Elsevier

Surgery

Volume 128, Issue 1, July 2000, Pages 86-92
Surgery

Original Communications
Seprafilm reduces adhesions to polypropylene mesh*,**

Presented at the 1998 meeting of the Minnesota Surgical Association.
https://doi.org/10.1067/msy.2000.106810Get rights and content

Abstract

Background. Adhesions to polypropylene mesh used for abdominal wall hernia repair may eventuate in intestinal obstruction or enterocutaneous fistula. A Seprafilm Bioresorbable Membrane translucent adhesion barrier has been shown to inhibit adhesions. This investigation was designed to determine if Seprafilm alters abdominal visceral adhesions to polypropylene mesh. Methods. A 2.5-cm square abdominal muscle peritoneal defect was created and corrected with polypropylene mesh. Mesh alone was used in 17 rats. In another 17, the Seprafilm membrane was applied between the viscera and the mesh. Five animals had the bioresorbable membrane placed in the subcutaneous space and between the mesh and the viscera. Laparoscopy was performed 7, 14, and 28 days later to evaluate adhesions as a percentage of mesh surface involved. Results. Polypropylene mesh alone was associated with adhesions in every rat. The average area involved was 90%, the minimum was 75%. Adhesions were present within 24 hours and progressed up to 7 days with no change thereafter. When the Seprafilm barrier was used, the mean area involved was 50%. In 16 such rats, the area involved was smaller than any control animal. No adhesions formed in 5 animals. Scanning electron microscopy demonstrated a mesothelial cell layer covering the mesh after 4 weeks. Conclusions. The use of the Seprafilm adhesion barrier resulted in a significant reduction of adhesion formation to polypropylene mesh (P <.001). (Surgery 2000;128:86-92)

Section snippets

Animals

Female Sprague-Dawley rats (Sasco, Inc, Madison, Wis) weighing 275 to 325 g, approximately 10 to 12 months of age were used. All rats were acclimated at least one week before the operation to adjust to the laboratory environment, during which time they received standard rat/mouse chow (Harlan, Inc, Madison, Wis) and water ad libitum. They were housed singly in polycarbonate microisolator cages in a controlled environment with a 68° to 78°F temperature and 50% to 70% relative humidity with a

Results

Two animals died of complications from the anesthetic and were replaced. Subcutaneous seromas of varying sizes occurred in most rats. Aspiration of the seroma was done to prevent threatened skin dehiscence in 9 of 39 animals: 3 in the control group, 4 in the visceral Seprafilm membrane group, and 2 in the group with the Seprafilm membrane over the viscera and in the subcutaneous space. The incision opened spontaneously in a single animal from Group 1, and it was eliminated from analysis because

Discussion

These results are in agreement with a similar study by Alponat et al11 who reported fewer adhesions and no adverse effect on healing at the prosthetic mesh abdominal wall interface in rats treated with the Seprafilm membrane placed on the viscera.

In pilot experiments, we observed that intraabdominal adhesions to polypropylene mesh developed within 24 hours after the operation. The total area involved at day 1 varied, but averaged around 60%. Between days 1 and 7, additional adhesions formed

References (16)

There are more references available in the full text version of this article.

Cited by (76)

  • Anti-adhesive bioresorbable elastomer-coated composite hernia mesh that reduce intraperitoneal adhesions

    2023, Biomaterials
    Citation Excerpt :

    The smooth degradable film acts a peritoneal interface to prevent adhesions while the prosthetic mesh promotes tissue bio-incorporation. However, these coatings are only minimally effective because they have insufficient properties to resist micro-fractures and delamination, and rapidly degrade (e.g. Proceed®, Sepramesh®, and Parietex® are completely absorbed in 4 weeks) exposing prosthetic mesh prior to neo-peritoneal formation [12–14]. Ideally, an anti-adhesive mesh barrier should be biocompatible, possess adequate mechanical properties and have sufficiently long degradation allowing native peritoneum to reform and remodel on the intraperitoneal surface of the mesh [10,15–24].

  • Zwitterionic amino acid-based Poly(ester urea)s suppress adhesion formation in a rat intra-abdominal cecal abrasion model

    2019, Biomaterials
    Citation Excerpt :

    Unfortunately, there is a chance that the mesh can become adhered to other layers inside the peritoneum space [7–9]. Depending on the mesh selected, the outcomes and chance of problematic adhesion can vary [10–13]. The severity of adhesions can manifest in symptoms ranging from patient discomfort to emergency surgery for complex cases [9,11,14].

  • Abdominal adhesions: Current and novel therapies

    2011, Journal of Surgical Research
    Citation Excerpt :

    While Seprafilm is one of the most studied and used adhesion prevention therapies, surgeons still argue about the efficacy of the product. The product has shown some efficacy in adhesion prevention in mouse, rat, rabbit, and dog models [43–59]. In addition, randomized, controlled, human trials comprising greater than 5,000 total patients show that Seprafilm has some efficacy in reducing the incidence, severity, extent, and/or area of abdominal adhesions (not all citations evaluate incidence, severity, extent, and area) [32, 40, 60–66].

  • Laparoscopic Ventral Hernia Repair: Mesh Options and Outcomes

    2009, Seminars in Colon and Rectal Surgery
    Citation Excerpt :

    The effectiveness of these meshes at preventing adhesion formation remains unclear. While studies examining adhesion formation in animals have shown a reduction in adhesions following composite mesh implantation secondary to peritonealization of the mesh, other reports have demonstrated fewer adhesions with uncoated ePTFE mesh.29,30 Because of the 2-sided nature of composite meshes, due diligence is required in the operating room to insure proper orientation and avoid placement of PP or PE against the intestinal surfaces.

View all citing articles on Scopus
*

Supported by grants from the Genzyme Corporation.

**

Reprint requests: John P. Delaney, MD, PhD, University of Minnesota, Health Sciences Center, Box 89, 420 Delaware St, SE, Minneapolis, MN 55455.

View full text