Abstract
Background: There is a high incidence of adhesions after ventral hernia repair with polypropylene
mesh. Hyaluronic acid (HA)–based membrane has been shown to reduce the incidence of
adhesions in the absence of prosthetic mesh. The purpose of this study was to determine
the effect of HA membrane on the quantity and grade of adhesions and its effect on
strength of repair after abdominal wall repair with polypropylene mesh. Methods: In 61 rats a full-thickness abdominal wall defect (excluding skin) was created, and
a section of small bowel was abraded. The animals were randomized, receiving either
HA membrane to cover the viscera or no membrane. The fascial defect was repaired with
polypropylene mesh. Equal numbers of animals from each group were killed at 4 weeks
and 8 weeks after surgery. Adhesion severity and percentage of mesh surface covered
with adhesions were estimated. Tensile strength between mesh and muscle from each
animal was measured. Sections of the mesh-muscle interface were examined histologically
and measured for thickness and graded for inflammation and fibrosis. Results: Fifty-five animals survived until the end point. Animals in the HA membrane group
had a significant reduction in (1) grade of adhesions between small bowel and mesh
at 4 weeks (P = .009) and 8 weeks (P = .000001), (2) grade of adhesions between colon and mesh at 8 weeks (P = .00003), and (3) percentage of mesh covered with adhesions at 4 weeks (P = .01) and 8 weeks (P = .0000002). There was no difference between the 2 groups in tensile strength of
the repairs, tissue thickness, degree of inflammation, or degree of fibrosis. Conclusions: HA membrane reduces the quantity and grade of adhesions of both small and large bowel,
to polypropylene mesh in a rat model of ventral hernia repair, without compromising
strength of the repair. (Surgery 1999;125:211-6.)
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Marlex mesh, a new plastic mesh for replacing tissue defects, I: experimental studies.Arch Surg. 1959; 78: 131-137
- Marlex mesh, a new plastic mesh for replacing tissue defects, II: clinical studies.Arch Surg. 1959; 78: 138-145
- Excision of abdominal wall tumours and reconstruction with Marlex mesh.Can J Surg. 1986; 29: 191-193
- Knitted polypropylene (Marlex) mesh in the repair of incisional hernias.Can J Surg. 1984; 27: 155-157
- Intraperitoneal polypropylene mesh support of incisional herniorraphy.Am J Surg. 1981; 142: 707-711
- Repair of abdominal wall defects: Gore-tex versus marlex graft.Am Surg. 1980; 46: 618-623
- A comparison of polypropylene mesh, expanded polytetrafluoroethylene patch and polyglycolic acid mesh for repair of experimental abdominal wall defects.Acta Chir Scand. 1990; 156: 759-762
- Comparison of Marlex and Gore-tex to repair abdominal wall defects in the rat.Can J Surg. 1989; 32: 244-247
- Comparison of a new type of polytetrafluoroethylene patch (Mycro Mesh) and polypropylene prosthesis (Marlex) for repair of abdominal wall defects.J Am Coll Surg. 1996; 183: 11-18
- Comparison of Marlex mesh and microporous Teflon sheets when used for hernia repair in the experimental animal.Am J Surg. 1979; 137: 342-345
- Postoperative adhesions: their treatment and relevance in clinical practice.Ann R Coll Surg Engl. 1993; 75: 147-153
- Peritoneal adhesions: incidence, cause and prevention.Surg Annu. 1992; 24: 27-45
- Intestinal obstruction from adhesions—how big is the problem?.Ann R Coll Surg Engl. 1990; 72: 60-63
- The incidence and risk of early postoperative small bowel obstruction: a cohort study.Am J Surg. 1987; 154: 643-647
- A comparison of prosthetic materials used to repair abdominal wall defects.Surgery. 1983; 94: 392-398
- Abdominal adhesiolysis: inpatient care and expenditures in the United States in 1994.J Am Coll Surg. 1998; 186: 1-9
- HAL-F™ film—a new hyaluronic acid based bioabsorbable barrier for the prevention of abdominal adhesions.Soc Surg Res. 1991; 381 ([abstract 28])
- Evaluation of HAL-F bioresorbable membrane for adhesion reduction in the rat cecal abrasion model [abstract 0-063].in: Proceedings of the annual meeting of the American Fertility Society; 1993 The Society, 1993: S79
- Prevention of postoperative abdominal adhesions by a sodium hyaluronate-based bioresorbable membrane: a prospective, randomized, double-blind multicenter study.J Am Coll Surg. 1996; 183: 297-306
- Fibrinolytic activity of mesothelial surfaces.Surg Forum. 1969; 20: 80-82
- The role of fibrinolysis in the formation of postoperative adhesions.Wound Rep Reg. 1994; 7: 171-176
- Contemporary adhesion prevention.Fertil Steril. 1994; 61: 219-235
- Prevention of postoperative adhesions in a rat cecal abrasion model.J Invest Surg. 1989; 2: 320
- Efficacy of a resorbable hydrogel barrier, oxidized regenerated cellulose, and hyaluronic acid in the prevention of ovarian adhesions in a rabbit model.Fertil Steril. 1994; 62: 630-634
- Prevention of postoperative pericardial adhesions with a hyaluronic acid coating solution.J Thorac Cardiovasc Surg. 1994; 107: 1481-1488
- Reduction in experimental pericardial adhesions using a hyaluronic acid bioabsorable membrane.Eur J Cardiothorac Surg. 1994; 8: 149-152
- Effects of physical barriers in prevention of adhesions: an incisional hernia model in rats.J Surg Res. 1997; 68: 126-132
- Prevention of adhesions by Seprafilm, an absorbable adhesion barrier: an incisional hernia model in rats.Am Surg. 1997; 63: 818-819
- Tensile strength of surgical wounds.J Surg Res. 1965; 5: 377-380
- Critical evaluation of prosthetic materials in repair of abdominal wall hernias.Am J Surg. 1977; 133: 338-345
- Effect of hyaluronic acid solution on healing of bowel anastomoses.J Invest Surg. 1994; 7: 431-437
Article info
Publication history
Accepted:
September 21,
1998
Footnotes
☆Supported by Physicians' Services Incorporated Foundation, Toronto, Ontario, Canada.
☆☆Reprint requests: Brian M. Taylor, MD, FRCSC, FACS, Department of Surgery, St Joseph's Health Centre, PO Box 5777, London, Ontario, Canada N6A 4L6.
Identification
Copyright
© 1999 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
