Elimination of Visceral Adhesions to Polypropylene Mesh
Abstracts
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PURPOSE: Repair of abdominal wall hernias is commonly accomplished with polypropylene mesh (PM). Direct contact of mesh with viscera leads to dense adhesions, difficult reoperations, and potential complications, including intestinal obstruction and entero-cutaneous fistulas. The purpose of this study was to develop means to prevent adhesions to polypropylene mesh. METHODS: A 2.5 cm square defect was excised from the rat abdominal wall and surgically replaced with---- Group1. Polypropylene mesh (PM)-- Group2. PM + Seprafilm (SF)-- Group3. Sepramesh (SM)-- Group4. SM + SF. Seprafilm is an anti-adhesive bio-resorbable membrane synthesized from sodium hyaluronate and carboxymethyl cellulose . Sepramesh is a bilayer composite of hyaluronate/ carboxymethyl cellulose and polypropylene mesh. In order to sequentially evaluate adhesion formation laparoscopy was done on post surgery days 7, 14, and 28. The percent of mesh surface involved with adhesions was visually estimated and video recorded. Tissues were harvested at sacrifice from other rats for scanning electron microscopy at the same time intervals. RESULTS: See the table. Adhesion area did not change after post procedure day 7. Any mesh surface free of adhesions was seen to have a confluent cover of mesothelial cells by 7 days following operation. CONCLUSIONS: 1. A mesothelial cell layer covers adhesion free areas of polypropylene mesh and confers subsequent adhesion resistance. 2. Seprafilm reduces mesh-visceral adhesions by about half, 3. Sepramesh reduces mesh-visceral adhesions by about three-quarters. 4. The combination of Sepramesh in the abdominal wall plus Seprafilm interposed over the viscera at the time of operation essentially eliminates adhesions between mesh and viscera. |
