Anti-inflammatory coating of hernia repair meshes: a 5-rabbit study

Abstract

Purpose Polymeric mesh implantation has become the golden standard in hernia repair, which nowadays is one of the most frequently performed surgeries in the world. However, many biocompatibility issues remain to be a concern for hernioplasty, with chronic pain being the most notable post-operative complication. Oxidative stress appears to be a major factor in the development of those complications. Lack of material inertness in vivo and oxidative environment formed by inflammatory cells result in both mesh deterioration and slowed healing process. In a pilot in vivo study, we prepared and characterized polypropylene hernia meshes with vitamin E (α-tocopherol)-a potent antioxidant. The results of that study supported the use of vitamin E as potential coating to alleviate post-surgical inflammation, but the pilot nature of the study yielded limited statistical data. The purpose of this study was to verify the observed trend of the pilot study statistically. Methods In this work, we conducted a 5-animal experiment where we have implanted vitamin E-coated and uncoated control meshes into the abdominal walls of rabbits. Histology of the mesh-adjacent tissues and electron microscopy of the explanted mesh surface were conducted to characterize host tissue response to the implanted meshes. Results As expected, modified meshes exhibited reduced foreign body reaction, as evidenced by histological scores for fatty infiltrates, macrophages, neovascularization, and collagen organization, as well as by the surface deterioration of the meshes. Conclusion In conclusion, results indicate that vitamin E coating reduces inflammatory response following hernioplasty and protects mesh material from oxidative deterioration.

Toward the New Generation of Surgical Meshes with 4D Response: Soft, Dynamic, and Adaptable

“…[ 22,23 ] Different strategies have been proposed, from alterations of the mesh structure (pore size, shape, transition from a heavyweight to a lightweight meshes, knitting design of the fibers), [ 24 ] to its modification by means of surface coatings. [ 25,26 ] The last approach has gained an increased attention because it allows to achieve protection of the implant from degradation and mitigation of the foreign body reaction. Here, an innovative approach is proposed to use a sensing coating material, based on a thermosensitive hydrogel, to improve the adaptability of the textile device and to convert a surgical mesh in a smart self‐evolving and self‐fixating device.…”

Recent Advances in Antiinflammatory Material Design

“…In the field of hernia repair, Bredikhin et al conducted in vivo studies of polypropylene hernia meshes coated with vitamin E (tocopherol). [69] The results showed reduced foreign body reaction and suggest that vitamin E can be a potential coating to decrease post-surgical inflammation.…”

Surface Modification of Polypropylene Mesh with a Porcine Cholecystic Extracellular Matrix Hydrogel for Mitigating Host Tissue Reaction

“…Adequate angiogenesis is essential in the remodeling phase of wound-healing responses . Here, angiogenesis in the healing skeletal muscle was studied by immunostaining for two parameters: CD31 for immature blood vessels and ASMA for functional blood vessels.…”

“…The common strategies are creating alterations in the mesh composition and optimizing the pore size . Nevertheless, these strategies have yielded only incremental improvements in the overall postoperative complications …”