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

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. Thirty-six Wistar-Albino rats were used in the study. Four rats were used to obtain platelet-rich fibrin. Remaining rats were divided to four separate groups. In sham group, abdominal wall was repaired by suture without mesh following laparotomy. Abdominal walls of remaining rats 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. Rats were sacrificed on the 14th postoperative day. Macroscopic Zühlke and Greca adhesion scores, histopathological fibrosis grading and multinucleated giant cells were evaluated. 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. Giant cell formation, an indicator of inflammation, 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). Platelet-rich fibrin significantly reduces the incidence of adhesion to polypropylene meshes in the early postoperative period and enhances fibrosis at the mesh-abdominal wall interface. Acting as a biological barrier, platelet-rich fibrin shows potential as an alternative to composite meshes and antiadhesive barriers.