C. Totten1, J. Tharappel1, J. S. Roth1 1University Of Kentucky,General Surgery/Surgery/Medicine,Lexington, KY, USA
Introduction: Incisional hernia is one of the most common complications of abdominal surgery and repairs are associated with significant recurrence rates. Mesh repairs are associated with the best outcomes, but failures are not uncommon. Doxycycline, an antibiotic with antioxidant properties, has been demonstrated to enhance mesh hernia repair outcomes with associated increases in Collagen deposition and improved tensio-metric strength. This study compares the outcomes of incisional hernia repair with doxycycline administration and the antioxidant tempol.
Methods: 28 male Sprague Dawley rats were assigned to 4 groups: Control (C), Doxycycline (D), Tempol (T), and Doxycyline/Tempol (D/T). Animals underwent midline laparotomy with excision of 1x4cm strip of the midline fascia and repair with a 5 x 6 cm polypropylene mesh as an intraperitoneal underlay. Animals were administered saline, doxycycline (30mg/kg), tempol (20mg/kg), or both beginning one day prior to operation and then daily for 8 weeks. Abdominal wall was harvested at 8 weeks with analysis of tensio-metric strength and biochemical analysis.
Results:Animals were survived for 8 weeks. The tensiometric strength of the mesh to fascial interface was increased in the experiemental groups compared to control. (C-15.29, D-24.45, T-24.35, D/T-19.36 ) [Fig 1.]. Collagen 1 deposition was increased and Collagen 3 deposition was decreased in each of the experimental groups relative to control. MMP-2 and MMP-9 was decreased in doxycycline treatment groups.
Conclusion:The strength of a polypropylene hernia repair is enhanced with the administration of doxycycline and tempol. Dual therapy with doxycycline and tempol provided no benefit over treatment with a single agent. Treatment with these agents is associated with increased Collagen 1/3 ratios. The benefits of antioxidant treatment following hernia repair are similar to treatment with doxycycline. The mechanism of antioxidant mediated collagen-1 increases are not well understood and require further study. In light of the high frequency of incisional hernia repair failures, this study has implications for improving outcomes following ventral hernia repair through the use of either doxycycline or antioxidant therapy.
