Background

The incidence of incisional hernia is with up to 30% one of the frequent long-term complication after laparotomy. After establishing minimal invasive operations, the laparoscopic intraperitoneal onlay mesh technique (lap. IPOM) was first described in 1993. Little is known about the foreign body reaction of IPOM-meshes, which covered a defect of the parietal peritoneum. This is becoming more important, since IPOM procedure with peritoneal-sac resection and hernia port closing (IPOM plus) is more frequently used.

Methods

In 18 female minipigs, two out of three Polyvinylidene-fluoride (PVDF) -meshes (I: standard IPOM; II: IPOM with modified structure [bigger pores]; III: IPOM with the same structure as IPOM II + degradable hydrogel-coating) were placed in a laparoscopic IPOM procedure. Before mesh placement, a 2x2cm peritoneal defect was created. After 30 days, animals were euthanized, adhesions were evaluated by re-laparoscopy and mesh samples were explanted for histological and immunohistochemichal investigations.

Results

All animals recovered after implantation and had no complications during the follow-up period. Analysing foreign body reaction, the IPOM II mesh had a significant smaller inner granuloma, compared to the other meshes (IPOM II: 8.4 µm ± 1.3 vs. IPOM I 9.1 µm ± 1.3, p < 0.001). The degradable hydrogel coating does not prevent adhesions measured by Diamond score (p = 0.46). A peritoneal defect covered by a standard or modified IPOM mesh was a significant factor for increasing foreign body granuloma, the amount of CD3+ lymphocytes, CD68+ macrophages and decrease of pore size.

Conclusion

A peritoneal defect covered by IPOM prostheses leads to an increased foreign body reaction compared to intact peritoneum. Whenever feasible, a peritoneal defect should be closed accurately before placing an IPOM-mesh to avoid an excessive foreign body reaction and therefore inferior biomaterial properties of the prosthesis.

中文翻译：

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腹膜内网状假体覆盖的腹膜缺损在小型猪模型中影响增加和独特的异物反应

背景

切口疝的发生率高达30%，是剖腹手术后常见的长期并发症之一。在建立微创手术后，腹腔镜腹腔内嵌补网技术（lap. IPOM）于 1993 年首次被描述。对覆盖壁层腹膜缺损的 IPOM 网的异物反应知之甚少。这变得越来越重要，因为采用腹膜囊切除术和疝气孔关闭术 (IPOM plus) 的 IPOM 手术被更频繁地使用。

方法

在 18 只雌性小型猪中，三分之二的聚偏二氟乙烯 (PVDF) 网格（I：标准 IPOM；II：具有改进结构的 IPOM [更大的孔]；III：具有与 IPOM II 相同结构的 IPOM + 可降解水凝胶涂层）被置于腹腔镜 IPOM 程序中。在放置网格之前，创建了一个 2x2cm 的腹膜缺损。30 天后，对动物实施安乐死，通过再次腹腔镜检查评估粘连，取出网片样本进行组织学和免疫组织化学研究。

结果

所有动物植入后均康复，随访期间无并发症。分析异物反应时，与其他网片相比，IPOM II 网片的内部肉芽肿明显更小（IPOM II：8.4 µm ± 1.3 与 IPOM I 9.1 µm ± 1.3，p < 0.001）。可降解的水凝胶涂层不会阻止由钻石评分测量的粘连 (p = 0.46)。标准或改良 IPOM 网片覆盖的腹膜缺损是增加异物肉芽肿、CD3+ 淋巴细胞、CD68+ 巨噬细胞数量和孔径减小的重要因素。

结论

与完整腹膜相比，被 IPOM 假体覆盖的腹膜缺损会导致异物反应增加。只要可行，在放置 IPOM 网之前应准确闭合腹膜缺损，以避免过度的异物反应，从而避免假体的生物材料性能较差。