Contents lists available at ScienceDirect Materials Science & Engineering C journal homepage: www.elsevier.com/locate/msec Polypropylene composite hernia mesh with anti-adhesion layer composed of polycaprolactone and oxidized regenerated cellulose Umran Aydemir Sezer a,b , Vildan Sanko c , Mehmet Gulmez d , Basak Aru e , Elif Sayman f , Ali Aktekin d , Fugen Vardar Aker f , Gulderen Yanıkkaya Demirel e , Serdar Sezer a,b, ⁎ a Suleyman Demirel University, Faculty of Medicine, Department of Pharmacology, Medicine, Medical Device and Dermocosmetic Research and Application Laboratory- IDAL, 32260 Isparta, Turkey b YETEM, Innovative Technologies Research and Application Center, Suleyman Demirel University, 32260 Isparta, Turkey c TUBITAK Marmara Research Center, Institute of Chemical Technology, 41470 Kocaeli, Turkey d Department of Surgery, Haydarpasa Numune Education and Research Hospital, 34688 Istanbul, Turkey e Yeditepe University, School of Medicine, Department of Immunology Section, 34755 Istanbul, Turkey f Department of Pathology, Haydarpasa Numune Education and Research Hospital, 34688 Istanbul, Turkey ARTICLE INFO Keywords: Polycaprolactone Oxidized regenerated cellulose Polypropylene Peritoneal adhesion Hernia ABSTRACT Hernia surgeries are at the top of the general surgery operations. However, visceral adhesion, which is one of the worst complications of these operations, is still a major problem. One of the most preferred methods to prevent adhesion is the use of biomaterials. Polypropylene (PP) mesh is frequently preferred product in clinical appli- cations owing to its mechanically robust structure against deformation within the body. However, PP meshes do not have anti-adhesive properties. Oxidized regenerated cellulose (ORC), on the other hand, is one of the most preferred products in preventing the adhesion in clinical use. ORC is not easily processable due to solubility limitations; and it must be used externally. In this study, for the first time, we designed a composite mesh structure with ORC and produced an antibacterial and anti-adhesive double-sided mesh by electro-spinning ORC micro-particles with poly(ε‑caprolactone) (PCL) on PP mesh to form a composite structure. We conducted in vitro cell culture studies to determine bio-compatibility performances. We evaluated the anti-adhesion and compre- hensive bio-compatibility studies through in vivo experiments. The results revealed that ORC presence and op- timization of ORC degradation by coating with PCL play an important role in adhesion prevention and in- troduced a product prototype with efficient anti-adhesion properties. 1. Introduction Hernia is a common disorder in the society. Since the only solution to this problem is surgery, hernia operations are at the top of the most frequently applied operations in general surgery [1,2]. Depending on the size of the hernia zone, the use of mesh is quite common in order to ensure the mechanical integrity of the zone during the surgical opera- tion. PP mesh is a product that has been accepted as a standard since 1950s [3]. Along with quite high mechanical properties and chemical stability, it has a flexible structure that is compatible with soft tissues on which it is applied [4–6]. On the other hand, adhesion is the most frequently encountered complication after the use of meshes in hernia operations especially in the abdominal zone [7]. Post-operative adhe- sions can lead to serious problems such as bowel obstruction and in- fertility in female individuals, and there is no other treatment than a second operation [8–11]. Various methods are employed to prevent adhesion. Drug treatment after surgery and the use of anti-adhesive bio-materials during opera- tion are among the most frequently used methods [12,13]. The use of anti-adhesive biomaterials comes to the forefront because it eliminates the systemic side effects of drug use and offers a local solution. For this purpose, external anti-adhesion barrier membranes can be used in ad- dition to the meshes for fixing the hernia zone. Alternatively, two-sided meshes with anti-adhesion properties at one side are preferred because they bring together two functions in one product. Various synthetic and natural polymers with hydrophilic and hydrophobic properties are combined with PP mesh as an adhesion barrier and put on the market [14]. However, none of these products have the desired level of success [2]. ORC is a remarkable material because it is biodegradable, https://doi.org/10.1016/j.msec.2019.02.064 Received 7 September 2018; Received in revised form 24 January 2019; Accepted 16 February 2019 ⁎ Corresponding author at: Suleyman Demirel University, Faculty of Medicine, Department of Pharmacology, Medicine, Medical Device and Dermocosmetic Research and Application Laboratory, 32260 Isparta, Turkey. E-mail address: serdarsezer@sdu.edu.tr (S. Sezer). Materials Science & Engineering C 99 (2019) 1141–1152 Available online 18 February 2019 0928-4931/ © 2019 Elsevier B.V. All rights reserved. T