Platelet-rich plasma PRP vs. absorbable mesh as cruroplasty reinforcement: a study on an animal model

Abstract

Background

Reinforcement of posterior cruroplasty has been proposed to minimize the failure of hiatal hernia repair (HHR). The applications of autologous platelet-rich plasma (PRP) and absorbable mesh are barely reported in this area.

Aims

To analyze local macroscopic and microscopic changes induced by mesh vs. PRP as reinforcement of HHR, using a reliable laparoscopic experimental porcine model.

Material and methods

This prospective, comparative pilot study was conducted on 14 female pigs, aged four to six months. An iatrogenic hiatal defect was laparoscopically simulated and repaired, reinforced with Bio-A® mesh (group A) or PRP (group B). Specimen retrieval was performed after seven months for histopathological (HP) examination.

Results

No local or general complications were registered, with complete resorption of reinforcements, that determined inflammatory infiltrates with local collagen production and tissue neo-vascularization. Group A had an increased mean chronic inflammation score (p = .3061), showing significant sclerotic collagenizing process. PRP enhanced angiogenesis, collagenizing, myofibroblast recruitment and tissue ingrowth.

Conclusions

No residual materials or evidence of anatomical distortion were found. Animal model was safe and reliable. This is the first report of complete absorption of Bio-A^® positioned on crural area. HP results suggest the clinical application of PRP in HHR as a promising co-adjuvant to local remodeling and healing.

Abbreviations: ASA: American Society of Anesthesiologists; AB: Alcian Blue; PAS: Periodic Acid-Schiff; CP: platelet concentrate; fPC: filtered plasma concentrate; GERD: gastro-esophageal reflux disease; HSA: hiatal surface area; HHR: hiatal hernia repair; HP: histopathological; HH: hiatal hernia; HE: hematoxylin and eosin; HR: hiatus repair alone; HRM: hiatus repair and acellular dermal matrix; NM: Nicolae Manolesccu; LNF: laparoscopic Nissen fundoplication; PC: posterior cruroplasty; PPP: platelet-poor plasma; RP: platelet-rich plasma

Keywords:

• Porcine model
• hiatal hernia
• laparoscopy
• reinforcement
• platelet-rich plasma
• biosynthetic absorbable mesh

Acknowledgments

The authors thank the Surgical Training Institute, Ponderas Academic Hospital, Bucharest, Romania for providing the structure and facilities needed for the organization and development of the experimental surgery. This work represents the main research and experimental activity of Dr. Cristian E. Boru during the PhD studies in Morphogenesis and Tissue Engineering at University La Sapienza of Rome, Department of Anatomical Sciences, Histology, Forensics and of the Locomotor Apparatus.

Declaration of interest

The authors disclose any commercial interest that they may have in the subject of study and the source of any financial or material support. All authors were involved in the final approval of the version to be published and agree to be accountable for all aspects of the work.

Data availability

All individual-participant data collected during this study will be available for access. Data and documents, including the study protocol, statistical analysis plan, technical details and animals’ experiment guidelines will also be available. Data will only be available for use in individual participant data meta-analyses, and access will be provided to researchers after a proposal has been approved by an independent review committee identified for this purpose. Data will be available beginning at 3 months and ending at 24 months after publication of this Article. Proposals should be directed to [email protected]; to gain access, data requesters will need to sign a data access agreement, and the de-identified database will be transferred by email.

Additional information

Funding

As a Funding Source Declaration, this work was supported by research grant from University La Sapienza of Rome, Italy [G17/3021 and G17/3028 of 2017] used for animals’ acquisition, transportation and 7 months monitoring and follow-up.