Adhesions and Meshes

Abstract

Adhesions are common after intra-abdominal surgery and are associated with significant morbidity, including bowel obstruction, pain, and infertility. Abdominal wall reconstruction carries the risk of adhesion formation, notably to synthetic or bioprosthetic mesh. This article reviews the pathophysiology of adhesion formation, adhesion grading, and adhesions to synthetic and biologic mesh in vitro and clinically. Bioprosthetic mesh in vitro appears to elicit fewer lower-grade adhesions than synthetic mesh. However, direct comparisons in humans of adhesions with synthetic versus bioprosthetic mesh are lacking. Future studies are warranted to determine whether there are significant differences in clinical outcomes, especially regarding secondary complications from adhesions.

Peritoneal Adhesions Type I, Iii and Total Collagen on Polypropylene and Coated Polypropylene Meshes: Experimental Study in Rats

“…Because the coated prosthesis is a new therapy in the treatment of hernia, there are scarce studies on human beings, therefore the animal study model is appropriate for the objectives of the research study. Direct comparisons of non-absorbable materials to biologically absorbable materials in humans are scarce, and long term complications are uncertain 26 .…”

“…Fibrin deposition results in a matrix where the fibroblasts produce extracellular matrix. The end of the process generates various degrees of adhesion 26 . There are many attempts at inhibiting or minimizing this reaction, considering the morbidity involved in the adhesions.…”

“…There are many attempts at inhibiting or minimizing this reaction, considering the morbidity involved in the adhesions. The bio-prostheses seek native tissue repair with less inflammatory activity and foreign body formation 26 . An experimental study in rabbits showed that up to 40% of the meshes structured with polypropylene, even coated with bio-absorbable materials, cause adhesions in an animal model 19 .…”

Biomaterial Implants in Abdominal Wall Hernia Repair: A Review on the Importance of the Peritoneal Interface

“…Adhesions are responsible for the majority of bowel obstructions in the Western world [58]. For these reasons, postoperative adhesions remain one of the most challenging issues in surgical practice [59][60][61].…”

Emerging Trends in Abdominal Wall Reinforcement: Bringing Bio‐Functionality to Meshes

“…Unfortunately, as the mesh is placed in direct contact to visceral tissues, IPOM technique can promote abdominal adhesions. These adhesions can affect all intraperitoneal tissues and when left untreated, can lead to chronic pain, bowel obstruction and bowel perforation . From a pathophysiological outlook, abdominal tissue adhesion corresponds to the formation of fibrosis between the material surface and the peritoneal cavity and is estimated to occur in more than 90% of hernia procedures .…”