Mechanical strength vs. degradation of a biologically-derived surgical mesh over time in a rodent full thickness abdominal wall defect

Costa, Alessandra; Naranjo, Juan Diego; Turner, Neill J.; Swinehart, Ilea T.; Kolich, Brian; Shaffiey, Shahab; Londoño, Ricardo; Keane, Timothy J.; Reing, Janet E.; Johnson, Scott A.; Badylak, Stephen F.

doi:10.1016/j.biomaterials.2016.08.053

Cited by 35 publications

(26 citation statements)

References 42 publications

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“…Importantly peak stress, modulus, and strain after day 7 post-implantation were always similar to the values measured for native abdominal wall skeletal muscle. The non-cross-linked urinary bladder matrix (UBM) also showed better tissue integration and remodeling [47]. The mechanisms described above may explain why different ECMs (varying in animal or tissue source) and/or different configurations (varying in the decellularization process or final customization, i.e., single/multi-layer) lead to different clinical outcomes.…”

Section: Biological Scaffolds For Abdominal Wall Repairmentioning

confidence: 99%

Biological Scaffolds for Abdominal Wall Repair: Future in Clinical Application?

et al. 2019

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Millions of abdominal wall repair procedures are performed each year for primary and incisional hernias both in the European Union and in the United States with extremely high costs. Synthetic meshes approved for augmenting abdominal wall repair provide adequate mechanical support but have significant drawbacks (seroma formation, adhesion to viscera, stiffness of abdominal wall, and infection). Biologic scaffolds (i.e., derived from naturally occurring materials) represent an alternative to synthetic surgical meshes and are less sensitive to infection. Among biologic scaffolds, extracellular matrix scaffolds promote stem/progenitor cell recruitment in models of tissue remodeling and, in the specific application of abdominal wall repair, have enough mechanical strength to support the repair. However, many concerns remain about the use of these scaffolds in the clinic due to their higher cost of production compared with synthetic meshes, despite having the same recurrence rate. The present review aims to highlight the pros and cons of using biologic scaffolds as surgical devices for abdominal wall repair and present possible improvements to widen their use in clinical practice.

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Section: Biological Scaffolds For Abdominal Wall Repairmentioning

confidence: 99%

Biological Scaffolds for Abdominal Wall Repair: Future in Clinical Application?

et al. 2019

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“…The temporal course of degradation of dermal ECM, UBM-ECM, and SIS-ECM has been determined by the use of a 14 C isotope incorporated into the collagen of donor animals (Gilbert et al 2007a). SIS-ECM and UBM-ECM are degraded within 60 -90 days of implantation, whereas the more densely organized dermal ECM degraded more slowly over a period of at least 24 months (Carey et al 2014;Costa et al 2016). The rate of degradation is likely dependent, in part, on the anatomic site of placement.…”

Section: Mechanisms Of Ecm Bioscaffold Remodelingmentioning

confidence: 99%

“…Soon after implantation, degradation of ECM bioscaffold begins and, as a result, there is an initial decrease in the strength of the ECM bioscaffold (Gilbert et al 2007b;Costa et al 2016). However, once infiltrating cells begin to secrete and organize the appropriate new ECM and tissue remodeling occurs, there is an associated increased strength and site-specific mechanical behavior of the graft Costa et al 2016).…”

Section: Mechanical Properties Of Ecm Bioscaffoldsmentioning

confidence: 99%

Biologic Scaffolds

Costa

Naranjo

Londoño

et al. 2017

Cold Spring Harb Perspect Med

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“…15,16,27 In a hiatal hernia animal model, UBM implants showed an improvement in strength of repair compared to a nonreinforced control between 2 to 3 months after surgery. 28 Two recent retrospective series of hiatal hernia repairs reinforced with UBM showed rare short-term complications. 17,19 One study of 62 patients, including 5 patients with concomitant sleeve gastrectomy, patients reported only one reoperation at 24 months for symptomatic recurrence.…”

Section: Discussionmentioning

confidence: 99%

Large Hiatal Hernia Repair with Urinary Bladder Matrix Graft Reinforcement and Concomitant Sleeve Gastrectomy

Sasse

Gevorkian

Lambin

et al. 2019

JSLS

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Background:There is no current consensus on the management of large hiatal hernias concomitant with performance of a sleeve gastrectomy procedure. Proposed solutions have included performing a modified Nissen fundoplication, performing cruroplasty alone, utilizing the Linx device, performing cruroplasty with reinforcement material, and avoiding the sleeve procedure altogether in favor of a bypass procedure in order to minimize gastroesophageal reflux. Urinary bladder matrix (UBM) represents a biologically derived material for use in hiatal hernia repair reinforcement with the potential to improve durability of repair without incurring the risks of other reinforcement materials.Methods: This study reports the results of a retrospective chart review of 32 cases of large hiatal hernia repair utilizing both primary crural repair and UBM reinforcement concomitant with laparoscopic sleeve gastrectomy by a single surgeon. Hernia diameter averaged 6 cm (range 4 -9 cm). After an average of 1 year followup, 30 patients were assessed for subjective symptoms of gastroesophageal reflux (GERD) using the Gastroesophageal Reflux Disease-Health Related Quality of Life (GERD-HRQL) score. Twenty patients were evaluated with either upper gastrointestinal (GI) series, endoscopy, or both. Results:Each repair was successful and completed laparoscopically concomitant with sleeve gastrectomy. Anterior and posterior cruroplasty was performed using interrupted 0-Ethibond suture using the Endostitch device. The UBM graft exhibited favorable handling characteristics placed as a keyhole geometry sutured to the crura with absorbable suture. A careful chart review was undertaken to assess for complications. There have been no reoperations. After a median of 12 months (range, 4 -27 months) of followup, an assessment of recurrences or long-term complications was completed. Median GERD-HRQL score was 6, with a range of 0 to 64 (of possible 75), indicating very low-level reflux symptomatology. Follow-up upper GI radiographs or endoscopy were obtained in 20 cases and show intact repairs. Conclusion:In this series of 32 cases, laparoscopic cruroplasty with UBM graft reinforcement has been effective and durable at 12 months of followup. This technique may offer one satisfactory solution for large hiatal hernia repair concomitant with laparoscopic sleeve gastrectomy that may achieve a durable repair with low GERD symptoms.

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Mechanical strength vs. degradation of a biologically-derived surgical mesh over time in a rodent full thickness abdominal wall defect

Cited by 35 publications

References 42 publications

Biological Scaffolds for Abdominal Wall Repair: Future in Clinical Application?

Biological Scaffolds for Abdominal Wall Repair: Future in Clinical Application?

Biologic Scaffolds

Large Hiatal Hernia Repair with Urinary Bladder Matrix Graft Reinforcement and Concomitant Sleeve Gastrectomy

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