Ayse Filiz Gokmen-Karasu1, Serdar Aydin2, Fatma Cavide Sonmez3, Ilknur Adanir2, Gulsah Ilhan4, Seda Ates2. 1. Department of Obstetrics and Gynecology, Medical Faculty, Bezmialem Vakif University, Adnan Menderes Bulvarı (Vatan St.), Fatih, 34093, İstanbul, Turkey. afgokmen@gmail.com. 2. Department of Obstetrics and Gynecology, Medical Faculty, Bezmialem Vakif University, Adnan Menderes Bulvarı (Vatan St.), Fatih, 34093, İstanbul, Turkey. 3. Department of Pathology, Medical Faculty, Bezmialem Vakif University, Istanbul, Turkey. 4. Department of Obstetrics and Gynecology, Suleymaniye Training and Research Hospital, Istanbul, Turkey.
Abstract
INTRODUCTION AND HYPOTHESIS: Peritonization of mesh during sacrohysteropexy is generally advocated to prevent adhesions to the viscera; however, randomized clinical trials are lacking, and peritonization may not be completely possible in a laparoscopic hysteropexy procedure. Our main objective was to describe a basic experimental rat sacrohysteropexy model. We hypothesized that even when peritoneal closure was omitted, using composite mesh would result in less adhesions to the viscera. METHODS: Twenty in-bred female virgin Wistar Hannover rats were used in this study. Standardized hysteropexy procedure and adhesion model is described step by step with two different mesh materials: polypropylene and a composite polyester. Mesh was anchored between the posterior cervix and anterior longitudinal ligament of the lumbar vertebrae. Macroscopic adhesion scores and histopathological tissue reaction was investigated. RESULTS: Macroscopically, the surface area involved in adhesions was similar between groups. However, adhesions in the polypropylene group were more dense, required sharp dissection for lysis, and yielded higher total macroscopic adhesion scores (p < 0.001). Histologically, a more pronounced host inflammatory response was encountered in the polyester group (p < 0.001). CONCLUSIONS: We describe a rat hysteropexy model and a previously established uterine adhesion model. Adhesion scores in the composite mesh group were lower, and bowel involvement was not seen. Our findings are promising, and further research investigating antiadhesive composite mesh use for hysterosacropexy would be appropriate, especially when peritoneal closure is omitted.
INTRODUCTION AND HYPOTHESIS: Peritonization of mesh during sacrohysteropexy is generally advocated to prevent adhesions to the viscera; however, randomized clinical trials are lacking, and peritonization may not be completely possible in a laparoscopic hysteropexy procedure. Our main objective was to describe a basic experimental rat sacrohysteropexy model. We hypothesized that even when peritoneal closure was omitted, using composite mesh would result in less adhesions to the viscera. METHODS: Twenty in-bred female virgin Wistar Hannover rats were used in this study. Standardized hysteropexy procedure and adhesion model is described step by step with two different mesh materials: polypropylene and a composite polyester. Mesh was anchored between the posterior cervix and anterior longitudinal ligament of the lumbar vertebrae. Macroscopic adhesion scores and histopathological tissue reaction was investigated. RESULTS: Macroscopically, the surface area involved in adhesions was similar between groups. However, adhesions in the polypropylene group were more dense, required sharp dissection for lysis, and yielded higher total macroscopic adhesion scores (p < 0.001). Histologically, a more pronounced host inflammatory response was encountered in the polyester group (p < 0.001). CONCLUSIONS: We describe a rat hysteropexy model and a previously established uterine adhesion model. Adhesion scores in the composite mesh group were lower, and bowel involvement was not seen. Our findings are promising, and further research investigating antiadhesive composite mesh use for hysterosacropexy would be appropriate, especially when peritoneal closure is omitted.
Authors: Fred E Govier; Kathleen C Kobashi; Paul M Kozlowski; Dimitri D Kuznetsov; Sean J Begley; Kathryn F McGonigle; Howard G Muntz Journal: Urology Date: 2005-06 Impact factor: 2.649
Authors: Peter P Pott; Markus L R Schwarz; Ralf Gundling; Kai Nowak; Peter Hohenberger; Eric D Roessner Journal: PLoS One Date: 2012-10-12 Impact factor: 3.240