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Liquid antiadhesive agents for intraperitoneal hernia repair procedures: Artiss® compared to CoSeal® and Adept® in an IPOM rat model

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Abstract

Background

Adhesion formation remains an important issue in hernia surgery. Liquid agents were developed for easy and versatile application, especially in laparoscopy. The aim of this study was to compare the antiadhesive effect of fibrin sealant (FS, Artiss®), Icodextrin (ID, Adept®) and Polyethylene glycol (PEG, CoSeal®) alone and in combination and to evaluate the resulting effect on tissue integration of the mesh.

Methods

A total of 56 Sprague–Dawley rats were operated in open IPOM technique. A middleweight polypropylene mesh of 2 × 2 cm size was implanted and covered with 1: FS, 2: ID, 3: PEG, 4: FS + ID, 5: FS + PEG, 6: PEG + ID, 7: control group, uncovered mesh (n = 8 per treatment/control). Observation period was 30 days. Macroscopic and histological evaluation was performed.

Results

Severe adhesions were found in group 2 (ID), group 6 (PEG + ID) and the controls. Best results were achieved with FS alone or FS + ID. Mesh integration in the treatment groups was reduced in comparison with the control group. This is a new finding possibly relevant for the outcome of intraperitoneal mesh repair. Group 6 (PEG + ID) showed an impairment of tissue integration with <50 % of the mesh surface in seven samples.

Conclusion

FS alone and in combination with ID yielded excellent adhesion prevention. ID alone did not show significant adhesion prevention after 30 days. Tissue integration of FS-covered meshes was superior to ID or PEG alone or combined. PEG did show adhesion prevention comparable to FS but evoked impaired tissue integration. So Artiss® is among the most potent antiadhesive agents in IPOM repair.

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Acknowledgments

The authors wish to thank K. Brenner for animal care, K. Kropik for technical support, W. Öhlinger for the histological analysis and I. Jung for statistical analysis. SGB was awarded the runner-up Andrew Kingsnorth Prize for presentation of the given data at the 36th International Congress of the European Hernia Society 2014 in Edinburgh, UK.

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Authors and Affiliations

  1. Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Austrian Cluster for Tissue Regeneration, Donaueschingenstrasse 13, 1200, Vienna, Austria

    Simone Gruber-Blum, C. Keibl, J. Brand, H. Redl & A. H. Petter-Puchner

  2. Department of General Surgery, Wilhelminenspital der Stadt Wien, Montleartstrasse 37, 1171, Vienna, Austria

    R. H. Fortelny & A. H. Petter-Puchner

  3. Department of Surgery, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020, Salzburg, Austria

    M. Lechner

Authors
  1. Simone Gruber-Blum
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  2. R. H. Fortelny
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  3. C. Keibl
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  4. J. Brand
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  5. M. Lechner
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  6. H. Redl
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  7. A. H. Petter-Puchner
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Correspondence to Simone Gruber-Blum.

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Disclosures

S. Gruber-Blum, J. Brand, C. Keibl and M. Lechner have no conflicts of interest or financial ties to disclose. H. Redl and R. H. Fortelny worked as consultant for Baxter Biosciences during the conduction of the study. A. H. Petter-Puchner has received travel grants from Baxter.

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Gruber-Blum, S., Fortelny, R.H., Keibl, C. et al. Liquid antiadhesive agents for intraperitoneal hernia repair procedures: Artiss® compared to CoSeal® and Adept® in an IPOM rat model. Surg Endosc 31, 4973–4980 (2017). https://doi.org/10.1007/s00464-016-5277-z

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  • DOI: https://doi.org/10.1007/s00464-016-5277-z

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