Histologic evaluation of absorbable and non-absorbable barrier coated mesh secured to the peritoneum with fibrin sealant in a New Zealand white rabbit model.

Abstract

PURPOSE:

The purpose of this study is to evaluate the histologic response to fibrin sealant (FS) as an alternative fixation method for laparoscopic ventral hernia repair.

METHODS:

One non-absorbable barrier mesh (Composix™) and three absorbable barrier meshes (Sepramesh™, Proceed™, and Parietex™ Composite) were used for the study, with uncoated macroporous polypropylene mesh (ProLite Ultra™) as the control. Three methods of fixation were used: #0-polypropylene suture + FS (ARTISS™, Baxter Healthcare Corp.), FS alone (ARTISS™), or tacks alone (n = 10 for each group). Two pieces of mesh (of dimensions 4 × 4-cm) were secured intraperitoneally in 75 New Zealand white rabbits. After 8 weeks, hematoxylin and eosin (H&E)-stained specimens were evaluated for host tissue response. Statistical significance (P < 0.05) was determined using a one-way analysis of variance (ANOVA) with Fisher's least significant difference (LSD) post hoc test.

RESULTS:

Composix™ with FS only showed significantly greater cellular infiltration than with suture + FS (P = 0.0007), Proceed™ with FS only had significantly greater neovascularization than with suture + FS (P = 0.0172), and ProLite Ultra™ with suture + FS had significantly greater neovascularization than with tacks only (P = 0.046). Differences due to mesh type showed that Composix™ exhibited less extensive cellular infiltration (P ≤ 0.0032), extracellular matrix (ECM) deposition, and neovascularization, and demonstrated less inflammatory cells and more fibroblasts compared to the other meshes (P < 0.05).

CONCLUSIONS:

FS did not have a significant histologic effect compared to tacks when utilized for the fixation of mesh to the peritoneum of New Zealand White rabbits. However, the mesh type did have a significant histologic effect. The permanent barrier mesh (Composix™) was associated with less histologic incorporation than absorbable barrier and macroporous meshes, as evidenced by lower levels of cellular infiltration, ECM deposition, and neovascularization, independent of the fixation method used.

• Authors: E D Jenkins, L Melman, S Desai, C R Deeken, S C Greco, M M Frisella, B D Matthews
• Journal: Hernia : the journal of hernias and abdominal wall surgery (Hernia) Vol. 15 Issue 6 Pg. 677-84 (Dec 2011) ISSN: 1248-9204 [Electronic] France
• PMID: 21607571 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Coated Materials, Biocompatible
• Polypropylenes
• Tissue Adhesives

Topics

• Absorbable Implants (adverse effects)
• Analysis of Variance
• Animals
• Coated Materials, Biocompatible
• Extracellular Matrix (metabolism)
• Materials Testing
• Neovascularization, Physiologic
• Peritoneum (anatomy & histology, blood supply, pathology)
• Peritonitis (etiology)
• Polypropylenes
• Rabbits
• Surgical Mesh (adverse effects)
• Sutures
• Tissue Adhesives (adverse effects)