Hydrogel coated mesh decreases tissue reaction resulting from polypropylene mesh implant: implication in hernia repair

Abstract

PurposeUse of polypropylene mesh (PPM) in hernia repair is associated with tissue reactivity. We examined, in a rat model, a novel non-biodegradable hydrogel coated PPM which may allow for decreased inflammation and a decreased foreign body reaction.MethodsThrough a dorsal midline incision, a 2 cm × 2 cm section of PPM (either coated or uncoated) was placed on the fascial surface 1.5 cm from the incision on the dorsal wall of Sprague–Dawley rats. At 2 and 12 weeks after placement, the PPM and surrounding tissue were harvested. A board-certified dermatopathologist examined H&E stained slides for fibrosis and foreign body reaction. In addition, tissues were stained for apoptotic cells, oxidative damage, macrophages, fibroblasts, neovascularization and metalloproteases.ResultsAt 2 and 12 weeks, there was a greater than 95 % decrease in foreign body giant cells in coated PPM samples compared to uncoated; fibrosis was decreased by 50 %. At 2 and 12 weeks, oxidative damage, fibroblast accumulation, apoptosis and macrophages were significantly decreased in coated PPM samples compared to uncoated PPM.ConclusionThese results demonstrate that a non-biodegradable hydrogel coating of PPM led to significant reduction in foreign body reaction, oxidative stress and apoptosis compared to uncoated PPM in vivo, and suggest that this coating could be clinically useful in hernia repair.

Methacrylic Acid Copolymer Coating Enhances Constructive Remodeling of Polypropylene Mesh by Increasing the Vascular Response

“…Unfortunately, coatings presented in the literature often change the architecture of the mesh, filling pores and adding weight. For example, Poppas et al devised an efficient synthetic coating made of a gel of a long chain polyol on a polyurethane backbone, but the gel filled the pores of the mesh . Therefore, it is unknown if the reported better compatibility was the result of the presence of the coating or a change in porosity.…”

Polypropylene mesh implantation for hernia repair causes myeloid cell–driven persistent inflammation

“…Mesh-induced inflammatory responses may lead to postoperative complications and inflammation (15,16). Previous studies have addressed the general issue of FBR development (2,17) and proposed different strategies, e.g., coating the implants with isolated extracellular matrix proteins (18), hydrogels (19,20), or mesenchymal stem cells (21), in order to attenuate mesh-associated inflammation. Nonetheless, the dynamics of underlying cellular and molecular mechanisms leading to the FBR and the modulations by the differential pretreatments have remained largely obscure.…”

Methods for Implant Acceptance and Wound Healing: Material Selection and Implant Location Modulate Macrophage and Fibroblast Phenotypes

“…It was reported to activate both inflammatory IL‐6 and anti‐inflammatory IL‐1Ra and caused chronic inflammation with fibrous capsule formation . Host responses that include macrophage and fibroblast overgrowth, fibrosis, and foreign body giant cells (FBGCs) could be largely decreased by coating with a polyurethane based hydrogel as shown by dermal implantation in rats . Loading TGF‐β1 on to PP mesh surface could also increase fibroblast proliferation in a dose dependent manner .…”