Polypropylene and polypropylene/polyglecaprone (Ultrapro(r)) meshes in the repair of incisional hernia in rats

PURPOSE: To compare the inflammatory response of three different meshes on abdominal hernia repair in an experimental model of incisional hernia. METHODS: Median fascial incision and skin synthesis was performed on 30 Wistar rats. After 21 days, abdominal hernia developed was corrected as follows: 1) No mesh; 2) Polypropylene mesh; and, 3) Ultrapro(r) mesh. After 21 days, the mesh and surrounding tissue were submitted to macroscopic (presence of adhesions, mesh retraction), microscopic analysis to identify and quantify the inflammatory and fibrotic response using a score based on a predefined scale of 0-3 degrees, evaluating infiltration of macrophages, giant cells, neutrophils and lymphocytes. RESULTS: No significant difference was seen among groups in adherences, fibrosis, giant cells, macrophages, neutrophils or lymphocytes (p>0.05). Mesh shrinkage was observed in all groups, but also no difference was observed between polypropylene and Ultrapro mesh (7.0±9.9 vs. 7.4±10.1, respectively, p=0.967). Post-operatory complications included fistula, abscess, dehiscence, serohematic collection and reherniation, but with no difference among groups (p=0.363). CONCLUSION: There is no difference between polypropylene (high-density) and Ultrapro(r) (low-density) meshes at 21 days after surgery in extraperitoneal use in rats, comparing inflammatory response, mesh shortening, adhesions or complications. .

Temporary abdominal closure with zipper-mesh device for management of intra-abdominal sepsis / Fechamento abdominal temporário com dispositivo tela-zíper para tratamento da sepse intra-abdominal

OBJECTIVE: To present our experience with scheduled reoperations in 15 patients with intra-abdominal sepsis. METHODS: we have applied a more effective technique consisting of temporary abdominal closure with a nylon mesh sheet containing a zipper. We performed reoperations in the operating room under general anesthesia at an average interval of 84 hours. The revision consisted of debridement of necrotic material and vigorous lavage of the involved peritoneal area. The mean age of patients was 38.7 years (range, 15 to 72 years); 11 patients were male, and four were female. RESULTS: forty percent of infections were due to necrotizing pancreatitis. Sixty percent were due to perforation of the intestinal viscus secondary to inflammation, vascular occlusion or trauma. We performed a total of 48 reoperations, an average of 3.2 surgeries per patient. The mesh-zipper device was left in place for an average of 13 days. An intestinal ostomy was present adjacent to the zipper in four patients and did not present a problem for patient management. Mortality was 26.6%. No fistulas resulted from this technique. When intra-abdominal disease was under control, the mesh-zipper device was removed, and the fascia was closed in all patients. In three patients, the wound was closed primarily, and in 12 it was allowed to close by secondary intent. Two patients developed hernia; one was incisional and one was in the drain incision. CONCLUSION: the planned reoperation for manual lavage and debridement of the abdomen through a nylon mesh-zipper combination was rapid, simple, and well-tolerated. It permitted effective management of severe septic peritonitis, easy wound care and primary closure of the abdominal wall.

OBJETIVO: Apresentar nossa experiência com reoperações agendadas em 15 pacientes com sepse intra-abdominal. MÉTODOS: foi empregada uma técnica mais eficaz que consiste em fechamento abdominal temporário com uma folha de malha de nylon contendo um zíper. Realizamos as reoperações no centro cirúrgico, sob anestesia geral, com um intervalo médio de 84 horas. A revisão consistiu de desbridamento de material necrosado e lavagem vigorosa da área peritoneal envolvida. A média de idade dos pacientes foi 38,7 anos; 11 pacientes eram do sexo masculino e quatro do sexo feminino. RESULTADOS: Quarenta por cento das infecções foram devido à pancreatite necrosante. Sessenta por cento foram ocasionadas por perfuração intestinal secundária à inflamação, oclusão vascular ou trauma. Foram realizadas 48 reoperações, média de 3,2 operações por paciente. O dispositivo tela-zíper foi deixado no local por uma média de 13 dias. Um estoma intestinal estava presente ao lado do zíper em quatro pacientes e não ocasionou complicação para o paciente. A mortalidade foi 26,6%. Nenhuma fístula resultou dessa técnica. Quando a doença intra-abdominal estava sob controle, o dispositivo de fecho do tipo de rede foi removido, e a fáscia foi fechada em todos os pacientes. Em três pacientes, a ferida foi fechada primariamente, em 12 permitiu-se fechar por intenção secundária. Dois pacientes desenvolveram hérnia: uma incisional e outra na incisão de drenagem. CONCLUSÃO: A nova operação prevista para lavagem manual e desbridamento do abdômen através de uma combinação de tela-zíper em nylon foi rápida, simples e bem tolerada, permitindo uma gestão eficaz da peritonite séptica grave, fácil tratamento das feridas e fechamento primário da parede abdominal.