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Baker JJ, Rosenberg J. Coatings for Permanent Meshes Used to Enhance Healing in Abdominal Hernia Repair: A Scoping Review. Surg Innov 2024:15533506241255258. [PMID: 38803124 DOI: 10.1177/15533506241255258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
INTRODUCTION Hernia meshes are used to reduce recurrence and pain rates, but the rates are still high. This could be improved with coatings of the mesh. This scoping review aimed to provide an overview of mesh coatings used to promote healing in abdominal hernia repair and to report beneficial and unbeneficial effects. METHODS We included human and animal studies with abdominal hernias that were repaired with non-commercially coated meshes. We searched Pubmed, Embase, Cochrane Central, LILACS, and CNKI without language constraints. RESULTS Of 2933 identified studies, 58 were included: six studies had a total of 408 humans and 52 studies had 2679 animals. The median follow-up was 12 months (range 1-156), and 95% of the hernias were incisional. There were 44 different coatings which included platelet-rich plasma, mesenchymal stem cells, growth factors, vitamin E, collagen-derived products, various polysaccharides, silk proteins, chitosan, gentamycin, doxycycline, nitrofurantoin, titanium, and diamond-like carbon. Mesenchymal stem cells and platelet-rich plasma were the most researched. Mesenchymal stem cells notably reduced inflammation and foreign body reactions but did not impact other healing metrics. In contrast, platelet-rich plasma positively influenced tissue ingrowth, collagen deposition, and neovascularization and had varying effects on inflammation and foreign body reactions. CONCLUSION We identified 44 different mesh coatings and they showed varying results. Mesenchymal stem cells and platelet-rich plasma were the most studied, with the latter showing considerable promise in improving biomechanical properties in hernia repair. Further investigations are needed to ascertain their definitive use in humans.
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Affiliation(s)
- Jason Joe Baker
- Center for Perioperative Optimization, Department of Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Jacob Rosenberg
- Center for Perioperative Optimization, Department of Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
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Dreger NZ, Zander ZK, Hsu YH, Luong D, Chen P, Le N, Parsell T, Søndergaard C, Dunbar ML, Koewler NJ, Suckow MA, Becker ML. Zwitterionic amino acid-based Poly(ester urea)s suppress adhesion formation in a rat intra-abdominal cecal abrasion model. Biomaterials 2019; 221:119399. [PMID: 31421314 DOI: 10.1016/j.biomaterials.2019.119399] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 07/29/2019] [Accepted: 07/29/2019] [Indexed: 12/16/2022]
Abstract
Hernia repair outcomes have improved with more robust material options for surgeons and optimized surgical techniques. However, ventral hernia repairs remain challenging with an inherent risk of post-surgical adhesions in the peritoneal space which can occur regardless of interventional material or its surgical placement. Herein, amino acid-based poly(ester urea)s (PEUs) with varied amount of an allyl ether side chains were modified post polymerization modification with the zwitterionic sulfnate group (3-((3-((3-mercaptopropanoyl)oxy)propyl) dimethylammonio)propane-1-sulfonate) to promote anti-adhesive properties. These alloc-PEUs were processed using roll-to-roll fabrication methods to afford films that were amenable to surface functionalization via a zwitterion-thiol. Functional group availability on the surface was confirmed via fluorescence microscopy, x-ray photoelectron spectroscopy (XPS), and quartz crystal microbalance (QCM) measurements. Zwitterionic treated PEUs exhibited reduced fibrinogen adsorption in vitro when compared to unfunctionalized control polymer. A rat intrabdominal cecal abrasion adhesion model was used to assess the extent and tenacity of adhesion formation in the presence of the PEUs. The 10% alloc-PEU zwitterion functionalized material was found to reduce the extent and tenacity of adhesions when compared to adhesion controls and the unfunctionalized PEU controls.
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Affiliation(s)
- Nathan Z Dreger
- Department of Polymer Science, The University of Akron, Akron, OH, 44325, USA
| | - Zachary K Zander
- Department of Polymer Science, The University of Akron, Akron, OH, 44325, USA
| | - Yen-Hao Hsu
- Department of Polymer Science, The University of Akron, Akron, OH, 44325, USA
| | - Derek Luong
- Department of Polymer Science, The University of Akron, Akron, OH, 44325, USA
| | - Peiru Chen
- Department of Polymer Science, The University of Akron, Akron, OH, 44325, USA
| | - Nancy Le
- Department of Polymer Science, The University of Akron, Akron, OH, 44325, USA
| | | | | | - Misha L Dunbar
- College of Veterinary Medicine, The University of Minnesota, Minneapolis, MN, 55455, USA
| | - Nathan J Koewler
- College of Veterinary Medicine, The University of Minnesota, Minneapolis, MN, 55455, USA
| | - Mark A Suckow
- Department of Biomedical Engineering, The University of Kentucky, Lexington, KY, 40506, USA
| | - Matthew L Becker
- Department of Polymer Science, The University of Akron, Akron, OH, 44325, USA; Biomedical Engineering, The University of Akron, Akron, OH, 44325, USA; Department of Chemistry, Duke University, Durham, NC, 27708, USA; Department of Mechanical Engineering and Material Science, Duke University, Durham, NC, 27708, USA; Orthopaedic Surgery, Duke University, Durham, NC, 27708, USA.
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Jamry A, Jałyński M, Piskorz Ł, Brocki M. Assessment of adhesion formation after laparoscopic intraperitoneal implantation of Dynamesh IPOM mesh. Arch Med Sci 2013; 9:487-92. [PMID: 23847671 PMCID: PMC3701981 DOI: 10.5114/aoms.2013.35345] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 07/18/2011] [Accepted: 09/26/2011] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Formation of adhesions after laparoscopic hernia repair using the intra-peritoneal onlay mesh (IPOM) procedure can lead to intestinal obstruction or mesh erosion into intestinal lumen. The aims of this study included: measurement of adhesion formation with Dynamesh IPOM after laparoscopic intraperitoneal implantation, and assessment of the occurrence of isolated adhesions at the fastening sites of slowly absorbable sutures. MATERIAL AND METHODS Twelve healthy pigs underwent laparoscopic implantation of 2 Dynamesh IPOM mesh fragments each, one was fastened with PDSII, and the other with Maxon sutures. An assessment of adhesion formation was carried out after 6 weeks and included an evaluation of surface area, hardness according to the Zhulke scale, and index values. The occurrence of isolated adhesions at slowly absorbable suture fixation points was also analyzed. RESULTS Adhesions were noted in 83.3% of Dynamesh IPOM meshes. Adhesions covered on average 37.7% of the mesh surface with mean hardness 1.46 and index value 78.8. In groups fixed with PDS in comparison to Maxon sutures adhesions covered mean 31.6% vs. 42.5% (p = 0.62) of the mesh surface, mean hardness was 1.67 vs.1.25 (p = 0.34) and index 85.42 vs. 72.02 (p = 0.95). CONCLUSIONS The Dynamesh IPOM mesh, in spite of its anti-adhesive layer of PVDF, does not prevent the formation of adhesions. Adhesion hardness, surface area, and index values of the Dynamesh IPOM mesh are close to the mean values of these parameters for other commercially available 2-layer meshes. Slowly absorbable sutures used for fastening did not increase the risk of adhesion formation.
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Affiliation(s)
| | - Marek Jałyński
- Surgery and Roentgenology Chair, Warmian-Masurian University, Olsztyn, Poland
| | - Łukasz Piskorz
- Department of Chest, General and Oncological Surgery, Medical University of Lodz, Poland
| | - Marian Brocki
- Department of Chest, General and Oncological Surgery, Medical University of Lodz, Poland
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