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Prevention of incisional hernia using different suture materials for closing the abdominal wall: a comparison of PDS, Vicryl and Prolene in a rat model
Ist Teil von
Hernia : the journal of hernias and abdominal wall surgery, 2020-02, Vol.24 (1), p.67-78
Ort / Verlag
Paris: Springer Paris
Erscheinungsjahr
2020
Link zum Volltext
Quelle
SpringerNature Journals
Beschreibungen/Notizen
Purpose
An incisional hernia occurs frequently after a midline incision with an incidence of 12.8%. The choice in suture material used for abdominal wall closure is not straightforward and the conflicting literature focuses on clinical outcomes. This study compares a non-absorbable, slow-absorbable and fast-absorbable suture in a rat model, focusing on histological outcomes predicting better fascia healing.
Methods
33 male Wistar rats, divided over three groups, each received two separate 1 cm incisions closed with either Prolene 4/0, PDS 4/0 or Vicryl 4/0. At 7 days and 21 days, one of the incisions was explanted. Tissue was semi-quantitatively scored regarding inflammatory cells and collagen fibres present. Using qPCR macrophage polarisation, fibroblast activity and vascularisation were evaluated. Data were analysed by Kruskal–Wallis test with Mann–Whitney
U
post hoc test. A
p
value of 0.017 was considered significant after Bonferroni correction.
Results
All animals recovered without complications and completed the 21 days of follow-up. The Vicryl group showed a higher presence of macrophages after 21 days in comparison with Prolene (
p
= 0.003) and PDS (
p
= 0.006) and more foreign body giant cells compared to Prolene at 7 days (
p
= 0.010) and PDS at 21 days (
p
< 0.001). qPCR showed 2.5-fold higher expression of clec10A in PDS compared to Prolene after 7 days (
p
= 0.007).
Conclusions
The results of this study carefully support the use of PDS suture, compared to Prolene and Vicryl, in abdominal wall closure based on a favourable macrophage response. The heterogeneity and variability in the data might be explained by the spectrum of the macrophage subtype paradigm.