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    Estudo da cicatrização da parede abdominal de coelhos em modelo experimental de hérnia incisional com a utilização dos biomateriais polipropileno, polipropileno/poliglecaprone e polipropileno/polidioxanona/celulose oxidada regenerada
    (Universidade Federal de São Paulo (UNIFESP), 2013-06-26) Aramayo, Ana Leticia Gomes [UNIFESP]; Lopes Filho, Gaspar de Jesus Lopes Filho [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Introduction: The incisional hernia (IH) is a common complication of abdominal surgery. The use of meshes for possible surgical correction of HI, marked reduction in recurrence of the disease. However, the contact with the viscera of the meshes can be associated with the formation of adhesions and various complications. Purpose: To assess the macro and microscopic healing process of the abdominal wall of rabbits before the repair of incisional hernias using specific biomaterials: Polypropylene (PREMILENE®), Polypropylene / polyglecaprone (ULTRAPRO®), Polypropylene / Polydioxanone / Oxidized Regenerated Cellulose (PROCEED®) Repair without mesh-Transposition peritoneum-aponeurotic bilateral longitudinal (TRANSPALB). Methods: 40 rabbits were operated, with production of incisional hernia. After 30 days, all developed HI and rabbits were reoperated with hernia repair with or without the use of meshes. The animals were randomly assigned: Group 1 (N = 10) - PREMILENE® (PPL): intraperitoneal mesh placed and secured in the posterior wall of the rectus abdominis muscles, group 2 (N = 10) - ULTRAPRO® (UP): intraperitoneal mesh placed and secured in the posterior wall of the rectus abdominis muscles, GROUP 3 (N = 10) - PROCEED® (PCD): intraperitoneal mesh placed and secured in the posterior wall of the rectus abdominis muscles; GROUP 4 (N = 10) - CONTROL GROUP - TRANSPALB (Transpose-peritoneum aponeurotic bilateral longitudinal). After 30 days, the animals were taken to euthanasia being performed macroscopic and microscopic study withdrawal part of the abdominal wall. Results: Macroscopic - Area of adhesions: PPL> UP and PCD (p = 0.031). Vascularization: PPL> UP and PCD (p = 0.001). Adhesion size: (p = 0.134). Type Separation of adhesions: p = 0.083. The total score of adhesions was not statistically significant when comparing the three groups with meshes (p = 0.064). For all animals with meshes there was a reduction of the mesh area. The group PPL showed an average reduction of 40.7% (p = 0.032) and the PCD group of 53% (p <0.001) greater percentage reduction when compared to UP (24.3%). The percentage reduction of meshes PPL group was not statistically significant when compared to the PCD group (p = 0.130). Microscopic - The PCD group had higher neutrophils than groups PPL, UP and TRANSPALB (p = 0.010). The PPL group showed greater eosinophils than groups UP, PCD and TRANSPALB (p = 0.010). The groups PPL and PCD showed increased presence of granulation tissue than the UP and TRANSPALB groups (p<0.001). The groups PPL, UP and PCD showed higher macrophages than TRANSPALB groups (p<0.001). The groups PPL and PCD showed higher lymphocyte presence than the UP group (p = 0.009) and TRANSPALB (p<0.001). The groups PPL, UP and PCD had higher presence of giant cells than TRANSPALB group (p<0.001). The mesothelial reaction (p = 0.061) and fibrosis (p = 0.353) were not statistically significant. The groups PPL and UP exhibited more viscera adhered than PCD and TRANSPALB groups (p<0.001). Conclusions: 1 - All types of meshes used in this study led to the formation of adhesions and the group without mesh showed no adhesions. 2 - The groups ULTRAPRO® and PROCEED® showed lower area of adhesions and lower vascularization of adhesions in relation to the PREMILENE® group. 3 - Comparison of measurements of areas of the meshes, there was a decrease in all meshes, but in the groups PREMILENE® and PROCEED® the decrease was greater. 4 - The inflammatory process both acute and chronic, was higher in groups PREMILENE® and PROCEED®, but there was a predominance of acute inflammatory process in the group PROCEED®.