Dataset Information

Annual Trainee Doctors’ Prize Day, Thursday 17th October 2019 : Postgraduate Medical Centre, Belfast City Hospital

ABSTRACT:

Aim:

Gore-Tex® is a widely used durable patch for repair of congenital diaphragmatic defects yet results in complications. Early reherniation has been reported in alternative xenografts such as Surgisis®. We wondered whether the matrix or decellularization (decel) process led to failure. We compared diaphragmatic reconstructions using SIS and decel porcine diaphragm (DPD), processed with a comparable decel protocol, to Gore-Tex in a fast-growing rabbit model.

Methods:

Twenty-three 6-weeks-old rabbits underwent intubation, left subcostal laparotomy and 3*3cm hemi- diaphragmatic excision. Defect closure was with a 3,5*3,5cm patch of (a) Gore-Tex® (n=10), (b) Surgisis® (n=6) or (c) DPD (n=7). Rates of herniation or eventration, uniaxial biomechanical testing, and histology were studied at 90days.

Results:

Eighteen (78%) rabbits survived to 90days. There was mesh failure in all decellularised matrices (p<0.001). Frank reherniation of abdominal contents in 14% of GoreTex group (n=1), 71% in SIS (n=5;fig.1e) and 25% with DPD (n=1). Eventration was observed in SIS (n=2 (29%)) or DPD (n=3 (75%); p<0.05) (fig.1f). Biomechanical testing was only possible with Gore-Tex. Decellularised matrices were replaced by thin fibrous tissue, almost acellular at the mesh centre. Gore-Tex induced a more vigorous inflammatory response.

Conclusion:

Reconstructions with natural matrices are more likely to fail than Gore-Tex repairs. Outcomes in our fast-growing rabbit model correlate to described clinical outcomes.

SUBMITTER: Eastwood M

PROVIDER: S-EPMC8279014 | biostudies-literature |

REPOSITORIES: biostudies-literature

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