Combination of Polypropylene Mesh and in Situ Injectable Mussel-Inspired Hydrogel in Laparoscopic Hernia Repair for Preventing Post-Surgical Adhesions in the Piglet Model
Combination of Polypropylene Mesh and in Situ Injectable Mussel-Inspired Hydrogel in Laparoscopic Hernia Repair for Preventing Post-Surgical Adhesions in the Piglet Model
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DOI：
10.1021/acsbiomaterials.9b01333
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发表时间：
2020-03-01
影响因子：
5.8
通讯作者：
Ji, Zhenling
中科院分区：
文献类型：
--
作者：
Hu, Wanjun;Zhang, Zhigang;Ji, Zhenling
聚丙烯（PP）补片已在临床实践中作为一种令人印象深刻的疝修补假体成功使用了很长时间。利用物理屏障将补片与内脏分离是临床实践中预防粘连的一般方法。然而，疝后补片与内脏之间可能发生严重的腹部粘连，尤其是小肠;这可能导致一系列并发症，如慢性疼痛、肠梗阻和瘘。因此，如何防止补片与内脏粘连仍是临床急需解决的问题。在这项研究中，多巴胺功能化的多糖衍生物（氧化羧甲基纤维素-g-多巴胺，OCMC-DA）的合成，这是共混与羧甲基壳聚糖（CMCS），形成水凝胶（OCMC-DA/CMCS）原位在适当的时间。对该水凝胶的理化性质进行了表征，并通过体外细胞实验证明其具有良好的生物相容性。该水凝胶和PP补片的组合用于腹腔镜手术中，以修复腹壁缺损，其中水凝胶可以原位固定在PP补片上，以形成防粘连凝胶补片。结果表明，在仔猪腹腔粘连模型中，明胶补片能有效地预防腹腔粘连。组织学和免疫组化染色结果表明，明胶补片能有效减轻补片周围的炎症反应和胶原沉积，且不影响补片与腹壁的结合。因此，凝胶网片具有上级组织相容性。
Polypropylene (PP) mesh has been used successfully for a long time in clinical practice as an impressive prosthesis for ventral hernia repair. To utilize a physical barrier for separating mesh from viscera is a general approach for preventing adhesions in clinical practice. However, a serious abdominal adhesion between the mesh and viscera can possibly occur post-hernia, especially with the small intestine; this can lead to a series of complications, such as chronic pain, intestinal obstruction, and fistula. Thus, determining how to prevent abdominal adhesions between the mesh and viscera is still an urgent clinical problem. In this study, a dopamine-functionalized polysaccharide derivative (oxidized-carboxymethylcellulose-g-dopamine, OCMC-DA) was synthesized; this was blended with carboxymethylchitosan (CMCS) to form a hydrogel (OCMC-DA/CMCS) in situ at the appropriate time. The physical and chemical properties of the hydrogel were characterized successfully, and its excellent biocompatibility was presented by the in vitro cell test. The combination of this hydrogel and PP mesh was used in laparoscopic surgery for repairing the abdominal wall defect, where the hydrogel could become fixed in situ on the PP mesh to form an anti-adhesion gel-mesh. The results showed that the gel-mesh could prevent abdominal adhesions effectively in the piglet model. Moreover, the histology and immunohistochemical staining proved that the gel-mesh could effectively alleviate the inflammation reaction and deposition of collagen around the mesh, and it did not disturb the integration between mesh and abdominal wall. Thus, the gel-mesh has superior tissue compatibility.