Reduction of abdominal adhesions using composite collagen-GAG implants for ventral hernia repair

Structural biomaterials can restore abdominal wall integrity but may cause adhesions to the underlying viscera. Collagen-glycosaminoglycan (CG) matrices induce the formation of connective tissue and may reduce adhesion formation to permanent biomaterials such as polypropylene (PP) mesh. Composite implants were created by interposing PP mesh within a porous CG matrix created composite implants. The implants were cross-linked with glutaraldehyde one group (CG-G/PP) or left untreated (CG-nG/PP) and compared to PP mesh. At 4 weeks, the abdominal wall was assessed for the degree of adhesions. The composite implants developed a nascent connective tissue-like structure that reduced adhesions to the bowel. The thickest connective tissue developed in the CG-G/PP group (0.7 +/- 0.1 mm) and thinnest in the PP mesh (0.05 +/- 0.01 mm). The surface area covered with adhesions was greatest in the PP group (72 +/- 17%) compared with the CG-G/PP group (28 +/- 15%) or the CG-nG/PP group (21 +/- 8%). Bowel preferentially adhered to the PP mesh, whereas omentum had some adherence to all constructs. Integrating a biodegradable extracellular matrix analog with a permanent structural biomaterial reduced adhesions in this animal model. Alterations in cross-linking of the CG matrix altered the biological response. This technology may be useful in reconstructive surgery by reducing adhesion formation, while maintaining the strength of permanent structural biomaterials.