Experimental study on synthetic and biological mesh implantation in a contaminated environment

Deerenberg, Eva B.; Mulder, Irene M.; Grotenhuis, Nienke; Ditzel, Max; Jeekel, J.; Lange, Johan F.

doi:10.1002/bjs.8954

Cited by 36 publications

(37 citation statements)

References 38 publications

(51 reference statements)

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“…The conclusion of Falgas’ study led to the introduction of a monofilament lightweight mesh containing less polypropylene into broad surgical practice [33]. Recently published papers by Sanders [34] and Deerenberg [35] are showing that low prosthetic load materials, i.e., lightweight meshes with large pores, may be beneficial. Certain permanent synthetic meshes might be somewhat infection-resistant and therefore useful for permanent hernia repair in a contaminated environment.…”

Section: Discussionmentioning

confidence: 99%

Effects of macroporous monofilament mesh on infection in a contaminated field

Bury

Śmietański²,

Bigda

et al. 2014

Langenbecks Arch Surg

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BackgroundThe aim of this study was to evaluate whether the type of the mesh and proper surgical technique can influence the outcome of a tension-free hernia repair in a contaminated filed.Materials and methodsThis study was based on the model of bacterial peritonitis in rats induced with a mixture composed of Escherichia coli and Bacteroides fragilis. Two animals were used as a control group without induced peritonitis and 10 animals with mesh implanted inside of the peritoneal cavity. For the 20 animals in the studied group, bacterial fluid was applied into the abdominal cavity together with the mesh implantation. In 10 cases, the mesh was fixed flatly upon the surface of the peritoneum; in the other 10, the mesh was rolled and then fixed within the peritoneal cavity. After 5 weeks, the animals were operated on again, and the meshes, the peritoneal fluid and, if present, any granulomas were taken for bacterial cultivation.ResultsThe results of the bacterial cultivation of the material from the control group (without mesh) and from the rats with flatly fixed mesh were almost completely negative (0/10 and 1/10, respectively). In 9 out of 10 rats that were exposed to the rolled mesh for 5 weeks, the colonisation of meshes with both B. fragilis and E. coli was found (p < 0.0198).ConclusionsWhen properly fixed, flat mesh, even in a contaminated field, may allow for a proper mesh healing and does not influence the ability to cure bacterial peritonitis in an animal model. A bad surgical technique, such as inadequately positioned or rolled mesh, may cause persistent peritoneal bacteraemia.

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Section: Discussionmentioning

confidence: 99%

Effects of macroporous monofilament mesh on infection in a contaminated field

Bury

Śmietański²,

Bigda

et al. 2014

Langenbecks Arch Surg

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“…Regarding the issue of mesh infection, a study by Engelsman relates the hydrophobia of PTFE to the susceptibility of persisting mesh bacterial colonisation [6] and Deerenberg et al [4] report an increased mesh infection of C-qur lite Ò in an infected environment.…”

Section: Foreign Body Reactionmentioning

confidence: 99%

The impact of hydrophobic hernia mesh coating by omega fatty acid on atraumatic fibrin sealant fixation

Gruber-Blum

Brand²,

Keibl

et al. 2014

Hernia

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“…[1214] If a mesh is used in a contaminated environment, consensus exists that a biological collagen mesh or a synthetic macroporous, monofilament mesh may be advantageous. [1223] Macroporous Parietene ® Composite meshes had a low risk of infection in an animal model,[14] which was explained by large pores allowing admission of macrophages, fibroplasia and angiogenesis, which in turn improves the ability to clear infection. [14] In this series coated materials did not appear to prevent infection, even though the PTX-Group was the only one without infected grafts on explantation.…”

Section: Discussionmentioning

confidence: 99%

“…[1213] As shown for an intra-abdominal model, in a clean environment antiadhesive coatings reduce adhesion formation to macroporous meshes and they may even be suitable for implantation in infected surgical sites. [14] As no published experience for full thickness chest wall resection and reconstruction with these meshes exists, we sought to examine their ingrowth pattern and bioincorporation as compared to uncoated polypropylene. Conventional polypropylene meshes are widely adopted due to ease of use and low cost.…”

mentioning

confidence: 99%

Properties of novel composite meshes in chest wall reconstruction: A comparative animal study

Zardo

Zhang

Freermann³

et al. 2014

Ann Thorac Med

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PURPOSE:Novel composite meshes routinely used in laparoscopic hernia repair reportedly lead to fewer and less dense visceral adhesions and may provide a viable alternative in thoracic surgery as well.METHODS:A total of 15 adult domestic pigs underwent full thickness chest wall resection and reconstruction with Parietene (polypropylene composite; PTE, n = 5), Parietex (polyester composite; PTX, n = 5) or Bard (purely polypropylene, n = 5) mesh. After an observation period of 90 days all animals were sacrificed, intrathoracic adhesions classified via thoracoscopy (VATS), meshes explanted and peak peal strength required for lung/mesh separation recorded.RESULTS:Adhesions assessed through VATS-exploration were strongest in the PTX-Group while PTE and BM showed comparable results. Tensiometric analyses of peak peal strength confirmed lower values in BM than for PTE and PTX. Both composite materials showed good overall bioincorporation with post-surgical perigraft-fibrosis being strongest in BM.CONCLUSION:We consider composite grafts a suitable alternative for chest wall reconstruction. They are characterized by good overall biointegration and limited perigraft-fibrosis, thus potentially facilitating redo-procedures, even though a hydrophilic coating per se does not appear to prevent intrathoracic adhesion formation.

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Experimental study on synthetic and biological mesh implantation in a contaminated environment

Abstract: Parietene Composite(®) and Omyramesh(®) performed well in a contaminated environment. Strattice(®) had little adhesion formation and no mesh infection, but poor incorporation. Some synthetic meshes can be as resistant to infection as biological meshes.

Cited by 36 publications

References 38 publications

Effects of macroporous monofilament mesh on infection in a contaminated field

Effects of macroporous monofilament mesh on infection in a contaminated field

The impact of hydrophobic hernia mesh coating by omega fatty acid on atraumatic fibrin sealant fixation

Properties of novel composite meshes in chest wall reconstruction: A comparative animal study

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