField®PH treatment and analysed statistically using student's t-test.
  
  
  RESULTS
  Treatment of de-peritonealised cecum with 4DryField®PH significantly reduced intestine-to-mesh adhesions in both treatment groups as compared to controls without 4DryField®PH treatment (68% reduction with premixed gel, P<0.0001; 80% reduction with in-situ gel, P<0.0001). There was no impact on the quality of mesh ingrowth, confirmed histologically by a single-layer mesothelial coverage.
  
  
  CONCLUSIONS
  These experiments mimick clinical IPOM implantation scenarios with adjacent bowel depleted from peritoneum. 4DryField®PH gel treatment resulted in intestinal mesothelial surface recovering without development of bowel-to-mesh adhesions. Concurrently, integration of mesh into the abdominal wall is undisturbed by 4DryField®PH treatment.
authors.affiliation: Department of General, Visceral and Transplant Surgery, Hannover Medical School Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Winny
authors.affiliation: Institute for Pathology, Hannover Medical School Germany.
authors.forename: Lavinia
authors.initials: L
authors.lastname: Maegel
authors.affiliation: Department of General, Visceral and Transplant Surgery, Hannover Medical School Germany.
authors.forename: Leonie Victoria
authors.initials: LV
authors.lastname: Grethe
authors.affiliation: Institute for Pathology, Hannover Medical School Germany.
authors.forename: Danny
authors.initials: D
authors.lastname: Jonigk
authors.affiliation: Institute for Pathology, Hannover Medical School Germany.
authors.forename: Paul
authors.initials: P
authors.lastname: Borchert
authors.affiliation: Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Centre-Transplantation (IFB-Tx), Hannover Medical SchoolGermany; Department of Trauma and Orthopaedic Surgery, Federal Armed Forces Hospital WesterstedeWesterstede, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kaltenborn
authors.affiliation: Department of General, Visceral and Transplant Surgery, Hannover Medical SchoolGermany; Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Centre-Transplantation (IFB-Tx), Hannover Medical SchoolGermany.
authors.forename: Harald
authors.initials: H
authors.lastname: Schrem
authors.affiliation: Department of General, Visceral and Transplant Surgery, Hannover Medical School Germany.
authors.forename: Juergen
authors.initials: J
authors.lastname: Klempnauer
authors.affiliation: Department of General, Visceral and Transplant Surgery, Hannover Medical School Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Poehnert
keywords: 4DryField® PH; Hernia mesh rat model; IPOM; adhesion barrier; adhesion prevention; polysaccharide