1. Prevention of incisional hernia using different suture materials for closing the abdominal wall: a comparison of PDS, Vicryl and Prolene in a rat model.
- Author
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van Steensel, S., van den Hil, L. C. L., Bloemen, A., Gijbels, M. J., Breukink, S. O., Melenhorst, J., Lenaerts, K., and Bouvy, N. D.
- Subjects
ABDOMINAL wall ,SUTURES ,HERNIA ,MANN Whitney U Test ,BONFERRONI correction ,FOREIGN body reaction ,HERNIA surgery ,PREVENTION of surgical complications ,WOUND healing ,BIOLOGICAL models ,OPERATIVE surgery ,ANIMAL experimentation ,POLYENES ,POLYESTERS ,RATS - Abstract
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. [ABSTRACT FROM AUTHOR]- Published
- 2020
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