Prospective Evaluation of Adhesion Formation and Shrinkage of Intra-Abdominal Prosthetics in a Rabbit Model

Abstract

Laparoscopic ventral hernia repair requires an intraperitoneal prosthetic; however, these materials are not without consequences. We evaluated host reaction to intraperitoneal placement of various prosthetics and the functional outcomes in an animal model. Mesh (n = 15 per mesh type) was implanted on intact peritoneum in New Zealand white rabbits. The mesh types included ePTFE (DualMesh®), ePTFE and polypropylene (Composix®), polypropylene and oxidized regenerated cellulose (Proceed®), and polypropylene (Marlex®). Adhesion formation was evaluated at 1, 4, 8, and 16 weeks using 2-mm mini-laparoscopy. Adhesion area, adhesion tenacity, prosthetic shrinkage, and compliance were evaluated after mesh explantation at 16 weeks. DualMesh® had significantly less adhesions than Proceed®, Composix®, or Marlex® at 1, 4, 8, and 16 weeks ( P < 0.0001). Marlex® had significantly more adhesions than other meshes at each time point ( P < 0.0001). There were no statistically significant differences in adhesions between Proceed® and Composix® meshes. After mesh explantation, the mean area of adhesions for Proceed® (4.6%) was less than for Marlex® (21.7%; P = 0.001). The adhesions to Marlex® were statistically more tenacious than the DualMesh® and Composix® groups. Overall prosthetic shrinkage was statistically greater for DualMesh® (34.7%) than for the remaining mesh types ( P < 0.01). Mesh compliance was similar between the groups. Prosthetic materials demonstrate a wide variety of characteristics when placed inside the abdomen. Marlex® formed more adhesions with greater tenacity than the other mesh types. DualMesh® resulted in minimal adhesions, but it shrank more than the other mesh types. Each prosthetic generates a varied host reaction. Better understanding of these reactions can allow a suitable prosthetic to be chosen for a given patient in clinical practice.

Porcine acellular lung matrix for wound healing and abdominal wall reconstruction: A pilot study

“… 23 These are plagued with a multitude of complications ranging from contraction to erosion and evisceration. 24 To address this, surgeons have looked to bioprosthetics as a solution to overcome the disadvantages of synthetic prosthetics. While biologically derived or biological material–based non-synthetic devices have shown some success, their place in the operative theater has been limited to repair in which infection is present.…”

Clinical Evaluation of the Use of Proceed ® Mesh in Reconstruction of Orbital Floor Fractures: Clinical Trial

“…Placement of ORC side facing the orbital soft tissue decreases but not prevent the adhesions between the mesh and the orbital soft tissue. Harrell AG et al (32), have evaluated the adhesion formation of intra-abdominal prosthetics in a rabbit model. They found that polypropylene mesh alone formed more adhesions with greater tenacity than Proceed mesh.…”

Bioprosthetic Mesh in Abdominal Wall Reconstruction

“…[11][12][13][14][15] The relative benefits of these different synthetic meshes with regard to adhesion formation, risk for infection, and outcomes have varied widely in different animal and human clinical studies. 9,13,[16][17][18][19] Furthermore, prospective data are lacking regarding the clinical benefits of these prostheses for ventral hernia repair, and no high-level evidence or comparative clinical data are currently available. Finally, lightweight polypropylene mesh with thinner-diameter polypropylene fibers and larger interstices is currently being used in both open and laparoscopic hernia repairs.…”