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Effectiveness of Hyalobarrier and Seprafilm to prevent polypropylene mesh shrinkage: a macroscopic and histological experimental study

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Abstract

Introduction and hypothesis

Polypropylene (PP) mesh shrinkage represents a serious complication, as a significant cause of pain and recurrence of pelvic organ prolapse or ventral hernias, frequently requiring several surgical interventions. The retraction seems to be caused by the host, in response to the implantation, through the occurrence of periprosthetic adhesions and fibrosis. We hypothesized that avoiding the postoperative adhesions can prevent PP mesh shrinkage.

Methods

Sixty rats were randomly assigned to three groups. A standardized hernia defect was induced on the abdominal wall, which was repaired using an extraperitoneal PP mesh alone (group 1), with application of a hyaluronate carboxymethylcellulose-based bioresorbable membrane (Seprafilm®, group 2), or an auto-cross-linked polysaccharide hyaluronan-based solution (Hyalobarrier® gel, group 3). Eight weeks after the procedure, a repeat laparotomy was performed. After scoring the adhesion and measuring the mesh surface, a microscopic study of the prosthesis-host tissue interfaces was performed.

Results

Group 1 displayed a median shrinkage of 29 % of the mesh. The Seprafilm® group (p = 0.0238) and Hyalobarrier® gel group (p = 0.0072) displayed a significantly smaller reduction of 19.12 and 17 %, respectively. Control group 1 displayed a significantly greater adhesion score (30.40) than the Seprafilm® (11.67, p = 0.0028) and Hyalobarrier® gel groups (11.19, p = 0.0013). The fibrosis was reduced in the Hyalobarrier® gel group only.

Conclusion

This experimental study revealed that Hyalobarrier® gel and Seprafilm® can prevent PP mesh shrinkage and postoperative adhesions. They might be integrated in a mesh size-saving strategy, which should preserve the quality and durability of the surgical repair and limit the postoperative pain.

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Acknowledgments

With great appreciation to our colleagues of the Statistical and Pathology Departments of the University Hospital of Clermont-Ferrand, to Dr. Bilal El Drayi and Mrs. Inga El Drayi for their cooperation in processing these results.

Conflicts of interest

Bernard Jacquetin holds the patent for TVM, for which he received royalties from Ethicon (the Prolift® has been withdrawn from the global market), and had a consultancy position with Ethicon.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, General Hospital of Thiers, Route du Fau, 63300, Thiers, France

    Erdogan Nohuz & Maher Alaboud

  2. Department of Obstetrics and Gynecology, University Hospital of Clermont-Ferrand, CHU Estaing, 1, Place Lucie Aubrac, 63001, Clermont-Ferrand, France

    Erdogan Nohuz & Bernard Jacquetin

  3. Department of Pathology, University Hospital of Clermont-Ferrand, 58, rue Montalembert, 63003, Clermont-Ferrand, France

    Claude Darcha

  4. Department of Pharmacology, Faculty of Medicine, Auvergne University, 28, Place Henri Dunant, 63001, Clermont-Ferrand, France

    Abdelkrim Alloui

  5. Department of Statistical and Medical Information, University Hospital of Clermont-Ferrand, 58, rue Montalembert, 63003, Clermont-Ferrand, France

    Bruno Aublet-Cuvelier

Authors
  1. Erdogan Nohuz
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  2. Maher Alaboud
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  3. Claude Darcha
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  4. Abdelkrim Alloui
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  5. Bruno Aublet-Cuvelier
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  6. Bernard Jacquetin
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Correspondence to Erdogan Nohuz.

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Nohuz, E., Alaboud, M., Darcha, C. et al. Effectiveness of Hyalobarrier and Seprafilm to prevent polypropylene mesh shrinkage: a macroscopic and histological experimental study. Int Urogynecol J 25, 1081–1087 (2014). https://doi.org/10.1007/s00192-014-2357-2

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  • DOI: https://doi.org/10.1007/s00192-014-2357-2

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