Relationship Between Tissue Ingrowth and Mesh Contraction

Abstract

Contraction is a well-documented phenomenon occurring within two months of mesh implantation. Its etiology is unknown, but it is suggested to occur as a result of inadequate tissue ingrowth into the mesh and has been associated with hernia recurrence. In continuation of our previous studies, we compared tissue ingrowth characteristics of large patches of polyester (PE) and heavyweight polypropylene (PP) and their effect on mesh contraction. The materials used were eight PE and eight PP meshes measuring 10 x 10 cm2. After random assignment to the implantation sites, the meshes were fixed to the abdominal wall fascia of swine using interrupted polypropylene sutures. A necropsy was performed three months after surgery for evaluation of mesh contraction/shrinkage. Using a tensiometer, tissue ingrowth was assessed by measuring the force necessary to detach the mesh from the fascia. Histologic analysis included inflammatory and fibroblastic reactions, scored on a 0-4 point scale. One swine developed a severe wound infection that involved two PP meshes and was therefore excluded from the study. The mean area covered by the PE meshes (87 +/- 7 cm2) was significantly larger than the area covered by the PP meshes (67 +/- 14 cm2) (p = 0.006). Tissue ingrowth force of the PE meshes (194 +/- 37 N) had a trend toward being higher than that of the PP meshes (159 +/- 43 N), although it did not reach statistical significance. There was no difference in histologic inflammatory and fibroblastic reactions between mesh types. There was a significant correlation between tissue ingrowth force and mesh size (p = 0.03, 95% CI: 0.05-0.84). Our results confirm those from previous studies in that mesh materials undergo significant contraction after suture fixation to the fascia. PE resulted in less contraction than polypropylene. A strong integration of the mesh into the tissue helps prevent this phenomenon, which is evidenced by a significant correlation between tissue ingrowth force and mesh size.

The Use of Biomaterials to Treat Abdominal Hernias

“…They also allow more immunocompetent cells to enter, providing protection from infection-causing germs. The larger the pore diameter, the greater and faster will be the fibroplasia and angiogenesis (Gonzalez et al, 2005). On the other hand, there will also be a greater risk of adhesions when the screen is inserted in the intraperitoneal space, especially if it is in contact with the viscerae; it may also promote erosion and fistula formation (Hutchinson et al, 2004;Mathews et al, 2003;Melo et al, 2003 (Erle & Mark, 2008).…”

“…It is a light, soft, flexible, elastic material, in a single direction. Its wide meshes encourage fibroblastic migration making it easier for tissue to incorporate -its pores are even greater than those of the PP, which is believed to allow faster cell migration and greater intensity of adherence to the underlying fascia (Gonzalez et al, 2005). It has good resistance to infection, although its threads are multifilament.…”

Abdominal Wall Hernia Mesh Repair

“…This irregular appearance due to "mesh shrinkage" is a function of the healing process, with scarring and incorporation of the mesh implant into the adjacent tissues. 10 By increasing the field of view (depth), the posterior acoustic shadowing may be better appreciated, increasing confidence for identification of mesh ( Figure 15). Implanted mesh for inguinal hernia repair may remain difficult to identify, and clinical information indicating the presence of mesh is important.…”

A Rare Cause of Acute Abdomen; Migration of Mesh Into Ileum: Case Report

“…2 Mesh serilmesini takip eden süreçte seroma, granülom, fistül oluşumu ve kronik ağrı gibi komplikasyonlarla beraber, mesh kontraksiyonu ve migrasyonunun fıtık nükslerinde etkisinin olabileceği düşünülmektedir. 3 Bu makalenin amacı, acil servise başvuran hastalarda ayrıntılı anamnezin önemini ve meshe ait komplikasyonların nadiren de olsa akut batın bulgularına yol aça-bileceğini vurgulamaktır.…”

“…In this study, we presented a 56-year-old female patient who presented to our clinic with acute abdomen with a history of ventral hernia repair using mesh. Fahrettin ACAR, 3 , düz karın grafisinde hava sıvı seviyeleri, karın ultrasonunda cilt altı hava ve sıvı birikimi saptanması üze-rine, bilgilendirilmiş oluru alınarak hasta acil ameliyata alındı. Göbek altı eskaratomisi geniş olacak şekilde cilt ve cilt altı dokuları disseke edilen hastada perfore fıtık kesesi ve intestinal içerik ile karşılaşıldı.…”