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• W2062151881 abstract "Introduction: Prosthetic materials have significantly improved the outcomes of abdominal-wall hernias, but implanted synthetic mesh may contract by as much as 50% after implantation. This project aimed to investigate a possible mechanism of mesh contraction by diminishing the immediate post-operative inflammatory process. Methods: 18 swine each underwent implantation of 4 pieces of 10×10cm mesh onto the anterior abdominal wall musculature. Three varieties of mesh were randomized to each placement site. Nine animals received daily weight-dosed corticosteroid injections. At the 3-month sacrifice point, mesh dimensions were measured and mesh samples were acquired for histology, immunohistochemistry and materials analysis. Statistical analysis was performed using mixed linear models. Results: Steroid administration reduced mesh contraction by a mean of 10% (p<0.02) in all mesh types. At three months, heavyweight polypropylene mesh size without steroid was 81.5% of its original area and 91.9% with steroid administration; Polyester was 84.6% without and 94.9% with steroid and Lightweight polypropylene was 95.5% and 105.8% of its original area. At study end, heavyweight polypropylene mesh was 14% smaller than lightweight polypropylene (p<0.0001), polyester mesh was 11% smaller than lightweight (p<0.004) and there was no statistical difference between heavyweight and polyester end sizes. A suture pull-out test demonstrated an average of 27% more force was needed to pull-out a 2-0 suture when steroids were administered for all mesh types. Histologic analysis did not find a significant difference in microscopic fibrosis between any groups, but steroids resulted in nearly a five-fold decrease in the odds of the presence of calcification (95%CI:1.335,16.717). Picrosirius red staining for collagen types I & III demonstrated that type III collagen predominated, either intimately associated to the mesh or in the surrounding stroma, regardless of type of mesh used. In 96% of the implants, at least 67% of collagen was collagen III. In 60% of the implants, the amount of collagen III was as high as 90%. Immunohistochemical data using a monoclonal antibody against type I collagen was less than 50% positive in most sections analyzed regardless of mesh type used. Conclusion: Blunting the inflammatory response with daily steroid injections interferes with the mechanism of post-operative mesh contraction. This may be due to reductions in cytokine release, lymphocyte activity or fibroblast differentiation; the exact mechanism will require further study." @default.
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• W2062151881 date "2008-02-01" @default.
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• W2062151881 title "176. Steroid Administration Reduces Synthetic Mesh Contraction in the Immediate Post-Operative Period" @default.
• W2062151881 doi "https://doi.org/10.1016/j.jss.2007.12.200" @default.
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