Platelet-rich fibrin decreases adhesion to polypropylene prosthetic mesh material in ventral hernia repair

Platelet-rich fibrin decreases adhesion to polypropylene prosthetic mesh material in ventral hernia repair | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Platelet-rich fibrin decreases adhesion to polypropylene prosthetic mesh material in ventral hernia repair Dogukan Dogu, Ozge Sular, Cenk Sokmensuer, Halil Kaya Yorganci This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4765003/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 23 May, 2025 Read the published version in Scientific Reports → Version 1 posted 13 You are reading this latest preprint version 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. Biological sciences/Biological techniques Biological sciences/Biotechnology Biological sciences/Cell biology Biological sciences/Physiology Biological sciences/Structural biology Health sciences/Anatomy Health sciences/Medical research Hernia Platelet rich fibrin mesh adhesion Intraperitoneal mesh repair Figures Figure 1 Figure 2 Figure 3 Figure 4 INTRODUCTION The use of mesh in ventral hernia repairs reduces recurrence. While strong mesh integration is essential for successful hernia repair, excessive or abnormal adhesion to nearby organs may also lead to an increase in mesh-related complications. One of the most important mesh related complications is mesh adhesion which may cause intestinal obstructions and enterocutaneous fistulas 1 . Although there are various mesh materials, there is no consensus on an ideal mesh and almost all of them cause more or less adhesion 2 . Adhesion formation is a complex and time dependent process which starts with the fibrin layer formed during the coagulation process with the suppression of fibrinolytic activity in conditions that cause local ischemia such as surgical trauma. This fibrin matrix is gradually replaced by vascular granulation tissue consisting of macrophages, fibroblasts and giant cells, and over time this granulation tissue turns into fibrous bands. Opposing of two damaged peritoneal surfaces triggers adhesion formation 3 . Intraperitoneal meshes are in direct contact with visceral organs as in minimal invasive hernia repairs, so mesh adhesion is a serious complication 4 . Platelet-rich fibrin is a second generation concentrate obtained autologously; it is a relatively new technique in the field of regenerative medicine 5 . The basic principle in the preparation of platelet concentrates is that concentrated platelets and the cytokines and growth factors they contain can be combined and used locally in the surgical field. The fact that the dense fibrin network formed is also rich in leukocytes both triggers tissue healing and shows antibacterial effect. It undergoes slow resorption in the tissue and continues to spread the cytokines and growth factors it contains to the surrounding tissue for 7–10 days 6 . PRF may be useful in hernia mesh surgery for several aims, such as: reduction of adhesions, enhanced tissue healing, anti-inflammatory effects, improved mesh integration. Local application of platelet concentrates was shown to reduce biological mesh adhesion, intraperitoneal adhesions and intrauterine adhesions in rodent experimental studies 7–9 . There is no study in the literature showing the effect of PRF on adhesion to prosthetic meshes. The aim of this study was to investigate the efficacy of PRF membrane as an adhesion barrier to prosthetic meshes. MATERIALS AND METHODS 10-week-old male Wistar-Albino rats weighing between 250–350 grams and fed with standard laboratory feed were used. Animal housing, care, and application of experimental procedures were all performed in accordance with institutional regulations as approved by the Hacettepe University Animal Ethics Committee (Approval numbers: 2022/01–10). The experiments were carried out according to the Guide for the Care and Use of Laboratory Animals and reported in accordance with the ARRIVE guidelines. The animals were housed under a 12-hour light-12-hour dark cycle at a temperature of 22 ± 3°C and 40–60% humidity and allowed free access to food and water. The animals were provided by Kobay Experimental Animals Laboratories, Inc. Thirty-two male Wistar-Albino rats were divided into four subgroups, each containing eight rats. Four rats were used to obtain platelet-rich fibrin. General anesthesia was achieved in all groups by intraperitoneal administration of a mixture of 90 mg/kg ketamine hydrochloride and 10 mg/kg Xylazine HCl. The abdomen was shaved and disinfected with povidone–iodine solution. Following 4-cm long midline skin incision, 2 cm-long laparotomy was done and repaired by running suture without mesh in sham group. Abdominal wall and peritoneum were excised for about 2 cm in length with margins 2 cm wide in other groups. (one cm from midline to each side). Group 1 (SH): Midline laparotomy was closed by running suture without mesh. Group 2 (PR): The midline defect of rats in the polypropylene group was repaired intraperitoneally with 2.5 x 2.5 cm sized polypropylene mesh. Group 3 (COM): The midline defect of the rats in the composite group was repaired intraperitoneally with 2.5 x 2.5 cm sized Parietex® composite mesh coated collagen film inside. Group 4 (PRF): The midline defect of rats in the PRF group was repaired intraperitoneally with 2.5 x 2.5 cm sized PRF coated polypropylene meshes which was fixed platelet rich fibrin membrane on the inner side facing the intra-abdominal cavity. Twelve ml blood obtained by cardiac puncture from four rats was divided equally into eight separate anticoagulant-free tubes. The tubes were centrifuged at 2700 rpm for 12 minutes. Red blood cells and platelet-poor plasma were separated from the sample obtained after centrifugation and platelet-rich fibrin was isolated and taken into a separate container. Platelet-rich fibrin layer was attached to the polypropylene meshes cut in 2.5x2.5 cm in dimensions with 4 − 0 polypropylene sutures from both ends (Fig. 1 ). Evaluation of Adhesion Formation The animals were sacrificed on postoperative day 14 with intraperitoneal high dose ketamine. Anterior abdominal wall was opened through a U-shaped incision and macroscopic adhesion assessment was performed at this stage. For macroscopic adhesion evaluation Greca adhesion scoring (Supplementary Table 1), which evaluates adhesion grade and surface area, Zühlke adhesion scoring (Supplementary Table 2), which evaluates adhesion tenacity were used. 10,11 Histopathological Examination Tissue sample was taken from the edge where the abdominal wall and the mesh meet, including the mesh, and embedded in paraffin. Subsequently, sections of 5 µm thickness were obtained by staining with hematoxylin-eosin and Masson-Trichrome stain. The sections were evaluated by a pathologist blinded to the groups. Fibrosis scoring was performed according to the parameters described in the literature 12 . They were graded on a scale of 0 (none) to 4 (severe). The extent of fibrosis was graded as 1 if the area involved less than 10% of the slide; 2 if it was between 10% and 40%; 3 if it was between 40% and 70%; 4 if it was more than 70%. Statistical Analysis Statistical analyses were performed using the Statistical Package for the Social Sciences version 25 (SPSS, IBM, USA). Since the data was not normally distributed, Kruskal-Wallis test was used to compare groups. Mann-Whitney U-test with Bonferroni correction was used for post- hoc analyses. P value less than 0.05 (two-sided) was appreciated as significant. RESULTS There was no mortality in all groups. Surgical site infection, fistula, intestinal obstruction, and hernia recurrence were not observed in any animal. On postoperative day 14, all animals except one in sham group had peritoneal adhesion. In sham group 7 of 8 animals had omental adhesion on suture line. In polypropylene mesh group 2 of 8 animals had visceral adhesion on mesh surface, remaining animals had omental adhesion on mesh surface. In composite mesh group 1 of 8 animal had visceral adhesion on mesh surface, remaining animals had omental adhesion on mesh surface. In PRF group, there was no visceral adhesion on mesh surface and all animals had omental adhesion. Adhesion types are illustrated in Fig.2. Evaluation of Adhesion Formation Each animal in four groups was evaluated according to Greca and Zühlke adhesion score as mentioned above. There was statistically significant difference between four groups (p=0.001 Greca adhesion score, p=0.013 Zühlke adhesion score, Kruskal-Wallis test). When pairwise comparison analysis was done, sham group had a significantly lower adhesion score than polypropylene and composite mesh group. Platelet rich fibrin group had a significantly lower adhesion score than polypropylene group (p=0.003, Mann-Whitney U test Bonferroni correction). There wasn’t significant difference between composite mesh group and PRF-coated mesh group (p=0.13, Mann-Whitney U test, Bonferroni correction) (Table 1 and 2). Histopathological Evaluation After macroscopic adhesion scoring in all groups, the anterior abdominal wall was excised and a sample was taken from the edge where the mesh and fascia meet, including the mesh. The specimens were stained with hematoxylin-eosin and Masson trichrome stain as shown in Fig.3 and Fig.4, then grade of fibrosis and inflammation were evaluated. There was a statistically significant difference between four groups in fibrosis score (p<0.001, Kruskal-Wallis test). When pairwise comparison was done, platelet rich fibrin group had a significantly higher fibrosis score than polypropylene mesh and sham groups (p=0.001 and p<0.001, Mann-Whitney U test, Bonferroni correction). There was a statistically significant difference between the groups in terms of giant cell formation as an indicator of inflammation (p<0.001, Kruskal-Wallis test). Paired group analysis showed that platelet rich fibrin group had significantly higher inflammation than polypropylene group but lower than composite mesh group (Table 1). DISCUSSION Adhesion of visceral organs to the mesh material causes significant complications. Intestinal obstruction and enterocutaneous fistula formation are the leading complications. In cases where the defect is too large to be closed with primary suture and in laparoscopic hernia repairs, the mesh surface and visceral organs are in direct contact. Although there are various mesh materials produced to prevent direct contact, there is no consensus on an ideal mesh material 13,14 . Platelet-rich fibrin is a second generation concentrate obtained autologously; it is a relatively new technique in the field of regenerative medicine. In our study, we investigated the effect of platelet-rich fibrin on the adhesion of visceral organs to polypropylene mesh material placed intraperitoneally in a ventral hernia model in rats. There are few studies in the literature on the adhesion of first- and second-generation platelet concentrates to intraperitoneal organs and mesh material. In our study, two scoring systems were used to compare the groups in terms of mesh adhesion. Zühlke scoring system provides a semiquantitative scoring based on the tenacity of adhesion and ease of dissection. The Greca scoring system is a semiquantitative system defined by the severity and structure of the adhesion 10,11 . When evaluated with both systems, there was a significant difference between the groups in terms of adhesion scoring. Pairwise analysis between the groups showed that adhesion to the abdominal wall was less in the sham group without mesh compared to the other three groups. This was thought to be due to the primary approximation of the peritoneal surfaces and minimal contact of the damaged peritoneal surface with visceral structures. In the pairwise analysis between the experimental groups, it was shown that adhesion to the mesh was higher in the group using polypropylene mesh than in the group using both composite mesh and PRF in both scoring systems. In many clinical studies in the literature, composite meshes have been shown to be superior to polypropylene meshes in terms of adhesion and are routinely used 15–17 . However, there is no study on PRF-coated meshes in the literature. Our study showed that PRF-coated polypropylene meshes are as effective as composite meshes in preventing adhesion. The basic principle of mesh hernia repair, as mentioned before, is that the mesh material increases tissue integrity by inducing fibrosis and fibroblast proliferation. One of the indicators of this in the literature is the histopathologic demonstration of the intensity of fibroblast proliferation and fibrosis at the junction of the fascia and mesh and scoring based on this 12 . The relativity in histopathologic examination was reduced by the fact that the pathologist was blinded to the control and experimental groups and the area where the mesh and fascia meet and where fibrosis is most intense was evaluated. Fibrosis and fibroblast density were significantly higher in the PRF and composite mesh group than in the sham surgery group and the polypropylene group. This may be explained by the fact that cytokines and growth factors released from platelet and leukocyte-rich fibrin increase mesenchymal cell migration to the area, which provides tissue regeneration. No significant difference was found between PRF-coated mesh and composite mesh. There are two limitations of our study. First one is that blood taken from rats sacrificed while obtaining platelet-rich fibrin was applied to the PRF group. This is because the blood volume required to obtain PRF is high, and the required amount cannot be obtained with a small amount of blood from the tail vein. Therefore, blood was obtained from four rats by cardiac puncture for PRF production. Since the rats used were inbred, they were considered genetically identical and therefore no immune reaction was observed in any animal in the experimental group. Second one is that the effect of platelet-rich fibrin on adhesion in the late period was not evaluated due to the small number of subjects and the fact that the subjects were sacrificed and examined on the 14th postoperative day. CONCLUSION In conclusion, platelet-rich fibrin was shown to have a positive effect on reducing mesh adhesion in mesh hernia repair and this was statistically significant compared to the group using polypropylene mesh alone. Statistical superiority to composite meshes, which are used in laparoscopic cases in our daily practice and in cases where the defect cannot be closed, has not been shown. Although it is thought that PRF may increase the integration of the mesh into the fascia by stimulating fibrosis and fibroblast proliferation more than the polypropylene group, this should be demonstrated in other studies with mechanical tests. In the light of the results of our study, it has been demonstrated that PRF decreases the adhesion of visceral organs to polypropylene meshes and shows results equivalent to composite meshes and should be supported by studies with greater number of subjects and long-term effects. Declarations Funding/support: This study was supported by Hacettepe University Scientific Research Unit (THD-2022-19932). Conflict of interest/Disclosure: The authors declare no conflict of interests. Data availability statement: All data generated or analyzed during this study are included in this published article (and its supplementary information files). References Kokotovic, D., Bisgaard, T. & Helgstrand, F. Long-term Recurrence and Complications Associated With Elective Incisional Hernia Repair. Jama 316 , 1575-1582, doi:10.1001/jama.2016.15217 (2016). Gaertner, W. B., Bonsack, M. E. & Delaney, J. P. Visceral adhesions to hernia prostheses. Hernia 14 , 375-381, doi:10.1007/s10029-010-0659-y (2010). Glucksman, D. L. Serosal integrity and intestinal adhesions. Surgery 60 , 1009-1011 (1966). Soare, A. M., Cârţu, D., Nechita, S. L., Andronic, O. & Șurlin, V. Complications of Intraperitoneal Mesh Techniques for Incisional Hernia - A Systematic Review. Chirurgia (Bucur) 116 , S36-s42 (2021). Choukroun, J. et al. Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part IV: clinical effects on tissue healing. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 101 , e56-60, doi:10.1016/j.tripleo.2005.07.011 (2006). Dohan Ehrenfest, D. M., Doglioli, P., de Peppo, G. M., Del Corso, M. & Charrier, J. B. Choukroun's platelet-rich fibrin (PRF) stimulates in vitro proliferation and differentiation of human oral bone mesenchymal stem cell in a dose-dependent way. Arch Oral Biol 55 , 185-194, doi:10.1016/j.archoralbio.2010.01.004 (2010). Van Eps, J. et al. Decreased hernia recurrence using autologous platelet-rich plasma (PRP) with Strattice™ mesh in a rodent ventral hernia model. Surg Endosc 30 , 3239-3249, doi:10.1007/s00464-015-4645-4 (2016). Wang, J. et al. Platelet-rich fibrin prevents postoperative intestinal adhesion. J Biomed Mater Res A 108 , 1077-1085, doi:10.1002/jbm.a.36883 (2020). Karakaş, D. et al. Effect of platelet-rich plasma on postoperative peritoneal inflammation and adhesions. Arch Med Sci 17 , 1408-1413, doi:10.5114/aoms.2020.94538 (2021). Zühlke, H. V., Lorenz, E. M., Straub, E. M. & Savvas, V. [Pathophysiology and classification of adhesions]. Langenbecks Arch Chir Suppl II Verh Dtsch Ges Chir , 1009-1016 (1990). Greca, F. H. et al. The influence of differing pore sizes on the biocompatibility of two polypropylene meshes in the repair of abdominal defects. Experimental study in dogs. Hernia 5 , 59-64, doi:10.1007/s100290100001 (2001). Baykal, A. et al. An experimental study of the adhesive potential of different meshes. Eur J Surg 166 , 490-494, doi:10.1080/110241500750008826 (2000). van 't Riet, M. et al. Prevention of adhesion to prosthetic mesh: comparison of different barriers using an incisional hernia model. Ann Surg 237 , 123-128, doi:10.1097/00000658-200301000-00017 (2003). Alimoglu, O. et al. Prevention of adhesion formations following repair of abdominal wall defects with prosthetic materials (an experimental study). Hepatogastroenterology 50 , 725-728 (2003). Hanna, E. M. et al. Outcomes of a prospective multi-center trial of a second-generation composite mesh for open ventral hernia repair. Hernia 18 , 81-89, doi:10.1007/s10029-013-1078-7 (2014). Aydemir Sezer, U. et al. Polypropylene composite hernia mesh with anti-adhesion layer composed of polycaprolactone and oxidized regenerated cellulose. Mater Sci Eng C Mater Biol Appl 99 , 1141-1152, doi:10.1016/j.msec.2019.02.064 (2019). Byrd, J. F. et al. Evaluation of composite mesh for ventral hernia repair. Jsls 15 , 298-304, doi:10.4293/108680811x13071180407393 (2011). Tables Tables 1 to 2 are available in the Supplementary Files section Additional Declarations No competing interests reported. Supplementary Files Supplementarytable1.docx Supplementarytable2.docx rawdataset.xlsx Tables.docx Cite Share Download PDF Status: Published Journal Publication published 23 May, 2025 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Revision requested 15 Apr, 2025 Reviews received at journal 14 Apr, 2025 Reviewers agreed at journal 03 Apr, 2025 Reviewers agreed at journal 18 Feb, 2025 Reviewers agreed at journal 27 Nov, 2024 Reviewers agreed at journal 14 Sep, 2024 Reviews received at journal 28 Aug, 2024 Reviewers agreed at journal 28 Aug, 2024 Reviewers invited by journal 10 Aug, 2024 Editor assigned by journal 10 Aug, 2024 Editor invited by journal 28 Jul, 2024 Submission checks completed at journal 25 Jul, 2024 First submitted to journal 18 Jul, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4765003","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":340694613,"identity":"1172149e-64ce-4ad0-ac10-2ab60492a075","order_by":0,"name":"Dogukan Dogu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/klEQVRIiWNgGAWjYDCCAwwMjA1Q/PBDBVCEmbmBaC3MxhJnQFoYidfCJsHbBhIioIXvePs1yRk1d2T7+deYSUjOq43mbwdq+VGxDacWyTNnyiQ3HHtmPHPGG2OLwm3Hc2ccZmxg7DlzG6cWgxs5aZIP2A4nbrhxxvCG5LZjuQ1ALcyMbYS0/ANrMZDgnXMsdz5hLenHJDe2AbWc7zGS4G2oyd1ASAvQL8yWM/sOA/3CVmwscexA7kagloP4/AIMsYc3e74dBobY4Y0PP9TU5c47f/jggx8VuLUwMPAYQGiJBBB5GMw+gEc9ELA/gND8YHV1+BWPglEwCkbBiAQAYOVqkFPtdFkAAAAASUVORK5CYII=","orcid":"","institution":"Hacettepe University","correspondingAuthor":true,"prefix":"","firstName":"Dogukan","middleName":"","lastName":"Dogu","suffix":""},{"id":340694614,"identity":"8d43fed4-d021-415f-9e78-4d9a5222cf47","order_by":1,"name":"Ozge Sular","email":"","orcid":"","institution":"Hacettepe University","correspondingAuthor":false,"prefix":"","firstName":"Ozge","middleName":"","lastName":"Sular","suffix":""},{"id":340694615,"identity":"50ac048c-9cd9-4a41-9fc3-0e133806c073","order_by":2,"name":"Cenk Sokmensuer","email":"","orcid":"","institution":"Hacettepe University","correspondingAuthor":false,"prefix":"","firstName":"Cenk","middleName":"","lastName":"Sokmensuer","suffix":""},{"id":340694616,"identity":"97879135-a374-45f4-acb7-a9b0b2ca02fc","order_by":3,"name":"Halil Kaya Yorganci","email":"","orcid":"","institution":"Hacettepe University","correspondingAuthor":false,"prefix":"","firstName":"Halil","middleName":"Kaya","lastName":"Yorganci","suffix":""}],"badges":[],"createdAt":"2024-07-18 20:47:25","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4765003/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4765003/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-025-02521-x","type":"published","date":"2025-05-23T15:57:25+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":62949044,"identity":"e3edf45c-d4df-4d78-b71c-18e8fc2b811f","added_by":"auto","created_at":"2024-08-21 10:53:05","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":14246763,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePreparation of PRF-coated meshes. A. \u003c/strong\u003eCentrifugate of whole blood sample\u003cstrong\u003e B. \u003c/strong\u003eIsolation of platelet rich fibrin\u003cstrong\u003e C. \u003c/strong\u003eSuturing the PRF membrane to polypropylene mesh\u003cstrong\u003e D. \u003c/strong\u003eIntraperitoneal mesh repair of ventral hernia in which the PRF membrane opposing to visceral cavity.\u003c/p\u003e","description":"","filename":"Fig.1.png","url":"https://assets-eu.researchsquare.com/files/rs-4765003/v1/5210a88af48abe891564e083.png"},{"id":62949042,"identity":"9002f615-a9af-4c38-a1ff-ae7ccf381cee","added_by":"auto","created_at":"2024-08-21 10:53:04","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":17136679,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePeritoneal adhesion types. A\u003c/strong\u003e. No adhesion. \u003cstrong\u003eB.\u003c/strong\u003e Omental adhesion on suture line. \u003cstrong\u003eC\u003c/strong\u003e. Omental adhesion on less than 50% of mesh surface. \u003cstrong\u003eD.\u003c/strong\u003eOmental adhesion on more than 50% of mesh surface. \u003cstrong\u003eE,F.\u003c/strong\u003e Visceral adhesion on mesh surface.\u003c/p\u003e","description":"","filename":"Fig.2.png","url":"https://assets-eu.researchsquare.com/files/rs-4765003/v1/bd8be13c4a43cb48f6b3f8be.png"},{"id":62949724,"identity":"deca0287-b211-4763-8cfd-cb3a33ee8c54","added_by":"auto","created_at":"2024-08-21 11:01:05","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":19258823,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eHistopathological evaluation of groups by H\u0026amp;E staining. \u003c/strong\u003eThick arrows show multinucleated giant cells, thin arrows show fibroblasts/fibrosis, and asterisks show mesh.\u003cstrong\u003e \u003c/strong\u003eScale bar: 100 µm.\u003c/p\u003e","description":"","filename":"Fig.3.png","url":"https://assets-eu.researchsquare.com/files/rs-4765003/v1/10f0a18feaf7d9b4b4aadf7c.png"},{"id":62949043,"identity":"05b5c0e1-7350-4c94-90f7-f405e0b6eaea","added_by":"auto","created_at":"2024-08-21 10:53:05","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":31958593,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eEvaluation of fibrosis by Masson trichrome staining. \u003c/strong\u003eM stands for mesh material, S stands for suture material, yellow arrowheads show muscle fibrils, and red arrowheads show fibrosis. Broad fibrosis around mesh material is noted in polypropylene + PRF group.\u003cstrong\u003e \u003c/strong\u003eScale bar: 200 µm\u003c/p\u003e","description":"","filename":"Fig.4.png","url":"https://assets-eu.researchsquare.com/files/rs-4765003/v1/fe107510ad7d5e71d14cbb53.png"},{"id":83460962,"identity":"824f989e-840d-49ac-9a2d-ec91778918a5","added_by":"auto","created_at":"2025-05-26 16:14:40","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":75472897,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4765003/v1/897649a5-a60c-4abe-b785-2f00ba127ee1.pdf"},{"id":62949039,"identity":"b34143e8-447b-409b-ab62-7817b0407248","added_by":"auto","created_at":"2024-08-21 10:53:04","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":14009,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementarytable1.docx","url":"https://assets-eu.researchsquare.com/files/rs-4765003/v1/812959a51c09e4e6da012a77.docx"},{"id":62949038,"identity":"9561b612-69df-4db3-bfed-f27b16185ce4","added_by":"auto","created_at":"2024-08-21 10:53:04","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":14689,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementarytable2.docx","url":"https://assets-eu.researchsquare.com/files/rs-4765003/v1/47350d39719b0c097399ed84.docx"},{"id":62949041,"identity":"e41e61f2-752e-4cf5-9058-e4fd1dea4f44","added_by":"auto","created_at":"2024-08-21 10:53:04","extension":"xlsx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":12513,"visible":true,"origin":"","legend":"","description":"","filename":"rawdataset.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-4765003/v1/8eef00e359b67a4552678b40.xlsx"},{"id":62949040,"identity":"de32d344-f5be-49ed-b5a0-d18f2b27fa5d","added_by":"auto","created_at":"2024-08-21 10:53:04","extension":"docx","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":42859,"visible":true,"origin":"","legend":"","description":"","filename":"Tables.docx","url":"https://assets-eu.researchsquare.com/files/rs-4765003/v1/d7421b1cb3c25d053cd71437.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Platelet-rich fibrin decreases adhesion to polypropylene prosthetic mesh material in ventral hernia repair","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eThe use of mesh in ventral hernia repairs reduces recurrence. While strong mesh integration is essential for successful hernia repair, excessive or abnormal adhesion to nearby organs may also lead to an increase in mesh-related complications. One of the most important mesh related complications is mesh adhesion which may cause intestinal obstructions and enterocutaneous fistulas\u003csup\u003e1\u003c/sup\u003e. Although there are various mesh materials, there is no consensus on an ideal mesh and almost all of them cause more or less adhesion\u003csup\u003e2\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAdhesion formation is a complex and time dependent process which starts with the fibrin layer formed during the coagulation process with the suppression of fibrinolytic activity in conditions that cause local ischemia such as surgical trauma. This fibrin matrix is gradually replaced by vascular granulation tissue consisting of macrophages, fibroblasts and giant cells, and over time this granulation tissue turns into fibrous bands. Opposing of two damaged peritoneal surfaces triggers adhesion formation\u003csup\u003e3\u003c/sup\u003e. Intraperitoneal meshes are in direct contact with visceral organs as in minimal invasive hernia repairs, so mesh adhesion is a serious complication\u003csup\u003e4\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003ePlatelet-rich fibrin is a second generation concentrate obtained autologously; it is a relatively new technique in the field of regenerative medicine\u003csup\u003e5\u003c/sup\u003e. The basic principle in the preparation of platelet concentrates is that concentrated platelets and the cytokines and growth factors they contain can be combined and used locally in the surgical field. The fact that the dense fibrin network formed is also rich in leukocytes both triggers tissue healing and shows antibacterial effect. It undergoes slow resorption in the tissue and continues to spread the cytokines and growth factors it contains to the surrounding tissue for 7\u0026ndash;10 days\u003csup\u003e6\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003ePRF may be useful in hernia mesh surgery for several aims, such as: reduction of adhesions, enhanced tissue healing, anti-inflammatory effects, improved mesh integration. Local application of platelet concentrates was shown to reduce biological mesh adhesion, intraperitoneal adhesions and intrauterine adhesions in rodent experimental studies\u003csup\u003e7\u0026ndash;9\u003c/sup\u003e. There is no study in the literature showing the effect of PRF on adhesion to prosthetic meshes. The aim of this study was to investigate the efficacy of PRF membrane as an adhesion barrier to prosthetic meshes.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cp\u003e10-week-old male Wistar-Albino rats weighing between 250\u0026ndash;350 grams and fed with standard laboratory feed were used. Animal housing, care, and application of experimental procedures were all performed in accordance with institutional regulations as approved by the Hacettepe University Animal Ethics Committee (Approval numbers: 2022/01\u0026ndash;10). The experiments were carried out according to the Guide for the Care and Use of Laboratory Animals and reported in accordance with the ARRIVE guidelines. The animals were housed under a 12-hour light-12-hour dark cycle at a temperature of 22\u0026thinsp;\u0026plusmn;\u0026thinsp;3\u0026deg;C and 40\u0026ndash;60% humidity and allowed free access to food and water. The animals were provided by Kobay Experimental Animals Laboratories, Inc.\u003c/p\u003e \u003cp\u003eThirty-two male Wistar-Albino rats were divided into four subgroups, each containing eight rats. Four rats were used to obtain platelet-rich fibrin. General anesthesia was achieved in all groups by intraperitoneal administration of a mixture of 90 mg/kg ketamine hydrochloride and 10 mg/kg Xylazine HCl. The abdomen was shaved and disinfected with povidone\u0026ndash;iodine solution. Following 4-cm long midline skin incision, 2 cm-long laparotomy was done and repaired by running suture without mesh in sham group. Abdominal wall and peritoneum were excised for about 2 cm in length with margins 2 cm wide in other groups. (one cm from midline to each side).\u003c/p\u003e \u003cp\u003eGroup 1 (SH): Midline laparotomy was closed by running suture without mesh.\u003c/p\u003e \u003cp\u003eGroup 2 (PR): The midline defect of rats in the polypropylene group was repaired intraperitoneally with 2.5 x 2.5 cm sized polypropylene mesh.\u003c/p\u003e \u003cp\u003eGroup 3 (COM): The midline defect of the rats in the composite group was repaired intraperitoneally with 2.5 x 2.5 cm sized Parietex\u0026reg; composite mesh coated collagen film inside.\u003c/p\u003e \u003cp\u003eGroup 4 (PRF): The midline defect of rats in the PRF group was repaired intraperitoneally with 2.5 x 2.5 cm sized PRF coated polypropylene meshes which was fixed platelet rich fibrin membrane on the inner side facing the intra-abdominal cavity.\u003c/p\u003e \u003cp\u003eTwelve ml blood obtained by cardiac puncture from four rats was divided equally into eight separate anticoagulant-free tubes. The tubes were centrifuged at 2700 rpm for 12 minutes. Red blood cells and platelet-poor plasma were separated from the sample obtained after centrifugation and platelet-rich fibrin was isolated and taken into a separate container. Platelet-rich fibrin layer was attached to the polypropylene meshes cut in 2.5x2.5 cm in dimensions with 4\u0026thinsp;\u0026minus;\u0026thinsp;0 polypropylene sutures from both ends (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003eEvaluation of Adhesion Formation\u003c/h3\u003e\n\u003cp\u003eThe animals were sacrificed on postoperative day 14 with intraperitoneal high dose ketamine. Anterior abdominal wall was opened through a U-shaped incision and macroscopic adhesion assessment was performed at this stage. For macroscopic adhesion evaluation Greca adhesion scoring (Supplementary Table\u0026nbsp;1), which evaluates adhesion grade and surface area, Z\u0026uuml;hlke adhesion scoring (Supplementary Table\u0026nbsp;2), which evaluates adhesion tenacity were used.\u003csup\u003e10,11\u003c/sup\u003e\u003c/p\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eHistopathological Examination\u003c/h2\u003e \u003cp\u003eTissue sample was taken from the edge where the abdominal wall and the mesh meet, including the mesh, and embedded in paraffin. Subsequently, sections of 5 \u0026micro;m thickness were obtained by staining with hematoxylin-eosin and Masson-Trichrome stain. The sections were evaluated by a pathologist blinded to the groups. Fibrosis scoring was performed according to the parameters described in the literature\u003csup\u003e12\u003c/sup\u003e. They were graded on a scale of 0 (none) to 4 (severe). The extent of fibrosis was graded as 1 if the area involved less than 10% of the slide; 2 if it was between 10% and 40%; 3 if it was between 40% and 70%; 4 if it was more than 70%.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eStatistical analyses were performed using the Statistical Package for the Social Sciences version 25 (SPSS, IBM, USA). Since the data was not normally distributed, Kruskal-Wallis test was used to compare groups. Mann-Whitney U-test with Bonferroni correction was used for post- hoc analyses. P value less than 0.05 (two-sided) was appreciated as significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThere was no mortality in all groups. Surgical site infection, fistula, intestinal obstruction, and hernia recurrence were not observed in any animal. On postoperative day 14, all animals except one in sham group had peritoneal adhesion. In sham group 7 of 8 animals had omental adhesion on suture line. In polypropylene mesh group 2 of 8 animals had visceral adhesion on mesh surface, remaining animals had omental adhesion on mesh surface. In composite mesh group 1 of 8 animal had visceral adhesion on mesh surface, remaining animals had omental adhesion on mesh surface. In PRF group, there was no visceral adhesion on mesh surface and all animals had omental adhesion. Adhesion types are illustrated in Fig.2.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e Evaluation of Adhesion Formation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEach animal in four groups was evaluated according to Greca and Zühlke adhesion score as mentioned above. There was statistically significant difference between four groups (p=0.001 Greca adhesion score, p=0.013 Zühlke adhesion score, Kruskal-Wallis test). When pairwise comparison analysis was done, sham group had a significantly lower adhesion score than polypropylene and composite mesh group. Platelet rich fibrin group had a significantly lower adhesion score than polypropylene group (p=0.003, Mann-Whitney U test Bonferroni correction). There wasn’t significant difference between composite mesh group and PRF-coated mesh group (p=0.13, Mann-Whitney U test, Bonferroni correction) (Table 1 and 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHistopathological Evaluation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAfter macroscopic adhesion scoring in all groups, the anterior abdominal wall was excised and a sample was taken from the edge where the mesh and fascia meet, including the mesh. The specimens were stained with hematoxylin-eosin and Masson trichrome stain as shown in Fig.3 and Fig.4, then grade of fibrosis and inflammation were evaluated.\u003c/p\u003e\n\u003cp\u003eThere was a statistically significant difference between four groups in fibrosis score (p\u0026lt;0.001, Kruskal-Wallis test). When pairwise comparison was done, platelet rich fibrin group had a significantly higher fibrosis score than polypropylene mesh and sham groups (p=0.001 and p\u0026lt;0.001, Mann-Whitney U test, Bonferroni correction). There was a statistically significant difference between the groups in terms of giant cell formation as an indicator of inflammation (p\u0026lt;0.001, Kruskal-Wallis test). Paired group analysis showed that platelet rich fibrin group had significantly higher inflammation than polypropylene group but lower than composite mesh group (Table 1).\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eAdhesion of visceral organs to the mesh material causes significant complications. Intestinal obstruction and enterocutaneous fistula formation are the leading complications. In cases where the defect is too large to be closed with primary suture and in laparoscopic hernia repairs, the mesh surface and visceral organs are in direct contact. Although there are various mesh materials produced to prevent direct contact, there is no consensus on an ideal mesh material\u003csup\u003e13,14\u003c/sup\u003e. Platelet-rich fibrin is a second generation concentrate obtained autologously; it is a relatively new technique in the field of regenerative medicine. In our study, we investigated the effect of platelet-rich fibrin on the adhesion of visceral organs to polypropylene mesh material placed intraperitoneally in a ventral hernia model in rats. There are few studies in the literature on the adhesion of first- and second-generation platelet concentrates to intraperitoneal organs and mesh material.\u003c/p\u003e \u003cp\u003eIn our study, two scoring systems were used to compare the groups in terms of mesh adhesion. Z\u0026uuml;hlke scoring system provides a semiquantitative scoring based on the tenacity of adhesion and ease of dissection. The Greca scoring system is a semiquantitative system defined by the severity and structure of the adhesion\u003csup\u003e10,11\u003c/sup\u003e. When evaluated with both systems, there was a significant difference between the groups in terms of adhesion scoring. Pairwise analysis between the groups showed that adhesion to the abdominal wall was less in the sham group without mesh compared to the other three groups. This was thought to be due to the primary approximation of the peritoneal surfaces and minimal contact of the damaged peritoneal surface with visceral structures.\u003c/p\u003e \u003cp\u003eIn the pairwise analysis between the experimental groups, it was shown that adhesion to the mesh was higher in the group using polypropylene mesh than in the group using both composite mesh and PRF in both scoring systems. In many clinical studies in the literature, composite meshes have been shown to be superior to polypropylene meshes in terms of adhesion and are routinely used\u003csup\u003e15\u0026ndash;17\u003c/sup\u003e. However, there is no study on PRF-coated meshes in the literature. Our study showed that PRF-coated polypropylene meshes are as effective as composite meshes in preventing adhesion.\u003c/p\u003e \u003cp\u003eThe basic principle of mesh hernia repair, as mentioned before, is that the mesh material increases tissue integrity by inducing fibrosis and fibroblast proliferation. One of the indicators of this in the literature is the histopathologic demonstration of the intensity of fibroblast proliferation and fibrosis at the junction of the fascia and mesh and scoring based on this\u003csup\u003e12\u003c/sup\u003e. The relativity in histopathologic examination was reduced by the fact that the pathologist was blinded to the control and experimental groups and the area where the mesh and fascia meet and where fibrosis is most intense was evaluated. Fibrosis and fibroblast density were significantly higher in the PRF and composite mesh group than in the sham surgery group and the polypropylene group. This may be explained by the fact that cytokines and growth factors released from platelet and leukocyte-rich fibrin increase mesenchymal cell migration to the area, which provides tissue regeneration. No significant difference was found between PRF-coated mesh and composite mesh.\u003c/p\u003e \u003cp\u003eThere are two limitations of our study. First one is that blood taken from rats sacrificed while obtaining platelet-rich fibrin was applied to the PRF group. This is because the blood volume required to obtain PRF is high, and the required amount cannot be obtained with a small amount of blood from the tail vein. Therefore, blood was obtained from four rats by cardiac puncture for PRF production. Since the rats used were inbred, they were considered genetically identical and therefore no immune reaction was observed in any animal in the experimental group. Second one is that the effect of platelet-rich fibrin on adhesion in the late period was not evaluated due to the small number of subjects and the fact that the subjects were sacrificed and examined on the 14th postoperative day.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eIn conclusion, platelet-rich fibrin was shown to have a positive effect on reducing mesh adhesion in mesh hernia repair and this was statistically significant compared to the group using polypropylene mesh alone. Statistical superiority to composite meshes, which are used in laparoscopic cases in our daily practice and in cases where the defect cannot be closed, has not been shown. Although it is thought that PRF may increase the integration of the mesh into the fascia by stimulating fibrosis and fibroblast proliferation more than the polypropylene group, this should be demonstrated in other studies with mechanical tests. In the light of the results of our study, it has been demonstrated that PRF decreases the adhesion of visceral organs to polypropylene meshes and shows results equivalent to composite meshes and should be supported by studies with greater number of subjects and long-term effects.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding/support:\u003c/strong\u003e This study was\u0026nbsp;supported by\u0026nbsp;Hacettepe University Scientific Research Unit (THD-2022-19932).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest/Disclosure:\u003c/strong\u003e The authors declare no conflict of interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement: \u003c/strong\u003eAll data generated or analyzed during this study are included in this published article (and its supplementary information files).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eKokotovic, D., Bisgaard, T. \u0026amp; Helgstrand, F. 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Experimental study in dogs. \u003cem\u003eHernia\u003c/em\u003e \u003cstrong\u003e5\u003c/strong\u003e, 59-64, doi:10.1007/s100290100001 (2001).\u003c/li\u003e\n \u003cli\u003eBaykal, A.\u003cem\u003e\u0026nbsp;et al.\u003c/em\u003e An experimental study of the adhesive potential of different meshes. \u003cem\u003eEur J Surg\u003c/em\u003e \u003cstrong\u003e166\u003c/strong\u003e, 490-494, doi:10.1080/110241500750008826 (2000).\u003c/li\u003e\n \u003cli\u003evan \u0026apos;t Riet, M.\u003cem\u003e\u0026nbsp;et al.\u003c/em\u003e Prevention of adhesion to prosthetic mesh: comparison of different barriers using an incisional hernia model. \u003cem\u003eAnn Surg\u003c/em\u003e \u003cstrong\u003e237\u003c/strong\u003e, 123-128, doi:10.1097/00000658-200301000-00017 (2003).\u003c/li\u003e\n \u003cli\u003eAlimoglu, O.\u003cem\u003e\u0026nbsp;et al.\u003c/em\u003e Prevention of adhesion formations following repair of abdominal wall defects with prosthetic materials (an experimental study). \u003cem\u003eHepatogastroenterology\u003c/em\u003e \u003cstrong\u003e50\u003c/strong\u003e, 725-728 (2003).\u003c/li\u003e\n \u003cli\u003eHanna, E. M.\u003cem\u003e\u0026nbsp;et al.\u003c/em\u003e Outcomes of a prospective multi-center trial of a second-generation composite mesh for open ventral hernia repair. \u003cem\u003eHernia\u003c/em\u003e \u003cstrong\u003e18\u003c/strong\u003e, 81-89, doi:10.1007/s10029-013-1078-7 (2014).\u003c/li\u003e\n \u003cli\u003eAydemir Sezer, U.\u003cem\u003e\u0026nbsp;et al.\u003c/em\u003e Polypropylene composite hernia mesh with anti-adhesion layer composed of polycaprolactone and oxidized regenerated cellulose. \u003cem\u003eMater Sci Eng C Mater Biol Appl\u003c/em\u003e \u003cstrong\u003e99\u003c/strong\u003e, 1141-1152, doi:10.1016/j.msec.2019.02.064 (2019).\u003c/li\u003e\n \u003cli\u003eByrd, J. F.\u003cem\u003e\u0026nbsp;et al.\u003c/em\u003e Evaluation of composite mesh for ventral hernia repair. \u003cem\u003eJsls\u003c/em\u003e \u003cstrong\u003e15\u003c/strong\u003e, 298-304, doi:10.4293/108680811x13071180407393 (2011).\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 2 are available in the Supplementary Files section\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Hernia, Platelet rich fibrin, mesh adhesion, Intraperitoneal mesh repair","lastPublishedDoi":"10.21203/rs.3.rs-4765003/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4765003/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction:\u003c/strong\u003e 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e There was statistically significant difference of adhesion scores of Zühlke (p=0.013) and Greca (p\u0026lt;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\u0026lt;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).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e 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.\u003c/p\u003e","manuscriptTitle":"Platelet-rich fibrin decreases adhesion to polypropylene prosthetic mesh material in ventral hernia repair","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-21 10:52:59","doi":"10.21203/rs.3.rs-4765003/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-04-15T12:16:30+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-14T17:28:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"304339078799774109388606398133264634437","date":"2025-04-03T17:30:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"144864429638371910906983415276891165080","date":"2025-02-18T12:55:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"1191012180219305111030243921106654257","date":"2024-11-27T18:50:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"28821105859901402540124856136523158790","date":"2024-09-14T17:53:34+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-08-28T14:18:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"266315531755832312188709536778911744944","date":"2024-08-28T13:11:59+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-08-10T12:34:52+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-08-10T12:30:33+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-07-28T15:14:07+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-07-25T05:21:30+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2024-07-18T20:46:10+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8b30c516-5405-41df-8156-473df8729e40","owner":[],"postedDate":"August 21st, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":36097032,"name":"Biological sciences/Biological techniques"},{"id":36097033,"name":"Biological sciences/Biotechnology"},{"id":36097034,"name":"Biological sciences/Cell biology"},{"id":36097035,"name":"Biological sciences/Physiology"},{"id":36097036,"name":"Biological sciences/Structural biology"},{"id":36097037,"name":"Health sciences/Anatomy"},{"id":36097038,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2025-05-26T16:13:03+00:00","versionOfRecord":{"articleIdentity":"rs-4765003","link":"https://doi.org/10.1038/s41598-025-02521-x","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2025-05-23 15:57:25","publishedOnDateReadable":"May 23rd, 2025"},"versionCreatedAt":"2024-08-21 10:52:59","video":"","vorDoi":"10.1038/s41598-025-02521-x","vorDoiUrl":"https://doi.org/10.1038/s41598-025-02521-x","workflowStages":[]},"version":"v1","identity":"rs-4765003","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4765003","identity":"rs-4765003","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}