Estudo comparativo de aderências intraperitoneais associadas ao uso das telas de polipropileno e de malha leve de polipropileno revestida com ácido graxo ômega-3

Abstract

OBJETIVO: Comparar as aderências entre dois grupos de ratas Wistar submetidas à colocação intraperitoneal da tela de polipropileno e malha leve de polipropileno revestida com ácido graxo ômega-3. MÉTODOS: Foram utilizadas 27 ratas Wistar randomizadas em três grupos. No grupo 0 não houve colocação de prótese, no grupo 1 houve implantação da prótese de polipropileno e no grupo 2, implantação de prótese de polipropileno revestida com ácido graxo ômega-3. Foi avaliadas a presença de aderências, grau, força de ruptura, percentual de área recoberta e retração das telas aferidas. RESULTADOS: O grupo 0 não apresentou aderência. Os grupos 1 e 2 apresentaram aderência na superfície da prótese, omento, fígado e alça intestinal. Foram encontradas aderências grau 1 e 2 em 100% do grupo polipropileno revestida com ácido graxo ômega-3 e em 60% do grupo polipropileno. As demais eram aderências grau 3, e diferiram significativamente entre os grupos (p< 0,001). A força de ruptura da aderência na tela polipropileno revestida com ácido graxo ômega-3 foi significativamente maior do que na tela de polipropileno (p= 0,016). Não houve diferença na retração das telas ou superfície acometida pelas telas. A análise da tela revestida com ácido graxo ômega-3 demonstrou distribuição preferencialmente nas bordas em relação ao polipropileno, com predomínio no centro. CONCLUSÃO: O tipo de aderência, percentual de superfície acometida e retração não foram significativamente diferentes entre as telas. A tela de baixo peso apresentou menor grau de aderências, e, estas, necessitaram força maior para ruptura, possivelmente pelo predomínio de sua ocorrência nas bordas da tela.

Comparison between polypropylene and polypropylene with poliglecaprone meshes on intraperitoneal adhesion formation

“…When inserted intraperitoneally, in general a mesh induces a foreign body reaction and the Experimental studies with surgical meshes for evaluation of biocompatibility and adhesion formation use animal models, such as rabbits [23][24][25] , sheep 26 , pigs 15 , and, especially, rats 11,27 . The variables analyzed include incidence, extent, quality and, in some studies, resistance to rupture and tenacity.…”

“…Consecrated by its excellent biocompatibility, incorporation, maintenance of abdominal wall traction and low cost, it is associated with a high incidence of adhesions 14,22 . In experimental studies, the formation of adhesions is observed in 100% of meshes, covering from 50% to 100% of their surface 11,12,27 . The authors described the omentum as the most often involved structure, followed by the liver and the bowel.…”

Critical Analysis of Experimental Model for Study of Adhesions After Incisional Hernias Induced in Rats’ and Repair of Abdominal Wall With Different Biomaterials

“…Environmental factors such as smoking, factors that are inherent to the patient as obesity and genetics, as well as local complications of the incision, with wound infection, are important to the development of incisional hernias 13 15 26 . Published articles on the various options of synthetic prostheses used in the repair of such hernias 1 3 9 18 19 22 23 29 show that even the state-of-the-art materials, developed for direct contact with the abdominal cavity, despite decreasing, they can not completely prevent the formation of adhesions on these prostheses 4 22 23 25 , demonstrating that these materials need to be improved. Several experimental studies describe tactics to minimize complications related to adhesions 2 14 20 27 and implanted biomaterials 3 6 16 .…”

“…They can be basically divided on: 1) those which an incision is made with standard size on the linea alba and its repair is made with different prostheses in the first operation 11 19 21 ; 2) on those that resect fragments with various formats of the wall 9 22 23 30 and also perform primary repair 1 10 29 ; and on 3) those whose model is similar to the usual clinical condition, initially producing an incisional hernia, with its subsequent correction 4 . The focus of these studies is the consequence of the synthetic implants directly in contact with the abdominal viscera, a topic that has gained importance with the development of laparoscopy as an option for treating ventral hernias 5 16 18 25 . From the experimental point of view, many authors make no distinction between such options, also calling incisional hernia when defects of abdominal wall are fixed in the first surgery 6 25 29 30 .…”

“…The biomaterials used for this purpose must be inert, have good resistance and trigger small inflammatory response at the site where they have been implanted to be properly integrated to the tissues 22 23 . When repaired with conventional technique, polypropylene is often used, due to easy handling and low cost, but this material can not stay in contact with the abdominal contents, because it may cause the formation of adhesions and the risk of an intestinal obstruction or enteric fistulae 6 18 25 . The compatible prostheses with the abdominal cavity have been developed primarily for use in laparoscopy 3 16 , but they have high cost and, although minimizing, they do not prevent adhesions completely; therefore some other tactical options have been used to correct this condition.…”