Abstract
Implant materials are increasingly being used in an effort to reduce recurrence after prolapse repair with native tissues. Surgeons should be aware of the biology behind both the disease as well as the host response to various implants. We will discuss insights into the biology behind hernia and abdominal fascial defects. Those lessons from “herniology” will, wherever possible, be applied to pelvic organ prolapse (POP) problems. Then we will deal with available animal models, for both the underlying disease and surgical repair. Then we will go over the features of implants and describe how the host responds to implantation. Methodology of such experiments will be briefly explained for the clinician not involved in experimentation. As we discuss the different materials available on the market, we will summarize some results of recent experiments by our group.
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References
Wagh PV, Read RC (1971) Collagen deficiency in rectus sheath of patients with inguinal herniation. Proc Soc Exp Biol Med 137:382–384
Friedman DW, Boyd CD, Norton P et al (1993) Increases in type III collagen gene expression and protein synthesis in patients with inguinal hernias. Ann Surg 218:754–760
Klinge U, Zheng H, Si ZY et al (1999) Expression of the extracellular matrix proteins collagen I, collagen III, fibrnectin and matrix metalloproteinase 1 and 13 in the skin of patients with inguinal hernia. Eur Surg Res 31:480–490
He Y, Chen J, Ren J et al (2002) Type I collagen inhibits hydroxyl radical-induced apoptosis. J Biochem 132:373–379
Cannon DJ, Read RC (1981) Metastatic emphysema: e mechanism for acquiring inguinal herniation. Ann Surg 194:270–278
Jackson SR, Avery NC, Tarlton JF et al (1996) Changes in metabolism of collagen in genitourinary prolapse. Lancet 347:1658–1661
Bellon JM, Bajo A, Honduvilla NG et al (2001) Fibroblasts from the transversalis fascia of young patients with direct inguinal hernias show constitutive MMP-2 overexpression. Ann Surg 233:287–291
Uden A, Lindhagen T (1988) Inguinal hernia in patients with congenital dislocation of the hip: a sign of general connective tissue disorder. Acta Orthop Scand 59:667–668
Cannon DJ, Casteel L, Read RC (1984) Abdominal aortic aneurysm, Leriche syndrome, inguinal herniation and smoking. Arch Surg 119:387–389
Agren MS, Jorgensen LN, Andersen M et al (1998) Matrix metalloproteinase 9 level predicts optimal collagen deposition during early wound repair in humans. Br J Surg 85:68–71
Bielicki K, Pulawski R (1988) Is cigarette smoking a causative factor in the development of inguinal hernia? Pol Tyg Lek 43:974–976
Christianson RE (1980) The relationship between maternal smoking and the incidence of congenital anomalies. Am J Epidemiol 112:684–695
Weber AM, Buchsbaum G, Chen B et al (2004) Basic science and translations research in female pelvic floor disorders: proceedings of an NIH-sponsored meeting. Neurourol Urodyn 23:288–301
Rortveit G, Hannestad YS, Daltveit AK et al (2001) Age- and type-dependent effects of parity on urinary incontinence: the Norwegian EPINCONT study. Obstet Gynecol 98:1004–1010
Sievert KD, Bekircioglu ME, Tsai T et al (2001) The effect of simulated birth trauma and/or ovariectomy on rodent continence mechanism. Part I: Functional and structural change. J Urol 166:311–317
Cannon TW, Ferguson C, Wojcik EM et al (2002) Effects of vaginal distension on urethral anatomy and function. B J U Int 90:403–407
Damaser MS, Ferguson CL, Broxton-King C et al (2003) Functional and neuroanatomical effects of vaginal distension and pudendal nerve crush in the female rat. J Urol 170:1027–1031
Moalli PA, Howden NS, Lowder J et al (2005) A rat model to study the structural properties of the vagina and its supportive tissues. Am J Obstet Gynecol 192:80–88
Janssens LAA, Peeters S (1997) Comparisons between stress incontinence in women and sphincter mechanism incompetence in the female dog. Veter Rec 141:620–625
Clark AL, Otto LN, Slayden OD et al (2002) Raloxifene suppression of vaginal smooth muscle. In: Proceedings of the 23rd annual meeting of the American Urogynecologic Society (Abstract), San Francisco, USA
Coates KW, Gibson S, Williams LF et al (1995) The squirrel monkey as an animal model of pelvic relaxation: an evaluation of a large breeding colony. Am J Obstet Gynecol 173:1664–1669
Pierce LM, Reyes M, Thor KB et al (2003) Innervation of the levator ani muscles in the female squirrel monkey. Am J Obstet Gynecol 188:1141–1147
Mattson JA, Kuehl T, Yandell P et al (2005) Evaluation of the aged female baboon as a model of pelvic organ prolapse and pelvic reconstructive surgery. Am J Obstet Gynecol 192:1395–1398
Klinge U, Conze J, Limberg W et al (1996) Pathophysiology of the abdominal wall. Chirurg 67:229–233
Junge K, Klinge U, Prescher A et al (2001) Elasticity of the anterior abdominal wall and impact for reparation of incisional hernias using mesh implants. Hernia 5:113–118
Junge K, Peiper C, Rosch R et al (2002) Effect of tension induced by Shouldice repair on postoperative course and long-term outcome. Eur J Surg 168:329–333
Seidel W, Tauber R, Hoffschulte KH (1974) Measurements of the solidity of sutures of the abdominal wall. Chirurg 45:266–272
Klosterhalfen B, Klinge U, Hermann SB, Schumpelick V (2000) Pathology of traditional surgical nets for hernia repair after long-term implantation in humans. Chirurg 71:43–51
Liles W, Van Voorhis WC (1995) Nomenclature and biological significance of cytokines involved in inflammation and host immune response. J Infect Dis 172:1573–1582
Vroman L, Adams AL (1969) Identification of absorbed protein films by exposure to antisera and water vapor. J Biomed Mater Res 3:669–671
Tang L, Eaton JW (1993) Fibrinogen mediates acute inflammatory responses to biomaterials. J Exp Med 178:2147–2156
Tang L, Eaton JW (1995) Inflammatory responses to biomaterials. Am J Clin Pathol 103:466–471
Horowitz SM, Gonzales JB (1997) Effects of polyethylene on macrophages. J Orthop Res 15:50–56
Klosterhalfen B, Junge K, Hermanns B, Klinge U (2002) Influence of implantation interval on the long-term biocompatibility of surgical mesh. Br J Surg 89:1043–1048
Junge KR (2002) Influence of mesh materials on collagen deposition in a rat model. J Invest Surg 15:319–328
Klosterhalfen B, Klinge U, Schumpelick V (1998) Functional and morphological evaluation of different polypropylene-mesh modifications for abdominal wall repair. Biomaterials 19:2235–2246
Besim H, Yalcin Y, Hamamci O et al (2002) Prevention of intra-abdominal adhesions produced by polypropylene mesh. Eur Surg Res 34:239–243
Klinge U, Losterhalfe B, Birkenhaure V et al (2002) Impact of polymer pore size on the interface scar formation in a rat model. J Surg Res 10:208–214
Bobyn JD, Wilson GJ, Macgregor DC, Pilaar PM, Weatherly GC (1982) Effect of pore size on the peel strength of attachment of fibrous tissue to porous-surfaced implants. Biomed Mater Res 16:571–584
Pourdeyhimi B (1989) Porosity of surgical mesh fabrics: new technology. J Biomed Mater Res 23:145–152
Beets GL, Go PM, van Mameren H (1996) Foreign body reactions to monofilament and braided polypropylene mesh used as preperitoneal implants in pigs. Eur J Surg 162:823–825
Rosch R, Junge K, Hölzl F et al (2004) How to construct a mesh. In: Schumpelick V, Nyhus LM (eds) Meshes: benefits and risks. Springer, Berlin Heidelberg New York, pp 179–184
Bellon JM, Contreras LA, Bujan J, Palomares D, Carrera-San Martin A (1998) Tissue response to polypropylene meshes used in the repair of abdominal wall defects. Biomaterials 19(7–9):669–675
Alponat A, Lakshminarasappa SR, Yavuz N, Goh PM (1997) Prevention of adhesions by Seprafilm, an absorbable adhesion barrier: an incisional hernia model in rats. Am Surg 63(9):818–819
Claerhout F, Deprest J, Zheng F, Konstantinovic M, Lagae P, De Ridder D (2003) Long term evaluation of the tissue response and mechanical properties of two collagen based and polypropylene implants in a rabbit model for abdominal wall repair. Neurourol Urodyn 5:516–517
Walter A, Morse A, Leslie K et al (2003) Changes in tensile strength of cadaveric human fascia lata after implantation in a rabbit vagina model. Urology 169:1907–1910
Zheng F, Lin Y, Verbeken E et al (2004) Host response after reconstruction of abdominal wall defects with porcine dermal collagen in a rat model. Am J Obstet Gynecol 191:1961–1970
Allman AJ, McPherson TB, Badylak SF, Merrill LC, Kallakury B, Sheehan C, Raeder RH, Metzger DW (2001) Xenogeneic extracellular matrix grafts elicit a Th2-restricted immune response. Transplantation 71(11):1631–1640
Chu CC, Welch L (1985) Characterisation of morphologic and mechanical properties of surgical mesh fabrics. J Biomed Mater Res 19:903–916
Amid PK (1997) Classification of biomaterials and their related complications in abdominal wall hernia surgery. Hernia 1:15–21
Klinge U, Conze J, Limberg W, Brucker C, Ottinger AP, Schumpelick V (1996) Pathophysiology of the abdominal wall. Chirurg 67(3):229–233
Amid PK, Shulman AG, Lichtenstein IL (1992) Selecting synthetic mesh for the repair of groin hernia. Postgrad Gen Surg 4:150–155
Moriss–Stiff GJ, Hughes LE (1998) The outcomes of nonabsorbable mesh placed within the abdominal cavity: literature review and clinical experience. J Am Coll Surg 186(3):352–367
Konstantinovic M, Pille E, Malinowska M, Verbeken E, De Ridder D, Deprest J (2005) Tensile strength and host response towards different polypropylene implant materials used for augmentation of fascial repair in a rat model. Int Urogynaecol J 16:S120–S121 (Abstract 375)
Leber GE, Garb JL, Alexander AI, Reed WP (1998) Long term complications associated with proesthetic repair of incisional hernias. Arch Surg 133:378–382
Fitzgerald MP, Mollenhauer J, Bitterman P, Brubaker L (1999) Functional failure of fascia lata grafts. Am J Obstet Gynecol 181:1339–1346
Buck BE, Malinin TI (1990) Human immunodeficiency virus cultured from bone: implications for transplantation. Clin Orthop 251:249–253
Clarke KM, Lantz GC, Salisbury SK, Badylak SF, Hiles MC, Voytik SL (1996) Intestine submucosa and polypropylene mesh for abdominal wall repair in dogs. J Surg Res 60:107–114
Prevel CD, Eppley BL, Summerlin DJ, Jack JR, McCarty, Badylak SF (1995) Small intestinal submucosa: use in repair of rodent abdominal wall defects. Ann Plast Surg 35:374–380
Badylak SF, Kokini K, Tullius B, Whitson B (2001) Strength over time of a resorbable bioscaffold for body wall repair in a dog model. J Surg Res 99:282–287
Konstantinovic M, Lagae P, Zheng F, Verbeken E, De Ridder D, Deprest J (2005) Comparison of host response to polypropylene and non-cross linked porcine small intestine serosal derived collagen implants in a rat model. Br J Obstet Gynaecol 112:1–7
Zheng F, Verbeken E, De Ridder D, Deprest J (2005) Improved surgical outcome by modification of Pelvicol xenograft in abdominal wall reconstruction in rats. Neurourol Urodyn 24(4):362–368
Hunt JA, Abrams KR, Williams DF (1994) Modelling the pattern of cell distribution around implanted materials. Anal Cell Pathol 7:43–52
Zheng F, Xu L, Verbeken E, De Ridder D, Deprest J (2004) Th1 vs Th2 Inflammatory responses to porcine dermal collagen and polyprolene implants in a mouse model. J Soc Gynecol Investig 11:271, 163A
de Tayrac R, Alves A, Thérin M (2005) Abstracts of 30th Annual Congress of the International Urogynaecology Association, Copenhaguen, Int Urogynecol J Pelvic Foor Dysfunct 16:S49, (abstract 61)
Acknowledgements
Our own animal research has been supported by unconditional grants from Tyco Healthcare, Bard, and Cook. The companies may also have donated standard commercially available implants for experimental implantation. None had input into the surgical protocols, randomization tables, or control on data analysis nor its reporting. The authors have no financial interests in these companies.
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Transcript of a lecture given at the 2006 IUGA Grafts Roundtable, in Fort Lauderdale, FL (USA), on July 9, 2005.
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Deprest, J., Zheng, F., Konstantinovic, M. et al. The biology behind fascial defects and the use of implants in pelvic organ prolapse repair. Int Urogynecol J 17 (Suppl 1), 16–25 (2006). https://doi.org/10.1007/s00192-006-0101-2
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DOI: https://doi.org/10.1007/s00192-006-0101-2