Prevention of adhesions to polypropylene mesh in a traumatized bowel model

Robert Charles Dinsmore, William C. Calton, Stephen B. Harvey, Michael W. Blaney

Research output: Contribution to journalArticle

72 Citations (Scopus)

Abstract

Background: Polypropylene mesh (PPM) is an effective material for the repair of abdominal wall defects, but has a tendency to induce dense adhesions when in contact with viscera. Seprafilm (Genzyme Corp, Cambridge, MA), a bioresorbable membrane, has been shown to reduce adhesion formation after midline closures in humans and to PPM in animals. Given the increased inflammatory response expected with surgical trauma, its efficacy under surgical conditions has been questioned. Study Design: A prospective, randomized, blinded study was conducted using a rabbit model. Standardized abdominal wall defects were created in three groups of New Zealand white rabbits. The cecum was deserosalized to simulate the effects of trauma. The abdominal defect was then repaired with PPM. In the control group, no Seprafilm was used. In the first experimental group Seprafilm was placed between the mesh and the abdominal viscera. In the second experimental group Seprafilm was placed over the deserosalized area and between the mesh and abdominal viscera. Animals were sacrificed at 30 days and adhesions were categorized and quantified using digital image analysis of inked specimens. The strength of incorporation was also determined. Results: The formation of adhesions between the viscera and mesh repair was dramatically reduced in both experimental groups compared with the control group. The incidence of visceral adhesions was reduced by 80% in the single film group (p = 0.0004) and 90% in the double film group (p = 0.00008). The reduction in surface area of adhesions was 96.4% in the single film group (p=0.000019) and 99.4% in the double Film group (p = 0.00002). Omental adhesions were reduced by 30% but this did not achieve statistical significance. Strength of incorporation was not adversely affected in either group. Conclusions: Seprafilm is highly effective in preventing adhesions to PPM. This effect was not diminished by the presence of visceral trauma and its resultant inflammatory response. The use of Seprafilm does not adversely affect tissue incorporation. Clinical trials are warranted to determine if the protective effects of Seprafilm demonstrated in this study are applicable in the clinical setting. (C) 2000 by the American College of Surgeons.

Original languageEnglish (US)
Pages (from-to)131-136
Number of pages6
JournalJournal of the American College of Surgeons
Volume191
Issue number2
DOIs
StatePublished - Aug 26 2000

Fingerprint

Polypropylenes
Viscera
Abdominal Wall
Wounds and Injuries
Rabbits
Control Groups
Cecum
Seprafilm
Clinical Trials
Membranes
Incidence

ASJC Scopus subject areas

  • Surgery

Cite this

Prevention of adhesions to polypropylene mesh in a traumatized bowel model. / Dinsmore, Robert Charles; Calton, William C.; Harvey, Stephen B.; Blaney, Michael W.

In: Journal of the American College of Surgeons, Vol. 191, No. 2, 26.08.2000, p. 131-136.

Research output: Contribution to journalArticle

Dinsmore, Robert Charles ; Calton, William C. ; Harvey, Stephen B. ; Blaney, Michael W. / Prevention of adhesions to polypropylene mesh in a traumatized bowel model. In: Journal of the American College of Surgeons. 2000 ; Vol. 191, No. 2. pp. 131-136.
@article{a770b28c452f4e9fbee71c5eb629ba40,
title = "Prevention of adhesions to polypropylene mesh in a traumatized bowel model",
abstract = "Background: Polypropylene mesh (PPM) is an effective material for the repair of abdominal wall defects, but has a tendency to induce dense adhesions when in contact with viscera. Seprafilm (Genzyme Corp, Cambridge, MA), a bioresorbable membrane, has been shown to reduce adhesion formation after midline closures in humans and to PPM in animals. Given the increased inflammatory response expected with surgical trauma, its efficacy under surgical conditions has been questioned. Study Design: A prospective, randomized, blinded study was conducted using a rabbit model. Standardized abdominal wall defects were created in three groups of New Zealand white rabbits. The cecum was deserosalized to simulate the effects of trauma. The abdominal defect was then repaired with PPM. In the control group, no Seprafilm was used. In the first experimental group Seprafilm was placed between the mesh and the abdominal viscera. In the second experimental group Seprafilm was placed over the deserosalized area and between the mesh and abdominal viscera. Animals were sacrificed at 30 days and adhesions were categorized and quantified using digital image analysis of inked specimens. The strength of incorporation was also determined. Results: The formation of adhesions between the viscera and mesh repair was dramatically reduced in both experimental groups compared with the control group. The incidence of visceral adhesions was reduced by 80{\%} in the single film group (p = 0.0004) and 90{\%} in the double film group (p = 0.00008). The reduction in surface area of adhesions was 96.4{\%} in the single film group (p=0.000019) and 99.4{\%} in the double Film group (p = 0.00002). Omental adhesions were reduced by 30{\%} but this did not achieve statistical significance. Strength of incorporation was not adversely affected in either group. Conclusions: Seprafilm is highly effective in preventing adhesions to PPM. This effect was not diminished by the presence of visceral trauma and its resultant inflammatory response. The use of Seprafilm does not adversely affect tissue incorporation. Clinical trials are warranted to determine if the protective effects of Seprafilm demonstrated in this study are applicable in the clinical setting. (C) 2000 by the American College of Surgeons.",
author = "Dinsmore, {Robert Charles} and Calton, {William C.} and Harvey, {Stephen B.} and Blaney, {Michael W.}",
year = "2000",
month = "8",
day = "26",
doi = "10.1016/S1072-7515(00)00337-9",
language = "English (US)",
volume = "191",
pages = "131--136",
journal = "Journal of the American College of Surgeons",
issn = "1072-7515",
publisher = "Elsevier Inc.",
number = "2",

}

TY - JOUR

T1 - Prevention of adhesions to polypropylene mesh in a traumatized bowel model

AU - Dinsmore, Robert Charles

AU - Calton, William C.

AU - Harvey, Stephen B.

AU - Blaney, Michael W.

PY - 2000/8/26

Y1 - 2000/8/26

N2 - Background: Polypropylene mesh (PPM) is an effective material for the repair of abdominal wall defects, but has a tendency to induce dense adhesions when in contact with viscera. Seprafilm (Genzyme Corp, Cambridge, MA), a bioresorbable membrane, has been shown to reduce adhesion formation after midline closures in humans and to PPM in animals. Given the increased inflammatory response expected with surgical trauma, its efficacy under surgical conditions has been questioned. Study Design: A prospective, randomized, blinded study was conducted using a rabbit model. Standardized abdominal wall defects were created in three groups of New Zealand white rabbits. The cecum was deserosalized to simulate the effects of trauma. The abdominal defect was then repaired with PPM. In the control group, no Seprafilm was used. In the first experimental group Seprafilm was placed between the mesh and the abdominal viscera. In the second experimental group Seprafilm was placed over the deserosalized area and between the mesh and abdominal viscera. Animals were sacrificed at 30 days and adhesions were categorized and quantified using digital image analysis of inked specimens. The strength of incorporation was also determined. Results: The formation of adhesions between the viscera and mesh repair was dramatically reduced in both experimental groups compared with the control group. The incidence of visceral adhesions was reduced by 80% in the single film group (p = 0.0004) and 90% in the double film group (p = 0.00008). The reduction in surface area of adhesions was 96.4% in the single film group (p=0.000019) and 99.4% in the double Film group (p = 0.00002). Omental adhesions were reduced by 30% but this did not achieve statistical significance. Strength of incorporation was not adversely affected in either group. Conclusions: Seprafilm is highly effective in preventing adhesions to PPM. This effect was not diminished by the presence of visceral trauma and its resultant inflammatory response. The use of Seprafilm does not adversely affect tissue incorporation. Clinical trials are warranted to determine if the protective effects of Seprafilm demonstrated in this study are applicable in the clinical setting. (C) 2000 by the American College of Surgeons.

AB - Background: Polypropylene mesh (PPM) is an effective material for the repair of abdominal wall defects, but has a tendency to induce dense adhesions when in contact with viscera. Seprafilm (Genzyme Corp, Cambridge, MA), a bioresorbable membrane, has been shown to reduce adhesion formation after midline closures in humans and to PPM in animals. Given the increased inflammatory response expected with surgical trauma, its efficacy under surgical conditions has been questioned. Study Design: A prospective, randomized, blinded study was conducted using a rabbit model. Standardized abdominal wall defects were created in three groups of New Zealand white rabbits. The cecum was deserosalized to simulate the effects of trauma. The abdominal defect was then repaired with PPM. In the control group, no Seprafilm was used. In the first experimental group Seprafilm was placed between the mesh and the abdominal viscera. In the second experimental group Seprafilm was placed over the deserosalized area and between the mesh and abdominal viscera. Animals were sacrificed at 30 days and adhesions were categorized and quantified using digital image analysis of inked specimens. The strength of incorporation was also determined. Results: The formation of adhesions between the viscera and mesh repair was dramatically reduced in both experimental groups compared with the control group. The incidence of visceral adhesions was reduced by 80% in the single film group (p = 0.0004) and 90% in the double film group (p = 0.00008). The reduction in surface area of adhesions was 96.4% in the single film group (p=0.000019) and 99.4% in the double Film group (p = 0.00002). Omental adhesions were reduced by 30% but this did not achieve statistical significance. Strength of incorporation was not adversely affected in either group. Conclusions: Seprafilm is highly effective in preventing adhesions to PPM. This effect was not diminished by the presence of visceral trauma and its resultant inflammatory response. The use of Seprafilm does not adversely affect tissue incorporation. Clinical trials are warranted to determine if the protective effects of Seprafilm demonstrated in this study are applicable in the clinical setting. (C) 2000 by the American College of Surgeons.

UR - http://www.scopus.com/inward/record.url?scp=0033856540&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0033856540&partnerID=8YFLogxK

U2 - 10.1016/S1072-7515(00)00337-9

DO - 10.1016/S1072-7515(00)00337-9

M3 - Article

VL - 191

SP - 131

EP - 136

JO - Journal of the American College of Surgeons

JF - Journal of the American College of Surgeons

SN - 1072-7515

IS - 2

ER -