Effect of prosthetic material on adhesion formation after laparoscopic ventral hernia repair in a porcine model

Abstract

Intraperitoneal placement of prosthetic mesh causes adhesion formation after laparoscopic incisional hernia repair. A prosthesis that prevents or reduces adhesion formation is desirable. In this study, 21 pigs were randomized to receive laparoscopic placement of plain polypropylene mesh (PPM), expanded polytetrafluoroethylene (ePTFE), or polypropylene coated on one side with a bioresorbable adhesion barrier (PPM/HA/CMC). The animals were sacrificed after 28 days and evaluated for adhesion formation. Mean area of adhesion formation was 14% (SD+/-15) in the PPM/HA/CMC group, 40% (SD+/-17) in the PPM group, and 41% (SD+/-39) in the ePTFE group. The difference between PPM/HA/CMC and PPM was significant ( P=0.013). A new visceral layer of mesothelium was present in seven out of seven PPM/HA/CMC cases, six out of seven PPM cases, and two out of seven ePTFE cases. Thus, laparoscopic placement of PPM/HA/CMC reduces adhesion formation compared to other mesh types used for laparoscopic ventral hernia repairs.

Comparative Evaluation of Adhesions to Intraperitoneally Placed Fixation Materials: A Laparoscopic Study in Rats

“…While secure fixation is a desired property of the fixation material, adhesions are not [9]. Tacks were known to cause fewer adhesions than the transfixion sutures [10]. The hyaluronic acid/carboxymethylcellulose covering of the mesh grafts by migrating over the metal tacks or remesothelialization over the foreign body, prevented adhesion formation to the tacks [10].…”

“…Foreign material, ischemic or avascular tissue, and factors that decrease peritoneal plasminogen activity cause intra-abdominal adhesions [6,8]. Most adhesions after LVHR are between the intraabdominal viscera and the prosthetic mesh graft but vary due to the nature of the graft itself [9][10][11]. In clinical aspects, intraabdominal adhesions may cause mechanical intestinal obstruction, intestinal fistula, early or late postoperative pain.…”

Reparo intraperitoneal de defeitos da parede ventral do abdome com telas de poliéster com colágeno e polipropileno com ácido poliglicólico

“…The choice of meshes is easily justified by the current interest in composite meshes, which can prevent the formation of intra-abdominal adhesions when exposed to the inside of the peritoneal cavity and, at the same time, confer adequate tensile strength to the abdominal wall on the side that is apposed to the musculature 8 . Therefore, in order to establish a comparison, two mesh types were used: a commercially available meshmade of polyester and coated with polyethylene-glycolglycerol collagen (Parietex®, Covidien), with good results in various experimental studies 8,[22][23][24] and another one comprising two superimposed meshes: polypropylene (Optilene® Mesh Elastic, BBD Aesculap) and polyglycolic acid (Safil®, BBD Aesculap).…”

“…This membrane covering the polyester on its peritoneal surface includes an oxidized solution of bovine type I collagen in its composition, in addition to polyethylene-glycol and glycerol. It features the qualities of being hydrophilic and completely absorbable in approximately three weeks 24 . Following resorption, a new layer of peritoneum forms over the mesh, maintaining its isolation from the intra-abdominal organs 24 .…”

Investigation into the optimal prosthetic material for wound healing of abdominal wall defects

“…Hernia repair treatment has improved recently, in parallel with the development in the technological era (4). Synthetic materials increase the tissue durability while used in abdominal hernias but on the other hand these materials cause intra-abdominal adhesions especially in the wide defects (5).…”