Peritoneal adhesions type i, iii and total collagen on polypropylene and coated polypropylene meshes: experimental study in rats / Aderências peritoneais tipo i, iii e colágeno total em telas de polipropileno e revestidas: estudo experimental em ratos

ABSTRACT Background: Hernia correction is a routinely performed treatment in surgical practice. The improvement of the operative technique and available materials certainly has been a great benefit to the quality of surgical results. The insertion of prostheses for hernia correction is well-founded in the literature, and has become the standard of treatment when this type of disease is discussed. Aim: To evaluate two available prostheses: the polypropylene and polypropylene coated ones in an experimental model. Methods: Seven prostheses of each kind were inserted into Wistar rats (Ratus norvegicus albinus) in the anterior abdominal wall of the animal in direct contact with the viscera. After 90 days follow-up were analyzed the intra-abdominal adhesions, and also performed immunohistochemical evaluation and videomorphometry of the total, type I and type III collagen. Histological analysis was also performed with hematoxylin-eosin to evaluate cell types present in each mesh. Results: At 90 days the adhesions were not different among the groups (p=0.335). Total collagen likewise was not statistically different (p=0.810). Statistically there was more type III collagen in the coated polypropylene group (p=0.039) while type I was not different among the prostheses (p=0.050). The lymphocytes were statistically more present in the polypropylene group (p=0.041). Conclusion: The coated prosthesis was not different from the polypropylene one regarding the adhesion. Total and type I collagen were not different among the groups, while type III collagen was more present on the coated mesh. There was a greater number of lymphocytes on the polypropylene mesh.

RESUMO Racional: A correção herniária é tratamento realizado rotineiramente na prática cirúrgica. O aprimoramento da técnica operatória e dos materiais disponíveis trouxe grande benefício na qualidade dos resultados cirúrgicos. A inserção de próteses para correção herniária é bem embasada na literatura e tornou-se o padrão de tratamento. Objetivo: Avaliar em modelo experimental dois tipos de próteses diferentes, de polipropileno e polipropileno revestido. Métodos: Foram inseridas sete próteses de cada tipo em ratos Wistar (Ratus norvegicus albinus) na parede abdominal anterior do animal em contato direto com as vísceras. Após o seguimento de 90 dias analisaram-se as aderências intra-abdominais, bem como avaliação por imunoistoquímica e videomorfometria do colágeno total, tipo I e tipo III. Também, fez-se análise histológica com hematoxylina-eosina para avaliação dos tipos celulares presentes em cada tela. Resultados: Aos 90 dias as aderências não foram diferentes entre os grupos (p=0,335). O colágeno total igualmente não foi estatisticamente diferente (p=0,810). O colágeno tipo III foi estatisticamente maior no grupo polipropileno revestido (p=0,039) enquanto o tipo I não diferiu entre as próteses (p=0,050). Os linfócitos foram estatisticamente mais presentes no grupo polipropileno (p=0,041). Conclusão: A prótese revestida não foi diferente da de polipropileno na variável aderência. O colágeno total e tipo I não foram diferentes entre os grupos enquanto que o colágeno tipo III foi mais presente na tela revestida. O número de linfócitos foi maior na tela de polipropileno.

Intraperitoneal abscesses: diagnostic dilemmas and therapeutic options.

BACKGROUND: The diagnosis of intraperitoneal abscesses is difficult, resulting in delay in treatment and poor prognosis. Although recent advances in the management have led to significant improvement in prognosis, the choice of therapeutic modality is unclear. AIMS: The role of clinical features and investigations in the diagnosis of intraperitoneal abscesses was studied. The relation of prognosis to delay in diagnosis was also analyzed. Also assessed was the efficacy of various therapeutic modalities. METHODS: Thirty consecutive patients diagnosed to have intraperitoneal abscesses were analyzed. Abscesses were analyzed. Abscesses were divided on the basis of ultrasonography findings into simple and complex (with or without fecal fistula). The following points were evaluated: clinical features, and hematological, biochemical and microbiological reports, imaging findings and the role of therapeutic modalities like percutaneous aspiration (single or multiple), catheter drainage and operative drainage (transperitoneal, extraperitoneal and percutaneous). RESULTS: Clinical features and hematological investigations, though sensitive, were non-specific in diagnosis. Klebsiella was the commonest organism cultured, followed by Proteus, E coli and Pseudomonas. Blood culture was positive in only 6 percent of cases. Real-time ultrasonography had an accuracy of 84%. Contrast X-rays were required in 43% of cases. All the deaths (4 of 30) occurred when the diagnosis and treatment were delayed by more than 4 days. USG-guided aspiration (single and multiple) and USG-guided catheter drainage were effective in simple abscesses but failed in complex abscesses. Transperitoneal operative drainage was successful in 15 of 18 cases (6 of 8 simple abscesses and 9 of 10 complex abscesses). The mortality in patients with simple and complex abscesses was 2 of 17 and 2 of 13 respectively. CONCLUSIONS: Early detection with consequent early treatment is vital for good prognosis of intraperitoneal abscesses. Early diagnosis requires a high degree of clinical suspicion and appropriate use of imaging modalities. USG-guided percutaneous drainage is effective for simple abscesses whereas complex abscesses require operative drainage, sometimes in combination with initial USG-guided drainage.