Thoracotomy patch repair of large diaphragmatic herniae in a porcine model: a tale of two patches
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Read the article on link.springer.com ↗Article · Nov 2024 · 1 min read
In brief
In brief
This porcine study compared biologic (Surgisis) versus composite (Parietex) mesh patches for large diaphragmatic hernia repair over 6 months. Parietex demonstrated superior outcomes with no recurrences, better muscle integration, and fewer adhesions, while all failures occurred in the Surgisis group despite similar tensile strength.
- Parietex composite mesh showed no recurrences or eventrations vs 5 failures with Surgisis biologic patch in large CDH repair (30% defect)
- Parietex demonstrated significantly greater muscle ingrowth and fewer adhesions compared to Surgisis at 6 months post-repair
- Both patches achieved tensile strength equivalent to native diaphragm tissue by 6 months in growing porcine model (6kg→94kg)
- Composite mesh may offer superior outcomes over biologic patch for large diaphragmatic defects requiring patch closure
Written by the GCMD Library team from the article.
Abstract
Purpose
Congenital diaphragmatic herniae (CDH) may require patch closure in 50% of the cases. We assessed a biologic and composite mesh in a porcine CDH model.
Methods
Left sided thoracotomy was performed in 20 pigs. Approximately, 30% of the diaphragm was excised and the patch (Surgisis® or Parietex®) inserted to close this defect. The pigs were killed at 6 months and the diaphragm was harvested for biomechanical and histological assessment.
Results
The mean weight of the pigs at surgery and killing were 6.1 kg (4.2–8.4 kg) and 94.1 kg (80–131 kg), respectively. There were two recurrences and three eventrations, all with Surgisis®. There were less dense lung and abdominal adhesions in the Parietex group (P < 0.0001 and 0.025, respectively). The tensile strength of the Surgisis®, the Parietex® groups and controls were similar. There was significantly more muscle in-growth in the Parietex® patch over Surgisis® (p = 0.016).
Conclusion
Parietex® and Surgisis® patches at 6 months have a similar tensile strength to normal tissue. All recurrences and eventrations were in the Surgisis® group. Parietex® patches demonstrated more muscle in-growth into the patch compared to Surgisis®. This is the first study utilising Parietex® composite patch in the repair of large diaphragmatic defects in a porcine model.