Immunological reaction and oxidative stress after light or heavy polypropylene mesh implantation in inguinal hernioplasty: A CONSORT-prospective, randomized, clinical trial

Marcello Donati, Giovanna Brancato, Giuseppe Grosso, Giovanni Li Volti, Giuseppina La Camera, Francesco Cardì, Francesco Basile, Angelo Donati, Marcello Donati, Giovanna Brancato, Giuseppe Grosso, Giovanni Li Volti, Giuseppina La Camera, Francesco Cardì, Francesco Basile, Angelo Donati

Abstract

The relationship between mesh weight and host tissue reaction has, so far, not been fully investigated. Lightweight meshes (LWM) are thought to give less inflammatory response compared with heavyweight meshes (HWM). The present study is a randomized, controlled, double-blind clinical trial performed in 61 patients who underwent an elective inguinal hernioplasty. The primary outcome of the study was to investigate the relationship between total amount of prosthetic material (polypropylene), immunological reaction, and oxidative stress. The study was double-blinded. Sixty-one patients were recruited for the study and randomly assigned to 2 groups (groups A and B). Levels of inflammation markers (interleukin-6 [IL-6] and tumor necrosis factor-α [TNF-α]) and oxidative stress markers (reduced glutathione [GSH] and lipid hydroperoxides [LOOH]) were determined preoperatively and after undergoing inguinal hernioplasty (after 6, 72, and 288 hours), respectively, with LWM and HWM. There was no significant difference in IL-6 levels between HWM and LWM (P = 0.3, 0.7, 0.8 after 6, 72, and 288 hours, respectively). A statistically significant difference was found after 72 hours for TNF-α (P = 0.01), for GSH after 6 hours (P < 0.01), and after 6 and 72 hours for LOOH (P = 0.05, 0.01, respectively). Oxidative stress occurred at earlier time points and was pore accentuated HWM versus LWM and prodromal to TNF-α increase.Also, in randomized clinical trial, the use of LWM gives advantages in terms of less inflammatory response when compared with HWM. Moreover, there is a significant higher oxidative stress after implantation of HWM. The intensity of oxidative stress seems to be strongly related to the amount of implanted polypropylene. (

Trial registration number: NCT01090284).

Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Overview of data, in blue lightweight mesh (LWM) mean values, and in red heavyweight meshes (HWM). Error bars represent standard error of the mean.

References

    1. Cobb WS, Kercher KW, Heniford BT. The argument for lightweight polypropylene mesh in hernia repair. Surg Innov 2005;12:63–9.
    1. Weyhe D, Schmitz I, Belyaev O, et al. Experimental comparison of monofile light and heavy polypropylene meshes: less weight does not mean less biological response. World J Surg 2006;30:1586–91.
    1. Tang GJ. [Similarity and synergy of trauma and sepsis: role of tumor necrosis factor-alpha and interleukin-6]. Acta Anaesthesiol Sin 1996;34:141–9.
    1. Agarwal BB, Agarwal KA, Sahu T, et al. Traditional polypropylene and lightweight meshes in totally extraperitoneal inguinal herniorrhaphy. Int J Surg 2010;8:44–7.
    1. Di Vita G, Balistreri CR, Arcoleo F, et al. Systemic inflammatory response in erderly patients following hernioplastical operation. Immun Ageing 2006;3:3.
    1. Di Vita G, Patti R, D’Agostino P, et al. Serum VEGF and b-FGF profiles after tension-free or conventional hernioplasty. Langenbecks Arch Surg 2005;390:528–33.
    1. Orenstein SB, Saberski ER, Kreutzer DL, et al. Comparative analysis of histopathologic effects of synthetic meshes based on material, weight, and pore size in mice. J Surg Res 2012;176:423–9.
    1. Pascual G, Hernandez-Gascon B, Rodriguez M, et al. The long-term behavior of lightweight and heavyweight meshes used to repair abdominal wall defects is determined by the host tissue repair process provoked by the mesh. Surgery 2012;152:886–95.
    1. O’Dwyer PJ, Kingsnorth AN, Molloy RG, et al. Randomized clinical trial assessing impact of a lightweight or heavyweight mesh on chronic pain after inguinal hernia repair. Br J Surg 2005;92:166–70.
    1. Pascual G, Rodriguez M, Sotomayor S, et al. Inflammatory reaction and neotissue maturation in the early host tissue incorporation of polypropylene prostheses. Hernia 2012;16:697–707.
    1. Nikkolo C, Lepner U, Murruste M, et al. Randomised clinical trial comparing lightweight mesh with heavyweight mesh for inguinal hernioplasty. Hernia 2010;14:253–8.
    1. Post S, Weiss B, Willer M, et al. Randomized clinical trial of lightweight composite mesh for Lichtenstein inguinal hernia repair. Br J Surg 2004;91:44–8.
    1. Weyhe D, Belyaev O, Muller C, et al. Improving outcomes in hernia repair by the use of light meshes—a comparison of different implant constructions based on a critical appraisal of the literature. World J Surg 2007;31:234–44.
    1. Currie A, Andrew H, Tonsi A, et al. Lightweight versus heavyweight mesh in laparoscopic inguinal hernia repair: a meta-analysis. Surg Endosc 2012;26:2126–33.
    1. Uzzaman MM, Ratnasingham K, Ashraf N. Meta-analysis of randomized controlled trials comparing lightweight and heavyweight mesh for Lichtenstein inguinal hernia repair. Hernia 2012;16:505–18.
    1. Ortiz-Oshiro E, Villalta GC, Furio-Bacete V, et al. Non-absorbable prosthetic meshes: which is the best option in the repair of abdominal wall defects? Int Surg 1999;84:246–50.
    1. Huffaker RK, Muir TW, Rao A, et al. Histologic response of porcine collagen-coated and uncoated polypropylene grafts in a rabbit vagina model. Am J Obstet Gynecol 2008;198:e581–7.
    1. Krambeck AE, Dora CD, Sebo TJ, et al. Time-dependent variations in inflammation and scar formation of six different pubovaginal sling materials in the rabbit model. Urology 2006;67:1105–10.
    1. Di Vita G, Patti R, Sparacello M, et al. Impact of different texture of polypropylene mesh on the inflammatory response. Int J Immunopathol Pharmacol 2008;21:207–14.
    1. Gurleyik E, Gurleyik G, Cetinkaya F, et al. The inflammatory response to open tension-free inguinal hernioplasty versus conventional repairs. Am J Surg 1998;175:179–82.
    1. Di Vita G, Patti R, Barrera T, et al. Impact of heavy polypropylene mesh and composite light polypropylene and polyglactin 910 on the inflammatory response. Surg Innov 2010;17:229–35.
    1. Klinge U, Klosterhalfen B, Birkenhauer V, et al. Impact of polymer pore size on the interface scar formation in a rat model. J Surg Res 2002;103:208–14.
    1. Rutkow IM, Robbins AW. “Tension-free” inguinal herniorrhaphy: a preliminary report on the “mesh plug” technique. Surgery 1993;114:3–8.
    1. Blume J, Peipert JF. Randomization in controlled clinical trials: why the flip of a coin is so important. J Am Assoc Gynecol Laparosc 2004;11:320–5.
    1. Simons MP, Aufenacker T, Bay-Nielsen M, et al. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia 2009;13:343–403.
    1. Di Vita G, D’Agostino P, Patti R, et al. Acute inflammatory response after inguinal and incisional hernia repair with implantation of polypropylene mesh of different size. Langenbecks Arch Surg 2005;390:306–11.
    1. Pereira-Lucena CG, Artigiani-Neto R, Lopes-Filho GJ, et al. Experimental study comparing meshes made of polypropylene, polypropylene + polyglactin and polypropylene + titanium: inflammatory cytokines, histological changes and morphometric analysis of collagen. Hernia 2010;14:299–304.
    1. Hill AD, Banwell PE, Darzi A, et al. Inflammatory markers following laparoscopic and open hernia repair. Surg Endosc 1995;9:695–8.
    1. Novo G, Cappello F, Rizzo M, et al. Hsp60 and heme oxygenase-1 (Hsp32) in acute myocardial infarction. Transl Res 2011;157:285–92.
    1. Campisi A, Caccamo D, Li Volti G, et al. Glutamate-evoked redox state alterations are involved in tissue transglutaminase upregulation in primary astrocyte cultures. FEBS Lett 2004;578:80–4.
    1. Marrazzo G, Bosco P, La Delia F, et al. Neuroprotective effect of silibinin in diabetic mice. Neurosci Lett 2011;504:252–6.
    1. Sacerdoti D, Colombrita C, Ghattas MH, et al. Heme oxygenase-1 transduction in endothelial cells causes downregulation of monocyte chemoattractant protein-1 and of genes involved in inflammation and growth. Cell Mol Biol (Noisy-le-grand) 2005;51:363–70.
    1. Malaguarnera M, Vacante M, Giordano M, et al. Oral acetyl-L-carnitine therapy reduces fatigue in overt hepatic encephalopathy: a randomized, double-blind, placebo-controlled study. Am J Clin Nutr 2011;93:799–808.
    1. Conze J, Rosch R, Klinge U, et al. Polypropylene in the intra-abdominal position: influence of pore size and surface area. Hernia 2004;8:365–72.
    1. Bone RC. Toward a theory regarding the pathogenesis of the systemic inflammatory response syndrome: what we do and do not know about cytokine regulation. Crit Care Med 1996;24:163–72.
    1. Costello CR, Bachman SL, Grant SA, et al. Characterization of heavyweight and lightweight polypropylene prosthetic mesh explants from a single patient. Surg Innov 2007;14:168–76.
    1. Pignatelli P, Tellan G, Marandola M, et al. Effect of L-carnitine on oxidative stress and platelet activation after major surgery. Acta Anaesthesiol Scand 2011;55:1022–8.
    1. Sternschuss G, Ostergard DR, Patel H. Post-implantation alterations of polypropylene in the human. J Urol 2012;188:27–32.
    1. Kotidis E, Papavramidis T, Ioannidis K, et al. Can chronic intra-abdominal hypertension cause oxidative stress to the abdominal wall muscles? An experimental study. J Surg Res 2012;1761:102–7.
    1. Kumar S, Kumar R, Sharma SB, et al. Effect of oral glutamine administration on oxidative stress, morbidity and mortality in critically ill surgical patients. Indian J Gastroenterol 2007;26:70–3.
    1. van Stijn MF, Ligthart-Melis GC, Boelens PG, et al. Antioxidant enriched enteral nutrition and oxidative stress after major gastrointestinal tract surgery. World J Gastroenterol 2008;14:6960–9.

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