Pode a tela de poliéster coberta com colágeno diminuir as taxas aderências intraperitoneais na correção de hérnia incisional?

Abstract

-Background -Among meshes used in incisional hernias in open techniquerepair, the polypropylene is the most commonly used due to flexibility, cellular growth stimulation, satisfactory inflammatory response, easy manipulation and low price. However, it induces adhesions formation when in contact with the intra-abdominal contents. Aim -To evaluate the formation of adhesions after polypropylene and collagen coated polyester mesh with intraperitoneal placement. Methods -Twenty six female Wistar rats were randomized in three groups. In the group 0 (sham) there was no prosthesis placement, in the polypropylene (group 1) the prosthesis was placed at the peritoneal surface and in the group 2, collagen coated polyester mesh was placed. The rats were killed on postoperative day 21 to evaluate adhesions regarding its degree, mesh percentage of involvement, bowel involvement and strength needed to cause rupture. Results -There was no difference in weight between groups. The group 0 did not develop any adhesions. The groups 1 and 2 developed prosthetic mesh surface adhesions, mostly in the omentum. There was no difference in adhesion degree and percentage of surface involvement between groups. The collagen coated mesh did not develop adhesions. The adhesions occurred at the free edge of the mesh, in contact with the polyester. The Polypropylene group presented 80% of the surface involved with adhesions, while the collagen coated polyester group presented 10% (p<0,005). Conclusion -There was no difference between adhesion, degree of adhesion and strength needed to cause rupture. However, the polypropylene mesh presented significantly higher surface of adhesion when compared to the collagen coated polyester mesh.RESUMO -Racional -Entre as telas utilizadas na reparação de hérnias incisionais na técnica aberta, a de polipropileno é a mais utilizada devido à flexibilidade, estimulação do crescimento celular, resposta inflamatória satisfatória, fácil manipulação e baixo preço. No entanto, induz a formação de aderências, quando em contato com os conteúdos intraabdominais. Objetivo -Avaliar as aderências formadas após a colocação intraperitoneal da tela de polipropileno e a tela de poliéster coberta com colágeno. Método -Foram utilizadas 26 ratas Wistar fêmeas, randomizadas em três grupos. No grupo 0 (sham) não houve colocação de prótese, apenas laparotomia; no grupo 1 foi implantada a prótese de polipropileno na superfície peritoneal; e no grupo 2, a prótese composta por poliéster coberta por colágeno. Todos os animais foram mortos 21 dias após o procedimento e avaliados quanto às vísceras envolvidas nas aderências, grau das aderências, percentual da tela acometimento por aderências e a força necessária para a sua ruptura. Resultados -Não houve diferença de peso entre os grupos. O grupo 0 não apresentou aderência. Os grupos 1 e 2 apresentaram aderências na superfície da prótese, predominante no omento. O grau de aderências, superfície acometida não teve diferença representativa entre os grupos. A cobertura de colágeno não ...

Comparative study of Polypropylene versus Parietex composite®, Vicryl® and Ultrapro® meshes, regarding the formation of intraperitoneal adhesions

“…However, surgical meshes have brought with them several complications, such as fistulas and adhesions, especially with intraperitoneal use 2,7,14,[16][17][18][19] . Postoperative adhesions to the surgical meshes may bring complications such as bowel obstruction, female infertility, postoperative abdominal pain, and repair difficulties in future surgeries 25 .…”

“…In the United States, incisional hernia is the most common surgical complication 2,3 . Treatment options are fascial repair with tissue reapproximation and suture, or repair with the use of surgical mesh, implemented by Usher in 1958 4,5 .…”

“…Hence, the use of surgical meshes for correction of abdominal hernias was strengthened due to its lower recurrence rates [6][7][8][9][10][11][12][13][14] . With the advent of laparoscopic surgery and the placement of intraperitoneal meshes, major adhesion formation was highlighted 2,7,[14][15][16][17][18][19] . The composite meshes -which have the surface facing the viscera made of absorbable and microporous material and the surface facing the muscles made of synthetic macroporous material -are the ones with the best results 20,21 .…”

“…The Parietex composite® mesh is comprised of a double-layer mesh. The layer on the muscle side is a polyester barrier, and the surface in contact with the interior of the cavity is a layer of absorbable collagen, polyethylene glycol, and glycerol 2,6 . The present study aims at evaluating the Vicryl®, Parietex composite® and Ultrapro® surgical meshes, regarding adhesion formation when they are applied intraperitoneally, and comparing them to polypropylene.…”

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

“…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.…”