Influence of the Elasticity Module of Synthetic and Natural Polymeric Tissue Substitutes on the Mobility of the Diaphragm and Healing Process in a Rabbit Model

Abstract

Mesh implants are frequently used in congenital diaphragmatic hernia. This experimental study aimed to examine the influence of different materials on the diaphragmatic movement over time as well as their mechanical qualities after 4 months. Ultrapro^®, Surgisis^®, and Proceed^® were implanted onto a diaphragmatic defect in growing rabbits. Diaphragmatic mobility was determined at three time points. At 4 months, defect shrinkage and mechanical properties were measured. The break strength decreased for Ultrapro^® and Surgisis^®, but did not change relevantly for Proceed^®. Ultrapro^® (32.46 N/cm) and Proceed^® (31.75 N/cm) showed a four-fold higher resistance to tearing than Surgisis^® (8.31 N/cm). The elasticity of Ultrapro^® showed no significant difference compared to Surgisis^® (p = 0.75). Proceed^®, on the other hand, was more than twice as elastic as Ultrapro^® or Surgisis^® (p = 0.015). Ultrapro^® had a higher spring rate (6.48 N/mm) compared to Surgisis^® (3.82 N/mm) or Proceed^® (5.23 N/mm). Observing the standardized movement rates of the diaphragm for each mesh group over time the only statistical differences were seen for the Proceed^® group. On account of its material qualities Ultrapro^® was found to be the most suitable mesh material for demanding locations in our model.

Keywords

diaphragm surgical mesh biological mesh mechanical properties Ultrapro®Surgisis®Proceed®.

Get full access to this article

View all access options for this article.

References

Moyer, V. , Moya, F. , Tibboel, R. , Losty, P. , Nagaya, M. and Lally, K.P. Late Versus Early Surgical Correction for Congenital Diaphragmatic Hernia in Newborn Infants (Review), Cochrane DB. Sys. Rev., 2000: Issue 4, Art. No.: CD001695.

Clark, R.H. , Hardin Jr, W.D. , Hirschl, R.B. , et al. for the Congenital Diaphragmatic Hernia Study Group. Current Surgical Management of Congential Diaphragmatic Hernia: A Report from the Congential Diaphragmatic Hernia Study Group, J. Pediatr. Surg., 1998: 33: 1004-1009.

Skari, H. , Bjornland, K. , Frenckner, B. , et al. Congenital Diaphragmatic Hernia: A Survey of Practice in Scandinavia , Pediatr. Surg. Int., 2004: 20: 309-313.

Grethel, E.J. , Cortes, R.A. , Wagner, A.J. , et al. Prosthetic Patches for Congenital Diaphragmatic Hernia Repair: Surgisis Vs. Gore-Tex, J. Pediatr. Surg., 2006: 41: 29-33.

Moss, R.L. , Chen, C.M. and Harrison, M.R. Prosthetic Patch Durability in Congenital Diaphragmatic Hernia: A Long-term Follow-up Study, J. Pediatr. Surg., 2001: 36: 152-154.

Hajer, G.F. , vd Staak, F.H. , de Haan, A.F. and Festen, C.

Recurrent Congenital Diaphragmatic Hernia: Which Factors are Involved?

Eur. J. Pediatr. Surg., 1998: 8: 329-333.

Lally, K.P. , Cheu, H.W. and Vazquez, W.D. Prosthetic Diaphragm Reconstruction in the Growing Animal, J. Pediatr. Surg., 1993: 28: 45-47.

Harrell, A.G. , Novitsky, Y.W. , Peindl, R.D. , et al. Prospective Evaluation of Adhesion Formation and Shrinkage of Intra-abdominal Prosthetics in a Rabbit Model, Am. Surg., 2006: 72: 808-814.

Dalla Vecchia, L. , Engum, S. , Kogon, B. , Jensen, E. , Davis, M. and Grosfeld, J. Evaluation of Small Intestine Submucosa and Acellular Dermis as Diaphragmatic Prostheses, J. Pediatr. Surg., 1999: 34: 167-171.

10.

Mitchell, I.C. , Garcia, N.M. , Barber, R. , Ahmad, N. , Hicks, B.A. and Fischer, A.C. Permacol: A Potential Biologic Patch Alternative in Congenital Diaphragmatic Hernia Repair, J. Pediatr. Surg. , 2008: 43: 2161-2164.

11.

Steinau, G. , Dreuw, B. , Schleef, J. , Lawong, G. and Schumpelick , V. Short-term Absorbable Material for Diaphragmatic Replacement, Pediatr. Surg. Int. , 2000: 16: 19-22.

12.

Kimber, C.P. , Dunkley, M.P. , Haddock, G. , Robertson, L. , Carey, F.A. and Cuschieri , A. Patch Incorporation in Diaphragmatic Hernia, J. Pediatr. Surg., 2000: 35: 120-123.

13.

Smith, M.J. , Paran, T.S. , Quinn, F. and Corbally, M.T. The SIS Extracellular Matrix Scaffold-preliminary Results of Use in Congenital Diaphragmatic Hernia (CDH) Repair, Pediatr. Surg. Int., 2004: 20: 859-862.

14.

Junge, K. , Rosch, R. , Krones, C.J. , et al. Influence of Polyglecaprone 25 (Monocryl) Supplementation on the Biocompatibility of a Polypropylene Mesh for Hernia Repair, Hernia, 2005: 9: 212-217.

15.

Klosterhalfen, B. , Junge, K. and Klinge, U. The Lightweight and Large Porous Mesh Concept for Hernia Repair, Expert Rev. Med. Devices, 2005: 2: 103-117.

16.

Junge, K. , Binnebösel, M. , Rosch, R. , et al. Influence of Mesh Materials on the Integrity of the Vas Deferens Following Lichtenstein Hernioplasty: An Experimental Model, Hernia, 2008: 12: 621-626.

17.

Bellon, J.M. , Rodriguez, M. , Garcia-Honduvilla , N. , Gomez-Gil, V. , Pascual, G. and Bujan, J. Postimplant Behavior of Lightweight Polypropylene Meshes in an Experimental Model of Abdominal Hernia, J. Invest. Surg., 2008: 21: 280-287.

18.

Emans, P.J. , Schreinemacher, M.H. , Gijbels, M.J. , et al. Polypropylene Meshes to Prevent Abdominal Herniation. Can Stable Coatings Prevent Adhesions in the Long Term? Ann. Biomed. Eng., 2009: 37: 410-418.

19.

Novitsky, Y.W. , Harrell, A.G. , Cristiano, J.A. , et al. Comparative Evaluation of Adhesion Formation, Strength of Ingrowth, and Textile Properties of Prosthetic Meshes After Long-term Intra-abdominal Implantation in a Rabbit, J. Surg. Res., 2007: 140: 6-11.

20.

Jacob, B.P. , Hogle, N.J. , Durak, E. , Kim, T. and Fowler, D.L. Tissue Ingrowth and Bowel Adhesion Formation in an Animal Comparative Study: Polypropylene Versus Proceed Versus Parietex Composite, Surg. Endosc., 2007: 21: 629-633.

21.

Burger, J.W. , Halm, J.A. , Wijsmuller, A.R. , ten Raa, S. and Jeekel, J. Evaluation of New Prosthetic Meshes for Ventral Hernia Repair, Surg. Endosc., 2006: 20: 1320-1325.

22.

Clarke, K.M. , Lantz, G.C. , Salisbury, S.K. , Badylak, S.F. , Hiles, M.C. and Voytik, S.L. Intestine Submucosa and Polypropylene Mesh for Abdominal Wall Repair in Dogs , J. Surg. Res., 1996: 60: 107-114.

23.

Scott, N.W. , McCormack, K. , Graham, P. , Go, P.M. , Ross, S.J. and Grant, A.M. Open Mesh Versus Non-mesh for Repair of Femoral and Inguinal Hernia, Cochrane DB. Sys. Rev., 2002: CD002197.

24.

Weyhe, D. , Belyaev, O. , Müller, C. , et al. Improving Outcomes in Hernia Repair by the Use of Light Meshes - A Comparison of Different Implant Constructions Based on a Critical Appraisal of the Literature, World J. Surg., 2007: 31: 234-244.