Acute inflammatory response in the subcutaneous versus periprosthethic space after incisional hernia repair: an original article

BMC Surgery

Gaetano Di Vita¹  Salvatore Buscemi¹  Giuseppe Livio Angelo¹  Paolo Aiello¹  Anna Maria Caruso¹  Rosalia Patti¹ 

[1] Department of Surgical, Oncological and Stomatological Science, General Surgery Unit, University of Palermo, Via Liborio Giuffrè n 5, 90127 Palermo, Italy

关键词: Prosthesis;    Inflammatory response;    Hernia repair;    Drain fluid;    Cytokines;   

Others  :  1091269
DOI  :  10.1186/1471-2482-14-91

 received in 2014-03-07, accepted in 2014-10-17,  发布年份 2014

【 摘 要 】

Background

The acute inflammatory response following mesh implantation has been often evaluated in vitro and in animal models. The aim of this study was to evaluate the acute inflammatory response near the prosthesis in human by analysing some inflammatory indicators.

Methods

We used a cohort of twelve male patients affected by midline incisional hernia, who were admitted for surgical mesh repair. A suction drain was placed between the mesh and rectal muscles whereas, the other one was placed between the subcutaneous tissue and the oblique external sheath. The acute inflammatory response was analyzed by measuring the production of interleukin [IL]-1, IL-10, IL-1ra, C-Reactive Protein (CRP), total proteins, albumin and pH in the drain fluids.

Results

The dynamics of CRP and ILs production resulted similar in both drainages. Comparing drain over mesh and subcutaneous drain at all times, IL-1 and CRP values always resulted significantly higher in the first one, whereas IL-1ra and IL-10 values were significantly higher in the last one. Total protein and albumin were similar in both drains at all time; only in the drain over mesh fluid, pH values resulted significantly reduced in the fourth post-operative day.

Conclusions

Our data showed that an acute inflammatory reaction is present in both sites examined. However, it was significantly higher in the space after mesh implantation.

【 授权许可】

   
2014 Patti et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

【 参考文献 】

• [1]Shin D, Lipshultz LI, Goldstein M, Barmé GA, Fuchs EF, Nagler HM, McCallum SW, Niederberger CS, Schoor RA, Brugh VM 3rd, Honig SC: Herniorrhaphy with polypropylene mesh causing inguinal vasal obstruction: a preventable cause of obstructive azoospermia. Ann Surg 2005, 241(4):553-558.
• [2]Legrand M, Klijn E, Payen D, Ince C: The response of the host microcirculation to bacterial sepsis: does the pathogen matter? J Mol Med 2010, 88(2):127-133.
• [3]Klinge U, Klosterhalfen B, Birkenhauer V, Junge K, Conze J, Schumpelick V: Impact of polymer pore size on the interface scar formation in a rat model. J Surg Res 2002, 103(2):208-214.
• [4]Asarias JR, Nguyen PT, Mings JR, Gehrich AP, Pierce LM: Influence of mesh materials on the expression of mediators involved in wound healing. J Invest Surg 2011, 24(2):87-98.
• [5]Pascual G, Rodríguez M, Sotomayor S, Pérez-Köhler B, Bellón JM: Inflammatory reaction and neotissue maturation in the early host tissue incorporation of polypropylene prostheses. Hernia 2012, 16(6):697-707.
• [6]Schumpelick V, Klinge U, Junge K, Stumpf M: Incisional abdominal hernia: the open mesh repair. Langenbecks Arch Surg 2004, 389(1):1-5.
• [7]Polverini PJ, Cotran PS, Gimbrone MA Jr, Unanue ER: Activated macrophages induce vascular proliferation. Nature 1977, 269(5631):804-806.
• [8]Hunt TK, Knighton DR, Thakral KK, Goodson WH 3rd, Andrews WS: Studies on inflammations and wound healing: angiogenesis and collagen synthesis stimulated in vivo by resident and activated wound macrophages. Surgery 1984, 96(1):48-54.
• [9]Anderson JM, Rodriguez A, Chang DT: Foreign body reaction to biomaterials. Semin Immunol 2008, 20(2):86-100.
• [10]Wilson CJ, Clegg RE, Leavesley DI, Pearcy MJ: Mediation of biomaterial-cell interactions by adsorbed proteins: a review. Tissue Eng 2005, 11(1–2):1-18.
• [11]Anderson JM: Biological responses to materials. Annu Rev Mater Res 2001, 31:81-110.
• [12]Jenney CR, Anderson JM: Adsorbed serum proteins responsible for surface dependent human macrophage behaviour. J Biomed Mater Res 2000, 49(4):435-437.
• [13]Brodbeck WG, Colton E, Anderson JM: Effects of adsorbed heat labile serum proteins and fibrinogen on adhesion and apoptosis of monocytes/macrophages on biomaterials. J Mater Sci Mater Med 2003, 14(2):671-675.
• [14]Barrientos S, Stojadinovic O, Golinko MS, Brem H, Tomic-Canic M: Growth factors and cytokines in wound healing. Wound Rep Reg 2008, 16(5):585-601.
• [15]Baker EA, Gaddal SE, Aitken DG, Leaper DJ: Growth factor profiles in intraperitoneal drainage fluid following colorectal surgery: relationship to wound healing and surgery. Wound Rep Reg 2003, 11(4):261-267.
• [16]Klinge U, Theuer S, Krott E, Fiebeler A: Absence of circulating aldosterone attenuates foreign body reaction around surgical sutures. Langenbecks Arch Surg 2010, 395(4):429-435.
• [17]Murphy JE, Robert C, Kupper TS: Interleukin-1 and cutaneous inflammation: a crucial link between innate and acquired immunity. J Invest Dermatol 2000, 114(3):602-608.
• [18]Dinnarello CA: Interleukin-1 beta, interleukin-18, and the interleukin-1 beta converting enzyme. Ann NY Acad Sci 1998, 856:1-11.
• [19]Arend WP, Malyak M, Guthridge CS, Gabay C: Interleukin-1 receptor antagonist: role in biology. Annu Rev Immunol 1998, 16:27-55.
• [20]Azouz A, Razzaque MS, El-Hallack M, Taguchi T: Immunoinflammatory responses and fibrinogenesis. Med Electron Microsc 2004, 37(3):141-148.
• [21]Sauder DN, Kilian PL, McLane JA, Quick TW, Jakubovic H, Davis SC, Eaglstein WH, Mertz PM: Interleukin-1 enhances epidermal wound healing. Lymphokine Res 1990, 9(4):465-473.
• [22]Marois Y, Cadi R, Gourdon J, Fatouraee N, King MW, Zhang Z, Guidoin R: Biostability, inflammatory response, and healing characteristics of a fluoropassivated polyesterknit mesh in the repair of experimental abdominal hernias. Artif Organs 2000, 24(7):533-543.
• [23]Junge K, Klinge U, Klosterhalfen B, Mertens PR, Rosch R, Schachtrupp A, Ulmer F, Schumpelick V: Influence of mesh materials on collagen deposition in a rat model. J Invest Surg 2002, 15(6):319-328.
• [24]Klink CD, Binnebösel M, Lucas AH, Schachtrupp A, Grommes J, Conze J, Klinge U, Neumann U, Junge K: Serum analyses for protein, albumin and IL-1-RA serve as reliable predictors for seroma formation after incisional hernia repair. Hernia 2011, 15(1):69-73.
• [25]Schreml S, Szeimies RM, Karrer S, Heinlin J, Landthaler M, Babilas P: The impact of the ph value on skin integrity and cutaneous wound healing. J Eur Acad Dermatol Venereol 2010, 24(4):373-378.
• [26]Schneider LA, Korber A, Grabbe S, Dissemond J: Influence of ph on wound-healing: a new perspective for wound-therapy? Arch Dermatol Res 2007, 298(9):413-420.
• [27]Pineda-Lucena A, Núñez De Castro I, Lozano RM, Muñoz-Willery I, Zazo M, Giménez-Gallego G: Effect of low ph and heparin on the structure of acidic fibroblast growth factor. Eur J Biochem 1994, 222(2):425-431.
• [28]Klink CD, Binnebösel M, Lucas AH, Schachtrupp A, Klinge U, Schumpelick V, Junge K: Do drainage liquid characteristics serve as predictors for seroma formation after incisional hernia repair? Hernia 2010, 14(2):175-179.
• [29]Heidemann W, Jeschkeit-Schubbert S, Ruffieux K, Fischer JH, Jung H, Krueger G, Wintermantel E, Gerlach KL: pH-stabilization of predegraded PDLLA by an admixture of water-soluble sodiumhydrogenphosphate–results of an in vitro- and in vivo-study. Biomaterials 2002, 23(17):3567-3574.