Combination of Polypropylene Mesh and in Situ Injectable Mussel-Inspired Hydrogel in Laparoscopic Hernia Repair for Preventing Post-Surgical Adhesions in the Piglet Model

Abstract

Polypropylene (PP) mesh has been used successfully for a long time in clinical practice as an impressive prosthesis for ventral hernia repair. To utilize a physical barrier for separating mesh from viscera is a general approach for preventing adhesions in clinical practice. However, a serious abdominal adhesion between the mesh and viscera can possibly occur post-hernia, especially with the small intestine; this can lead to a series of complications, such as chronic pain, intestinal obstruction, and fistula. Thus, determining how to prevent abdominal adhesions between the mesh and viscera is still an urgent clinical problem. In this study, a dopamine-functionalized polysaccharide derivative (oxidized-carboxymethylcellulose-g-dopamine, OCMC-DA) was synthesized; this was blended with carboxymethylchitosan (CMCS) to form a hydrogel (OCMC-DA/CMCS) in situ at the appropriate time. The physical and chemical properties of the hydrogel were characterized successfully, and its excellent biocompatibility was presented by the in vitro cell test. The combination of this hydrogel and PP mesh was used in laparoscopic surgery for repairing the abdominal wall defect, where the hydrogel could become fixed in situ on the PP mesh to form an anti-adhesion gel-mesh. The results showed that the gel-mesh could prevent abdominal adhesions effectively in the piglet model. Moreover, the histology and immunohistochemical staining proved that the gel-mesh could effectively alleviate the inflammation reaction and deposition of collagen around the mesh, and it did not disturb the integration between mesh and abdominal wall. Thus, the gel-mesh has superior tissue compatibility.

Biomaterials to Prevent Post-Operative Adhesion

“…In addition, it is challenging to achieve minimal tissue ingrowth and stable fixation on the surgical site at the same time. There have been studies conducted in an effort to enhance fixation by incorporating polymeric mesh structures in the scaffold layer of the anti-adhesion barriers, and this is another aspect that can be considered in the development of new barrier products in the future as a possible solution to achieve both of the above [ 130 , 131 ].…”

“…Recently, studies have been conducted in which polymer mesh and hydrogel are combined to enhance the effectiveness of preventing post-operative adhesion (e.g., polypropylene mesh combined with hydrogel) [ 130 , 131 ].…”

Biodegradable Zwitterionic Cream Gel for Effective Prevention of Postoperative Adhesion

“…[ 18–21 ] Comparatively injectable hydrogels, mostly under development, can be straightforwardly applied: the injected pre‐gel solution is typically fluid‐like and can completely cover the injured surface. [ 22–24 ] This is followed by an in situ polymerization, Michael addition thiol–ene reactions [ 25,26 ] or Schiff base amino‐aldehyde reactions, [ 18,27,28 ] to form a chemically crosslinked hydrogel. Nevertheless, a dual valve applicator must be in place to separate the reactive components before they are mixed and extruded through the syringe.…”

“…Nevertheless, a dual valve applicator must be in place to separate the reactive components before they are mixed and extruded through the syringe. The applied pre‐gel solution also requires one to several minutes to completely cure, [ 18,25–28 ] which presents a burden in surgical duration and risk of infection. Certain chemical hydrogels require an ultraviolet source for curing, [ 29,30 ] which poses further concerns on irradiation safety.…”

Enhancement of the Surface Properties on Polypropylene Film Using Side-Chain Crystalline Block Copolymers

“…Therefore, PP had been used in various fields spanning from the industrial scale to daily life and accounts for 17% of the total plastic production [ 1 ]. Recently, the application of PP as a separator for lithium-ion batteries and as a biomaterial for various applications has been explored to expand its usage [ 8 , 9 , 10 ]. However, because PP solely consists of alkane chains, it exhibits a low surface free energy.…”