Mice Peritoneal Macrophage Activation Response to Surgical Suture Material

Objective: Studies have suggested that closure of the peritoneum at the time of cesarean may reduce adhesion formation postoperatively. Basic science implicates the macrophage as one of the primary initiators of the inflammatory response. Activated macrophages secrete inflammatory cytokines and other proteins noted to contribute to adhesion formation. The goal of this study is to identify which suture materials cause the least peritoneal macrophage activation as an indicator of inflammatory response and predictor of adhesion formation. Methods: Peritoneal macrophages were harvested from euthanized mice. The harvested cells were placed in culture for 12 hours prior to exposure to suture, PDS, 3–0 Vicryl, 3–0 Plain gut, 3–0 Chromic, or 3–0 Monocryl. Macrophage activation rates were documented at 24 hrs and 72 hrs for each treatment. The macrophage activation rate was calculated by counting the number of activated cells compared to partially activated or non–activated cells in the microscope field, then dividing each activation classification by the total number of cells in the field and multiplying by 100. Results: There is a direct correlation between the suture exposure and inflammatory response mediated by macrophages. Monofilament suture causes the least macrophage activation. Monocryl is predicted to cause less activation than PDS. Conclusion: The magnitude of inflammatory response mediated by macrophage activation in peritoneal exposure may be minimized by suture selection. Thus, choosing the correct suture in closure of the human peritoneum at the time of cesarean may reduce the inflammatory response and subsequently reduce adhesion formation.