Prevention of adhesions to polypropylene mesh in a traumatized bowel model

Background: Polypropylene mesh (PPM) is an effective material for the repai r of abdominal wall defects, but has a tendency to induce dense adhesions w hen in contact with viscera. Seprafilm (Genzyme Corp, Cambridge, MA), a bio resorbable membrane, has been shown to reduce adhesion formation after midl ine closures in humans and to PPM in animals. Given the increased inflammat ory response expected with surgical trauma, its efficacy under surgical con ditions has been questioned. Study Design: A prospective, randomized, blinded study was conducted using a rabbit model. Standardized abdominal wall defects were created in three g roups of New Zealand white rabbits. The cecum was deserosalized to simulate the effects of trauma. The abdominal defect was then repaired with PPM. In the control group, no Seprafilm was used. In the first experimental group Seprafilm was placed between the mesh and the abdominal viscera. In the sec ond experimental group Seprafilm was placed over the deserosalized area and between the mesh and abdominal viscera. Animals were sacrificed at 30 days and adhesions were categorized and quantified using digital image analysis of linked specimens. The strength of incorporation was also determined. Results: The formation of adhesions between the viscera and mesh repair was dramatically reduced in both experimental groups compared with the control group. The incidence of visceral adhesions was reduced by 80% in the singl e film group (p = 0.0004) and 90% in the double film group (p = 0.00008). T he reduction in surface area of adhesions was 96.4% in the single film grou p (p = 0.000019) and 99.4% in the double film group (p = 0.00002). Omental adhesions were reduced by 30% but this did not achieve statistical signific ance. Strength of incorporation was not adversely affected in either group. Conclusions: Seprafilm is highly effective in preventing adhesions to PPM. This effect was not diminished by the presence of visceral trauma and its r esultant inflammatory response. The use of Seprafilm does not adversely aff ect tissue incorporation. Clinical trials are warranted to determine if the protective effects of Seprafilm demonstrated in this study are applicable in the clinical setting. (J Am Coll Surg 2000;191:131-136. (C) 2000 by the American College of Surgeons).