Evaluation of a biodegradable polyurethane patch for repair of diaphragmatic hernia in a rat model: A pilot study.

Abstract

INTRODUCTION:

Congenital diaphragmatic hernia (CDH) repair is an area of active research. Large defects requiring patches have a hernia recurrence rate of up to 50%. We designed a biodegradable polyurethane (PU)-based elastic patch that matches the mechanical properties of native diaphragm muscle. We compared the PU patch to a non-biodegradable Gore-Tex™ (polytetrafluoroethylene) patch.

METHODS:

The biodegradable polyurethane was synthesized from polycaprolactone, hexadiisocyanate and putrescine, and then processed into fibrous PU patches by electrospinning. Rats underwent 4 mm diaphragmatic hernia (DH) creation via laparotomy followed by immediate repair with Gore-Tex™ (n = 6) or PU (n = 6) patches. Six rats underwent sham laparotomy without DH creation/repair. Diaphragm function was evaluated by fluoroscopy at 1 and 4 weeks. At 4 weeks, animals underwent gross inspection for recurrence and histologic evaluation for inflammatory reaction to the patch materials.

RESULTS:

There were no hernia recurrences in either cohort. Gore-Tex™ had limited diaphragm rise compared to sham at 4 weeks (1.3 mm vs 2.9 mm, p = 0.003), but no difference was found between PU and sham (1.7 mm vs 2.9 mm, p = 0.09). There were no differences between PU and Gore-Tex™ at any time point. Both patches formed an inflammatory capsule, with similar thicknesses between cohorts on the abdominal (Gore-Tex™ 0.07 mm vs. PU 0.13 mm, p = 0.39) and thoracic (Gore-Tex™ 0.3 mm vs. PU 0.6 mm, p = 0.09) sides.

CONCLUSION:

The biodegradable PU patch allowed for similar diaphragmatic excursion compared to control animals. There were similar inflammatory responses to both patches. Further work is needed to evaluate long-term functional outcomes and further optimize the properties of the novel PU patch in vitro and in vivo.

LEVEL OF EVIDENCE:

Level II, Prospective Comparative Study.

• Authors: Christina M Theodorou, Alan Taylor, Su Yeon Lee, Lia Molina Cortez, Huikang Fu, Christopher D Pivetti, Chaoxing Zhang, Anastasiya Stasyuk, Dake Hao, Priyadarsini Kumar, Diana L Farmer, Jun Liao, Erin G Brown, Yi Hong, Aijun Wang
• Journal: Journal of pediatric surgery (J Pediatr Surg) Vol. 58 Issue 5 Pg. 964-970 (May 2023) ISSN: 1531-5037 [Electronic] United States
• PMID: 36797111 (Publication Type: Journal Article)
• Copyright: Copyright © 2023 Elsevier Inc. All rights reserved.

Chemical References

• Polyurethanes

Topics

• Rats
• Animals
• Hernias, Diaphragmatic, Congenital (surgery)
• Pilot Projects
• Polyurethanes
• Prospective Studies
• Diaphragm (surgery)
• Retrospective Studies