ESOPHAGEAL HIATUS REPAIR: COMPARISON STUDY OF THREE REINFORCEMENT MESHES IN A PRECLINICAL PORCINE MODEL

CECILIA ZUBIETA; PEDRO RENDA; JUAN MARTIN RIGANTI; CARLOS VIGLIANO; ROMINA LOVERA; THOMAS GILBERT; DAMIAN CRAIEM; ALEJANDRO NIEPONICE; AMIGO NATALIA; MAURICIO RAMIREZ; ARIEL PASCANER; ADAM YOUNG

Mar del Plata

Congreso; XIV Encuentro Biólog@s En Red; 2019

Asociación de Jóvenes Investigadores en Formación (AJIF)

Recurrence rates in the laparoscopic repair of the hiatal hernia range from 12%-59%. Limitation of reinforcement has been principally the risk of adverse events caused by synthetic materials. Biologic and resorbable synthetic materials are valid alternatives. This study compares the host response to all these materials after hiatal hernia repair.20 Landrace pigs were subjected to laparoscopic hiatal hernia repair and reinforced with a polypropylene mesh (PROLENE®: PP), an absorbable synthetic scaffold (GORE®BIO-A®: PGA), a urinary bladder matrix scaffold, (Gentrix®: UBM), or without reinforcement, Control group (C). Animals were survived for 3 months. Endpoints included gross morphology, biomechanical testing and histology.Pigs in PP and PGA groups showed fibrosis at the repair site, with robust adhesions. In UBM and C groups, only mild adhesions were found. Load at failure (gr) and stiffness (gr/mm) of PP were higher than C group (PP:2103±548.3 vs. C:951.1±372.7, p=0.02; PP:643.3±301 vs. C:152.6±142.7, p=0.01). PGA and UBM values for both parameters were in between PP and C samples. However, stiffness in UBM was tended to be lower than PP group, and approached a significant difference (643.3±301 vs. 243±122.1, p=0.0536). In UBM group, the histology resembled native tissue. In contrast, PP and PGA groups showed mononuclear infiltrates, fibroencapsulation, necrosis, remnants of mesh and disorganized tissue that was validated with a histologic score. In this setting, UBM scaffolds showed the most appropriate features for hiatal hernia repair, recovering the tissue properties that can help reduce the possibility of early failure and prevent complications associated with the implanted material.