OBJECTIVE
Evaluation of the results of the use of adhesion barrier agents Adept and Mesogel in intraperitoneal onlay mesh repair in the experiment.
MATERIAL AND METHODS
In 4 pigs during laparoscopy, 24 meshes with fluoropolymer coating Ftorex and with collagen coating Symbotex were fixed on the parietal peritoneum. The meshes were fixed with a SecureStrap hernia stapler or fluoropolymer-coated thread Ftorex. In 2 animals adhesion barriers Adept (4% icodextrin solution) and Mesogel (gel based on carboxymethyl cellulose) were injected into the abdominal cavity. After 45 days, the animals were taken out of the experiment. The number of meshes with inflammation, deformation, retraction, migration of tacks and sutures, mesh area, mechanical strength of mesh fixation, adhesion formation, thickness, breaking load and breaking elongation of the mesh-tissue complex were recorded, histological changes.
RESULTS
The use of adhesion barriers did not cause a difference in the number of meshes with signs of inflammation, deformation, retraction, mechanical strength of fixation. Tack migration or suture unraveling was not observed. Adhesive barriers reduced mesh retraction. After excision, the area of the mesh in the group without an adhesion barrier was 82.1% of the initial one, with an adhesion barrier — 92.0% (p=0.018). The Ftorex mesh was more susceptible to this process. Adhesion barriers had the advantage of reducing adhesion, but no significant difference was found. The indicators turned out to be somewhat better when using Mesogel. In animals that were injected with adhesion barriers, adhesions to parenchymal and hollow organs were absent. Mesogel did not affect the biomechanical strength of the mesh-tissue complex. Adept resulted in the formation of a thinner mesh-tissue complex (0.6±0.1 mm vs. 0.9±0.0 mm in the Mesogel group, p=0.005) and reduced mean elongation at break (77.4±4.3 mm vs. 91.7±0.7 mm in the Mesogel group, p=0.029). Histological examination showed that when using adhesion barriers over the surface of the peritoneum, the number of connective tissue cords covered with neoperitoneum increases (p=0.024). It cannot be excluded that it is the number of these structures that determines the anti-adhesive properties of the barrier.
CONCLUSION
In case of intraperitoneal onlay mesh repair, the use of Adept and Mesogel adhesion barriers does not cause clinically significant adverse reactions and complications. The agents have approximately comparable capabilities in the additional prevention of adhesions, however, Adept changes the biomechanical strength of the mesh-tissue complex, which requires further research.
