Characteristics of different mesh types for abdominal wall repair in an experimental model of peritonitis

Abstract

This experimental study suggested that XCM Biologic was superior in terms of incorporation, macroscopic mesh infection, and histological parameters such as collagen deposition and neovascularization. There must be sufficient overlap of mesh during placement, as XCM Biologic showed a high rate of shrinkage. Surgical relevance The use of synthetic mesh to repair a potentially contaminated incisional hernia is not supported unequivocally, and may lead to a higher failure rate. A biological mesh might be considered as an alternative. There are few long-term studies, as these meshes are expensive and rarely used. This study evaluated the use of biological mesh in a contaminated environment, and investigated whether there is an ideal mesh. A new non-cross-linked biological mesh (XCM Biologic ) was evaluated in this experiment. The new non-cross-linked biological mesh XCM Biologic performed best and may be useful in patients with a potentially contaminated incisional hernia.

Non-Cross-Linked Collagen Mesh Performs Best in a Physiologic, Noncontaminated Rat Model

“…Parietene and XCM Biologic showed a moderate amount of shrinkage (9% and 10% after 180 days) in this study. This is contrary to a previous study, in which a very high percentage of shrinkage was found in XCM Biologic (21 16 It is unclear why XCM Biologic shrunk excessively in the presence of infection and shrunk less in a physiologic, noncontaminated environment. This finding could again be explained by a more fulminant foreign body response in XCM Biologic in a contaminated environment versus a noncontaminated environment.…”

“…A previous study from this research group with the same mesh materials in a contaminated environment showed similar results for mesh incorporation in Permacol and Strattice. 16 XCM Biologic, however, had a much higher incorporation of the mesh in a contaminated environment than in a physiologic, non-contaminated environment (88 [interquartile range [IQR]: 72-100] % versus 43 ± 12 SD % after 180 days). The other meshes showed a comparable incorporation after 180 days in both the contaminated environment (median [IQR]) and the physiologic, noncontaminated environment (mean ± SD) (Parietene 57 [32-87] % vs 56 ± 9%, Permacol 62 [58-67] % vs 62 ± 11%, Strattice 21 [10-30] % vs 23 ± 13%, and Omyra Mesh 54 [40-66] % vs 58 ± 20%).…”

“…The other meshes showed a comparable incorporation after 180 days in both the contaminated environment (median [IQR]) and the physiologic, noncontaminated environment (mean ± SD) (Parietene 57 [32-87] % vs 56 ± 9%, Permacol 62 [58-67] % vs 62 ± 11%, Strattice 21 [10-30] % vs 23 ± 13%, and Omyra Mesh 54 [40-66] % vs 58 ± 20%). 16 When reviewing the histological parameters of XCM Biologic in a contaminated environment versus a noncontaminated environment, all the following parameters scored much higher values in the contaminated environment: the total number of inflammatory cells, macrophages and foreign body giant cells, mononuclear cells, and the amount of collagen deposition. It is possible that a more fulminant inflammatory response led to a better incorporation of XCM Biologic in a contaminated environment.…”

“…This model is contrary to a previous study from this research group in which the same meshes were examined in a contaminated intraperitoneal environment to assess their characteristics in the presence of a fulminant infection. 16…”

Systematic review of the stage of innovation of biological mesh for complex or contaminated abdominal wall closure

“…In a rat study of 85 laparoscopic ventral hernia repairs, Strattice™ and Parietex™ (Covidien Surgical, Dublin, Ireland) were seen to grow a new mesothelial layer on their visceral side, whereas microscopic degradation and new collagen formation were seen in the Surgisis ® group. In a mouse model of 135 mice with peritonitis, XCM BIOLOGIC ® (LifeCell, KCI, Branchburg, New Jersey, USA) and Permacol™ showed better incorporation than Strattice™, whereas Strattice™ had fewer strong adhesions. More accurate information from human studies may allow improved selection of mesh for patients in future clinical practice.…”