Effectiveness of Hyalobarrier and Seprafilm to prevent polypropylene mesh shrinkage: a macroscopic and histological experimental study

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• 作者：Erdogan Nohuz (1) (2)
  Maher Alaboud (1)
  Claude Darcha (3)
  Abdelkrim Alloui (4)
  Bruno Aublet-Cuvelier (5)
  Bernard Jacquetin (2)
  
• 关键词：Polypropylene mesh ; Shrinkage ; Postoperative adhesion ; Seprafilm ; Hyalobarrier ; Pelvic organ prolapse
• 刊名：International Urogynecology Journal
• 出版年：2014
• 出版时间：August 2014
• 年：2014
• 卷：25
• 期：8
• 页码：1081-1087
• 全文大小：720 KB
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• 作者单位：Erdogan Nohuz (1) (2)
  Maher Alaboud (1)
  Claude Darcha (3)
  Abdelkrim Alloui (4)
  Bruno Aublet-Cuvelier (5)
  Bernard Jacquetin (2)
  
  1. Department of Obstetrics and Gynecology, General Hospital of Thiers, Route du Fau, 63300, Thiers, France
  2. Department of Obstetrics and Gynecology, University Hospital of Clermont-Ferrand, CHU Estaing, 1, Place Lucie Aubrac, 63001, Clermont-Ferrand, France
  3. Department of Pathology, University Hospital of Clermont-Ferrand, 58, rue Montalembert, 63003, Clermont-Ferrand, France
  4. Department of Pharmacology, Faculty of Medicine, Auvergne University, 28, Place Henri Dunant, 63001, Clermont-Ferrand, France
  5. Department of Statistical and Medical Information, University Hospital of Clermont-Ferrand, 58, rue Montalembert, 63003, Clermont-Ferrand, France
  
• ISSN：1433-3023

文摘

Introduction and hypothesis Polypropylene (PP) mesh shrinkage represents a serious complication, as a significant cause of pain and recurrence of pelvic organ prolapse or ventral hernias, frequently requiring several surgical interventions. The retraction seems to be caused by the host, in response to the implantation, through the occurrence of periprosthetic adhesions and fibrosis. We hypothesized that avoiding the postoperative adhesions can prevent PP mesh shrinkage. Methods Sixty rats were randomly assigned to three groups. A standardized hernia defect was induced on the abdominal wall, which was repaired using an extraperitoneal PP mesh alone (group 1), with application of a hyaluronate carboxymethylcellulose-based bioresorbable membrane (Seprafilm?, group 2), or an auto-cross-linked polysaccharide hyaluronan-based solution (Hyalobarrier? gel, group 3). Eight weeks after the procedure, a repeat laparotomy was performed. After scoring the adhesion and measuring the mesh surface, a microscopic study of the prosthesis-host tissue interfaces was performed. Results Group 1 displayed a median shrinkage of 29?% of the mesh. The Seprafilm? group (p--.0238) and Hyalobarrier? gel group (p--.0072) displayed a significantly smaller reduction of 19.12 and 17?%, respectively. Control group 1 displayed a significantly greater adhesion score (30.40) than the Seprafilm? (11.67, p--.0028) and Hyalobarrier? gel groups (11.19, p--.0013). The fibrosis was reduced in the Hyalobarrier? gel group only. Conclusion This experimental study revealed that Hyalobarrier? gel and Seprafilm? can prevent PP mesh shrinkage and postoperative adhesions. They might be integrated in a mesh size-saving strategy, which should preserve the quality and durability of the surgical repair and limit the postoperative pain.