Use of hyaluronidase cream to prevent peritoneal adhesions in laparoscopic ventral hernia repair by means of intraperitoneal mesh fixation using spiral tacks.

BACKGROUND: The aim of this study was to investigate the effects of hyaluronidase gel on the prevention of post-operative peritoneal adhesions to prosthetic materials used in laparosopic ventral hernia repair. METHODS: Ten pigs were included in this study. The animals were anesthetized using Na-penthotal for induction and isofluorane for maintenance. The abdomen was opened and, using helical fasteners, four implantations were performed (squares of 4 x 4 cm). Two of the implants, placed in an upper location, were in polypropylene mesh, and two of the implants, placed in a lower area, were in polytetrafluoroethylene (PTFE-e, Dualmesh Plus Corduroy). The implants located in the right side of animals were painted with hyaluronidase gel. Two helical fasteners, painted and unpainted, were implanted in a medial location. After a five-week period the pigs were operated on again, intraperitoneal adhesion ratios and grades were determined, and the pigs later sacrificed. Specimens having abdominal wall implants were taken for histological studies. RESULTS: Intraperitoneal adhesions decreased in implants painted with hyaluronidase gel in a comparative study with implants located in the left side of animals (not painted). On the other hand the polypropylene mesh, said typically to produce intraperitoneal adhesions, produced almost no adhesion in many animals. CONCLUSIONS: Hyaluronidase gel reduces post-operative peritoneal adhesions ratio and grades including in the presence of polypropylene mesh.

[Prevention of peritoneal adhesions to intraperitoneal prostheses. An experimental study in pigs]. / Prevención de adherencias peritoneales a las prótesis intraperitoneales. Estudio experimental en cerdos.

INTRODUCTION: The aim of this study was to investigate the effect of fibrin glue and hyaluronidase gel on the prevention of postoperative peritoneal adhesions to intraperitoneal prostheses. MATERIAL AND METHOD: Twenty pigs, divided in two groups, were included. In all animals, four implants (4 x 4 cm) were placed: two polypropylene mesh implants were placed in an upper location and two polytetrafluoroethylene (PTFE) implants (Dualmesh Plus Corduroy) were placed in a lower position. Implants located in the right side of the animals were painted with fibrin glue (group A, n = 10) or with hyaluronidase gel (group B, n = 10). After 5 weeks, the animals were sacrificed and the results (number and grade of intraperitoneal adhesions, histological data on prosthesis integration, such as mesothelialization, fibroblast infiltration, vessel neoformation, etc.) were evaluated. RESULTS: Intraperitoneal adhesions decreased in implants painted with fibrin glue and hyaluronidase gel compared with untreated implants. When right-sided adhesions formed, they were looser and in many animals, the implants were completely peritonized. Integration of the prostheses was not affected by either fibrin glue or hyaluronidase gel. CONCLUSIONS: Adhesion formation can be reduced after abdominal surgery. The reduction achieved in this study was greater in the quantity than in the consistency of the adhesions. The results with hyaluronidase gel were moderately superior to those obtained with fibrin glue. Hyaluronidase gel has the advantage of being inexpensive.

Prevención de adherencias peritoneales a las prótesis intraperitoneales. Estudio experimental en cerdos / Prevention of peritoneal adhesions to intraperitoneal prostheses. An experimental study in pigs

Introducción. El objetivo de este estudio es investigar el efecto de la cola de fibrina y del gel de hialuronidasa en la prevención de adherencias peritoneales a las prótesis intraperitoneales. Material y método. En este estudio hemos utilizado 20 cerdos, divididos en 2 grupos: en todos los animales se procedió a colocar implantes de 4 x 4 cm: 2 de malla de polipropileno en una posición más cefálica, y otros dos de politetrafluoroetileno (Dualmesh® Plus Corduroy) en una posición más caudal. Los implantes situados en el lado derecho del animal se impregnaron de inhibidores de la producción de adherencias (en 10 animales se utilizó cola de fibrina, serie A, y en otros 10 se utilizó gel de hialuronidasa, serie B). Después de 5 semanas, se procedió al sacrificio de los animales y se evaluaron los resultados (cantidad y calidad de las adherencias formadas, así como datos histológicos de integración de las prótesis, como mesotelización infiltración por fibroblastos, vasos neoformados, etc.). Resultados. Al cabo de 5 semanas se apreciaba que los implantes impregnados de sustancias inhibidoras de la producción de adherencias presentaban menos adherencias, éstas (cuando existían) eran más laxas, e incluso en muchos casos los implantes estaban perfectamente peritonizados. La integración de las prótesis no estaba afectada por la presencia de los inhibidores. Conclusiones. La formación de adherencias puede disminuirse tras la cirugía abdominal. La disminución conseguida es mayor en la cantidad que en la consistencia de adherencias. Los resultados son algo mejores en la serie en la que se utilizó hialuronidasa que en la que se utilizó cola de fibrina. La hialuronidasa tiene la ventaja de tener un menor coste (AU)

Introduction. The aim of this study was to investigate the effect of fibrin glue and hyaluronidase gel on the prevention of postoperative peritoneal adhesions to intraperitoneal prostheses. Material and method. Twenty pigs, divided in two groups, were included. In all animals, four implants (4 x 4 cm) were placed: two polypropylene mesh implants were placed in an upper location and two polytetrafluoroethylene (PTFE) implants (Dualmesh Plus Corduroy) were placed in a lower position. Implants located in the right side of the animals were painted with fibrin glue (group A, n = 10) or with hyaluronidase gel (group B, n = 10). After 5 weeks, the animals were sacrificed and the results (number and grade of intraperitoneal adhesions, histological data on prosthesis integration, such as mesothelialization, fibroblast infiltration, vessel neoformation, etc.) were evaluated. Results. Intraperitoneal adhesions decreased in implants painted with fibrin glue and hyaluronidase gel compared with untreated implants. When right-sided adhesions formed, they were looser and in many animals, the implants were completely peritonized. Integration of the prostheses was not affected by either fibrin glue or hyaluronidase gel. Conclusions. Adhesion formation can be reduced after abdominal surgery. The reduction achieved in this study was greater in the quantity than in the consistency of the adhesions. The results with hyaluronidase gel were moderately superior to those obtained with fibrin glue. Hyaluronidase gel has the advantage of being inexpensive (AU)