Functional and morphologic properties of a modified mesh for inguinal hernia repair

Junge, K.; Klinge, U.; Rösch, R.; Klosterhalfen, B.; Schumpelick, Volker

doi:10.1007/s00268-002-6444-z

Cited by 148 publications

(92 citation statements)

References 50 publications

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“…All materials induce a specific and material-dependent foreign-body reaction, as shown in rodent animal models and clinical trials investigating human mesh explants [15, 16, 17]. These typical inflammatory foreign-body reactions were confirmed by this study.…”

Section: Discussionsupporting

confidence: 63%

Persistent Extracellular Matrix Remodelling at the Interface to Polymers Used for Hernia Repair

Junge¹,

Rösch²,

Bialasinski³

et al. 2003

Eur Surg Res

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On the one hand, recurrence rates and postoperative complications following hernia repair are supposed to be influenced by the kind of mesh material used. On the other hand, an impaired collagen metabolism and cleavage within connective tissue has been suggested as decisive factor in the pathogenesis of recurrent hernia formation. The aim of our study was, therefore, to analyze the impact of commonly used mesh materials on quality of collagen deposition, expression of collagenases (matrix metalloproteinases; MMP-1/MMP-13), and specific tissue inhibitors of MMPs (TIMPs) in an animal study. Four different mesh materials were used (Prolene^® = polypropylene, Mersilene^® = polyester, and Vypro^® and Vypro II^® = combinations of polypropylene and polyglactin) and implanted as abdominal wall replacement in 60 male Wistar rats. Mesh samples were explanted after 3, 21, and 90 days and investigated using immunohistochemistry (expression of MMP-1/MMP-13 and TIMP-1) and cross-polarization miscroscopy (percentage of collagen type III to overall collagen). Besides an insufficient collagen composition with an increased percentage of collagen type III, we found a complex expression of collagenases and their inhibitors combined with a persistent chronic foreign-body reaction even 90 days after implantation. Except for TIMP-1 expression, which was significantly related to a lowered amount of inflammatory (r = –0.980, p = 0.02) and connective tissue formation (r = –0.951, p = 0.049), there was no relation to the expression of collagenases (MMP-1/MMP-13) with regard to the amount of inflammarory and connective tissue formation despite partly significant differences between implanted polymers.

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Section: Discussionsupporting

confidence: 63%

Persistent Extracellular Matrix Remodelling at the Interface to Polymers Used for Hernia Repair

Junge¹,

Rösch²,

Bialasinski³

et al. 2003

Eur Surg Res

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“…Hereafter, as shown in a previous investigation, the stiffness proved comparable to a heavy-weight polypropylene mesh (Prolene ® ), still retaining a markedly reduced restriction of the abdominal wall mobility and a decreased inflammatory reaction and fibrosis [20]. Nevertheless, it is still unclear if the additional supplementation with polyglactin holds pro- or anti-inflammatory properties in the incorporation of low-weight large-pore meshes.…”

Section: Introductionmentioning

confidence: 85%

Vypro II<sup>®</sup> Mesh in Hernia Repair: Impact of Polyglactin on Long-Term Incorporation in Rats

Rösch¹,

Junge²,

Quester

et al. 2003

Eur Surg Res

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Background: To the Vypro II^® mesh, a large-pore-sized multifilamentous polypropylene mesh for hernia repair, supplementary polyglactin 910 multifilaments were added to improve intraoperative handling. As it has been suggested that polyglactin induces fibroplastic reactions and wound complications, this study was designed to evaluate the long-term tissue reaction to polyglactin in the Vypro II mesh. Materials and Methods: Two mesh materials, the Vypro II composite mesh (PP + PG) and the pure polypropylene variant (PP), were compared after inlay implantation in a standardized rodent animal model. After 14, 28, 42, 56, 84 and 112 days of implantation, histological analysis of the inflammatory response was performed: material absorption, inflammatory tissue reaction, fibrosis and granuloma formation were investigated. Results: Total absorption of polyglactin filaments of the Vypro II mesh occurred between 56 and 84 days of implantation. Both the inflammatory and the fibrotic reaction were initially increased in the PP + PG mesh group. These differences disappeared in the following implantation period. After 112 days, inflammation was even less pronounced in the PP + PG mesh group. Conclusion: The present data confirm a short-term polyglactin-induced increase in inflammation and fibrosis around implanted Vypro II meshes in rats. With regard to the long-term tissue response, even an anti-inflammatory property of polyglactin multifilaments in low-weight and large-pored polypropylene meshes cannot be ruled out.

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“…Junge et al observed in experimental study on animal model after implantation of mesh, that the lesser degree of reaction was followed by less connective tissue formation and a higher partial volume of fat tissue (23). After analysis of a possible causal factor, it was found that the extent of the foreign body reaction with its provoked scar tissue depends on the amount and structure of incorporated material (23).…”

Section: Discussionmentioning

confidence: 99%

Impact of Different Texture of Polypropylene Mesh on the Inflammatory Response

Vita

Patti

Sparacello

et al. 2008

Int J Immunopathol Pharmacol

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Over the past decade, hernia surgery has undergone a considerable transformation with the use of prosthetic materials. The most used polypropylene meshes induce a rapid acute inflammatory response followed by chronic foreign body reaction. Many factors influence this response such as density, size, physical characteristics, different texture and porosity of each biomaterial. The aim of this study is to assess whether the implant of monofilament or multifilament meshes, in the inguinal hernioplasty, determine a different inflammatory response. Thirty-two male patients were included in the study and were randomly divided into two groups. In the first group (MO) inguinal hernioplasty was performed using monofilament polypropylene mesh, while in the second one (MU) multifilament prosthesis was used. Peripheral venous blood samples were collected 24 hours before surgery and then 6, 24, 48 and 168 hours posto-peratively. Modifications in leukocyte count, C-reactive protein (CRP), alpha-1 antitrypsin (a1-AT), interleukin (IL)-1, IL-6, IL-1 ra and IL-10 serum levels were recorded at all sampling times. We present evidence that serum levels of CRP, (a1-AT), leukocytes and cytokines were significantly increased post-operatively in both groups, returning to basal values 168 hours afterwards. In particular, the production of all pro-inflammatory mediators was higher in the MU group, whereas the antiinflammatory cytokine (IL-10, IL-1ra) production was higher in MO patients. Our results indicate that polypropylene multifilament mesh allows a higher intense acute inflammatory response as compared to monofilament mesh implantation.

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Functional and morphologic properties of a modified mesh for inguinal hernia repair

Cited by 148 publications

References 50 publications

Persistent Extracellular Matrix Remodelling at the Interface to Polymers Used for Hernia Repair

Persistent Extracellular Matrix Remodelling at the Interface to Polymers Used for Hernia Repair

Vypro II<sup>®</sup> Mesh in Hernia Repair: Impact of Polyglactin on Long-Term Incorporation in Rats

Impact of Different Texture of Polypropylene Mesh on the Inflammatory Response

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