The effects of synthetic patches used in laparoscopic ventral hernia repairs to intra-abdominal adhesions: Experimental study in rats
Ali Gök, Koray Topgül, Bülent Güngör, Mehmet Bilgin, A. Naki Ulusoy, Mete Kesim, Zafer Malazgirt
Ondokuz Mayıs Üniversitesi Tıp Fakültesi Genel Cerrahi AD, SAMSUN
Purpose: Today, synthetic patches are being used in open or laparoscopic ventral hernia repairs widely. We have aimed to examine adhesive potentials of various patches in rats treated with laparoscopic ventral hernia repairs.
Material and Method: Rats were divided into six different groups with 8 subjects on each group: control (group 1), polypropylene (PP) (group 2), hyaloronic acid/carboxymethylcellulose coated polypropylene (PP+H/K) (group 3), expanded polytetraflouroethylene (ePTFE) (group 4), anti-adhesive collagen coated polyester (PO+AHK) (group 5) and polyester (PO) (group 6). Only laparoscopy was practiced on the rats in control group. PP, PP+H/K, ePTFE, PO+AHK and PO patches were placed on front abdominal walls of the rats by laparoscopy method. After two weeks, the rats were sacrificed. Frontal abdominal walls were opened with a wide (U) cut, adhesion force and adhesion area were evaluated. Photos of the adhesions as a result of patches were taken in all rats.
Results: Intra-abdominal adhesion was not observed in the rats of control group. Adhesion was observed in all the rats with patches. But there were differences in terms of adhesion force and area. In the other patch groups other than polypropylene, the amount of adhesions was lower (p<0.05) than polypropylene group. The adhesion observed on polyester patch was equivalent to ePTFE and composite patches. In two composite patches coated with anti-adhesive material and ePTFE, similar adhesion was observed. In laparoscopic use of PP+H/K and PO+AHK composite patches, defects on anti-adhesive layer were observed as a result of tight rolling and intra-abdominal manipulations.
Conclusion: Intra-abdominal adhesion was observed in all the patches. In laparoscopic use of composite patches, adhesions were higher probably as a result of defects in adhesive layers.
Keywords: Laparoscopy, mesh, ventral hernia repair, adhesions, rat model.