Abstract
Introduction: Mesh adhesion is an important complication in prosthetic hernia repairs which may lead to intestinal obstruction, enterocutaneous fistula and viscus perforation. Therefore, direct contact between visceral organs and mesh should be avoided. The aim of this study was to investigate the efficacy of platelet rich fibrin (PRF) as an adhesion barrier.
Methods: Thirty-six Wistar-Albino rats were used in the study. Four rats were used to obtain platelet-rich fibrin. Remaining animals were divided to four separate groups. In sham group, laparotomy was done and repaired by suture without mesh. Abdominal walls of remaining animals were excised for about 2 cm in length with margins 2 cm wide. The defect was repaired with polypropylene mesh, Parietex composite mesh, or PRF coated polypropylene mesh in three separate groups. Animals were sacrificed on the 14th postoperative day. Macroscopic Zühlke and Greca adhesion scores, histopathological fibrosis grading and multinucleated giant cells were evaluated.
Results: There was statistically significant difference of adhesion scores of Zühlke (p=0.013) and Greca (p<0.001) between all groups. It was observed that the adhesion score in the platelet-rich fibrin group was lower than the polypropylene mesh group (p=0.003), and there was no significant difference between the composite mesh group and the PRF group (p=0.13). Fibroblast density and degree of fibrosis were higher in the platelet-rich fibrin group than in the polypropylene group (p<0.001), but there was no significant difference with the composite mesh group. When giant cell numbers were compared as an indicator of inflammation, giant cell formation was significantly higher in the platelet-rich fibrin group than in the polypropylene mesh group (p=0.001), and it was significantly less than in the composite mesh group (p=0.007).
Conclusion: Platelet-rich fibrin reduces the incidence of adhesion to prosthetic mesh in the early postoperative period and increase fibrosis on abdominal wall-mesh interface. Platelet-rich fibrin as a biological barrier can be considered as an alternative to composite mesh and antiadhesive barriers.