Anti-inflammatory coating of hernia repair meshes: a 5-rabbit study
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ORIGINAL ARTICLE
Anti‑inflammatory coating of hernia repair meshes: a 5‑rabbit study M. Bredikhin1 · D. Gil1 · J. Rex1 · W. Cobb2 · V. Reukov1 · A. Vertegel1 Received: 21 August 2019 / Accepted: 4 January 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
Abstract Purpose Polymeric mesh implantation has become the golden standard in hernia repair, which nowadays is one of the most frequently performed surgeries in the world. However, many biocompatibility issues remain to be a concern for hernioplasty, with chronic pain being the most notable post-operative complication. Oxidative stress appears to be a major factor in the development of those complications. Lack of material inertness in vivo and oxidative environment formed by inflammatory cells result in both mesh deterioration and slowed healing process. In a pilot in vivo study, we prepared and characterized polypropylene hernia meshes with vitamin E (α-tocopherol)-a potent antioxidant. The results of that study supported the use of vitamin E as potential coating to alleviate post-surgical inflammation, but the pilot nature of the study yielded limited statistical data. The purpose of this study was to verify the observed trend of the pilot study statistically. Methods In this work, we conducted a 5-animal experiment where we have implanted vitamin E-coated and uncoated control meshes into the abdominal walls of rabbits. Histology of the mesh-adjacent tissues and electron microscopy of the explanted mesh surface were conducted to characterize host tissue response to the implanted meshes. Results As expected, modified meshes exhibited reduced foreign body reaction, as evidenced by histological scores for fatty infiltrates, macrophages, neovascularization, and collagen organization, as well as by the surface deterioration of the meshes. Conclusion In conclusion, results indicate that vitamin E coating reduces inflammatory response following hernioplasty and protects mesh material from oxidative deterioration. Keywords Hernia · Vitamin E · Polypropylene mesh · Rabbit model
Introduction An abdominal wall hernia is a protrusion of tissues through the musculoaponeurotic wall of the abdomen. This type of hernia is very common, with an estimated 800,000 new cases in the United States and 20 million repair procedures worldwide every year [1, 2]. While many of these are attributed to 10–30% patients following laparotomy, the overall incidence rate is likely to increase as obesity continues to rise in the US [2]. The use of polymeric meshes for the reinforcement of hernia repairs was first pioneered in 1958 by Usher et al. [3]. Mesh implantation has become heavily practiced, as these * A. Vertegel [email protected] 1
Department of Bioengineering, Clemson University, 301 Rhodes Hall, Clemson, SC 29634, USA
Department of Surgery, The Hernia Center, Prisma Health, 2104 Woodruff rd., Greenville, SC 29607, USA
2
implants were shown to strengthen the rupture site and produce less than half the recurrence rate of the sutured closures [4]. Most o
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