The Role of Suture Fixation on Mesh Contraction after Abdominal Hernia Repair

Abstract

Mesh contraction is a threat for hernia repair. Our aim is to analyze the effects of fixation techniques on mesh contraction. Forty-eight rats with abdominal wall defects were equally divided into four groups (G): G1 (control) with no repair, G2 defects were repaired with free polypropylene mesh, and G3 and G4 defects were reinforced with prolene mesh fixed by running and interrupted sutures, respectively. The corners of the defect and prolene mesh were marked with silver clips. The contraction rate was calculated by radiological measurement of distances between corner clips and by measuring the mesh areas after harvesting abdominal wall containing the patch. Host reaction was histhopathologically and biochemically examined by inflammation score, fibroblast count, thickness of the granulation tissue, and tissue hydroxyproline level. Distances between corner clips and mesh area have decreased by 31.5% and 26.4% respectively in G2, while in G3 the decrease was 24.4% (p = .008) and 22% (p = .01), respectively. Granulation tissue thickness was highest in the group with mesh fixed by running suture. The tissue hydroxyproline levels were similar in mesh repair groups. Our study suggests that mesh contraction, which reduces mesh surface, occurs during the wound healing process. In order to decrease the contraction rate, it is important to keep the mesh in place until its incorporation into the surrounding tissue. Our results suggest that mesh contraction is minimized by suture fixation, and running fixation suture, which provides more balanced tension around the mesh, seems more beneficial for decreasing contraction rate.

Comparative Analysis of Graft Structure Retraction and Tissue Integration of Urogynecology Synthetic Grafts - An Experimental Study

“…The inversely influenced filament thickness on retraction is also important. Other studies reported significantly lower retraction rates (10) but with graft placement over the intact fascia. One of the most prominent researchers reports that the LWPP had lower retraction rates due to induction of weaker immune response (11), which is in keeping with our results.…”

Application of Acellular Tissue Matrix for Enhancement of Weak Abdominal Wall in Animal Model

“…Biological ACTM may possibly reduce the shrinkage on the basis of its repairing mechanism different from polypropylene mesh. e polypropylene mesh is nonabsorbent; thus, the repair relies on the contraction of scar tissue [5]. e ACTM degrades while tissue grows; thus, the repair makes the use of tissue regeneration [41].…”

“…Moreover, the mesh used in abdominal hernia repair is less suitable for the weak abdominal wall treatment. Based on the scar repair to tighten surrounding tissues, the classical polypropylene mesh results in the decrease of local abdominal wall compliance after healing and brings strong discomfort when patients move the waist [5]. Besides, the increasing risk of infection from effusion stimulated by exogenous polypropylene mesh and unsatisfied therapeutic improvement of abdominal muscle strength after polypropylene mesh implantation are in urgent need to be solved.…”

“…Meanwhile, the biomaterial scaffold itself can be gradually degraded and absorbed and utilized by the body, since the main component of the acellular matrix repair material is protein including collagen fibers, glycoproteins, and mucins [7]. e mechanism of acellular tissue matrix repair is that the implanted biological materials gradually degrade and are replaced by host tissue with the two processes almost in synchronization, unlike the mechanism of traditional nonabsorbent synthetic polymer material patch repair relying on the body inflammation to stimulate the formation of continuously enhanced fibrotic scar tissue [5,8]. More importantly, the acellular tissue matrix attracts and induces stem cells to secrete the extracellular matrix to replace the gradually degraded biomaterial.…”

Effectiveness of polypropylene mesh coated bovine amniotic membrane with adhesion barrier (polyethylene glycol) in repair of abdominal wall hernias in rats

“…It was reported that running suture technique, which provides more balanced tension around the mesh until its integration into adjacent healthy tissue, to be more useful for decreasing of mesh contraction (Sekmen et al 2009). The continuous suture pattern was used within the inlay technique, in which the breakdown of one stitch results in the dehiscence of the whole suture line.…”