Prevention of incisional hernia using different suture materials for closing the abdominal wall: a comparison of PDS, Vicryl and Prolene in a rat model

S. van Steensel, L. C. L. van den Hil, A. Bloemen, M. J. Gijbels, S. O. Breukink, J. Melenhorst, K. Lenaerts, N. D. Bouvy*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Web of Science)

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.

Original languageEnglish
Pages (from-to)67-78
Number of pages12
JournalHernia
Volume24
Issue number1
DOIs
Publication statusPublished - Feb 2020

Keywords

  • Incisional hernia
  • Prevention
  • Suture
  • PDS
  • Vicryl
  • Prolene
  • Rat model
  • Abdominal wall
  • AORTIC-ANEURYSM
  • MIDLINE LAPAROTOMIES
  • ADHESION FORMATION
  • FASCIAL CLOSURE
  • DOUBLE-BLIND
  • MESH REPAIR
  • FOLLOW-UP
  • CELLS
  • SKIN
  • CLASSIFICATION

Cite this