Comparative morphological analysis of connective tissue response to polypropylene endoprosthesis implantation

Abstract

Nowadays, the palm of superiority in elective surgery belongs to the problem of hernias. According to the literature worldwide, more than 20 million patients undergo surgical treatment for hernia of the anterior abdominal wall every year, most of whom undergo alloplasty using various kinds of nets. The study of the influence of methods for fixing implants and the emerging local inflammatory response of tissues on the frequency of relapses after allognioplasty is devoted to isolated works. Aim of the study was to investigate in an experiment the characteristics of the reaction of local tissues when implanting a rigid monofilament mesh polypropylene implant with a shape memory effect, and a classic mesh endoprosthesis made of monofilament polypropylene (PP) with various methods of fixing implants. Material and methods. An experimental study on 60 white male Wistar rats was performed to identify tissue reaction features around the PP mesh. Group 1 animals (n = 30) were implanted with a rigid mesh monofilament PP implant (Herniamesh, Italy) with shape memory effect, group 2 animals (n = 30) – with a classic mesh endoprosthesis made of monofilament PP for soft tissue repair ESFIL® standard (Lintex, Russia). Biopsies were examined at 1, 2, 3 months after implantation of the PP mesh. Results. A morphological study showed that 1 month after the implantation of a rigid mesh monofilament PP implant, the inflammatory reaction is less obvious than when implanting a classical PP endoprosthesis. This reaction contributed to the earlier germination of collagen fibers around the rigid implant monofilaments. At 2 and 3 months after the implantation of PP nets in both groups of animals, there were no advantages as the regenerate formed. Conclusions. When introducing PP mesh with suture fixation and rigid monofilament PP mesh without fixation, there is a natural response to the integration of the endoprosthesis, which is characterized by aseptic inflammation followed by pronounced fibrosis around the implant. Such processes, occurring in response to the implantation of synthetic polypropylene nets, increase local mechanical tissue resistance, and can create additional strength against recurrence of inguinal hernias.

Keywords

• hernias
• hernioplasty
• polypropylene endoprostheses
• local soft tissue reaction
• inflammation
• regeneration