Skip to main content
SpringerLink
Log in

Intraperitoneal onlay mesh: an experimental study of adhesion formation in a sheep model

  • Original Article
  • Published:
Hernia Aims and scope Submit manuscript

Abstract

Purpose

Current hernia literature shows that the use of mesh in ventral hernia repair reduces the risk of recurrence significantly. In laparoscopic repair, the mesh is placed intraperitoneally. Accordingly, the close contact between mesh and viscera involves a risk of adhesion formation. In this experimental study, we examined the degree of de novo adhesion formation over time to currently available meshes.

Methods

Sixteen sheep each received laparoscopic placement of four (10 × 10 cm) meshes on intact peritoneum. Two different mesh materials (coated vs. non-coated) and two different fixation devices (absorbable/non-absorbable) were investigated. (Parietex®Composite, DynaMesh®IPOM, ProTack™ and AbsorbaTack™). After 3, 6, 12 and 18 months, four animals, respectively, underwent a new laparoscopy to determine the extent of adhesions to the mesh.

Results

Parietex®Composite significantly reduced the formation of intraabdominal adhesions compared to DynaMesh®IPOM. The mean extent of adhesions increases over time without reaching a steady state within the first 12 months after laparoscopic placement.

Conclusions

This is the first long-term (18 months) experimental study on adhesion formation in sheep after laparoscopic placement of mesh and may serve as a template for future studies on meshes before marketing.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Sorensen LT, Hemmingsen UB, Kirkeby LT, Kallehave F, Jorgensen LN (2005) Smoking is a risk factor for incisional hernia. Arch Surg 140:119–123

    Article  PubMed  Google Scholar 

  2. George CD, Ellis H (1986) The results of incisional hernia repair: a 12-year review. Ann R Coll Surg Engl 68:185–187

    CAS  PubMed  Google Scholar 

  3. Usher FC, Ochsner J, Tuttle LL Jr (1958) Use of marlex mesh in the repair of incisional hernias. Am Surg 24:969–974

    CAS  PubMed  Google Scholar 

  4. LeBlanc KA, Booth WV (1993) Laparoscopic repair of incisional abdominal hernias using expanded polytetrafluoroethylene: preliminary findings. Surg Laparosc Endosc 3:39–41

    CAS  PubMed  Google Scholar 

  5. McGreevy JM, Goodney PP, Birkmeyer CM, Finlayson SR, Laycock WS, Birkmeyer JD (2003) A prospective study comparing the complication rates between laparoscopic and open ventral hernia repairs. Surg Endosc 17:1778–1780

    Article  CAS  PubMed  Google Scholar 

  6. Goodney PP, Birkmeyer CM, Birkmeyer JD (2002) Short-term outcomes of laparoscopic and open ventral hernia repair: a meta-analysis. Arch Surg 137:1161–1165

    Article  PubMed  Google Scholar 

  7. Carbajo MA, Martin del Olmo JC, Blanco JI, de la CC, Toledano M, Martin F, Vaquero C, Inglada L (1999) Laparoscopic treatment vs. open surgery in the solution of major incisional and abdominal wall hernias with mesh. Surg Endosc 13:250–252

    Article  CAS  PubMed  Google Scholar 

  8. Velanovich V (2000) Laparoscopic vs open surgery: a preliminary comparison of quality-of-life outcomes. Surg Endosc 14:16–21

    Article  CAS  PubMed  Google Scholar 

  9. Itani KM, Neumayer L, Reda D, Kim L, Anthony T (2004) Repair of ventral incisional hernia: the design of a randomized trial to compare open and laparoscopic surgical techniques. Am J Surg 188:22S–29S

    Article  PubMed  Google Scholar 

  10. Lomanto D, Iyer SG, Shabbir A, Cheah WK (2006) Laparoscopic versus open ventral hernia mesh repair: a prospective study. Surg Endosc 20:1030–1035

    Article  CAS  PubMed  Google Scholar 

  11. Carbajo MA, Martp del Olmo JC, Blanco JI, Toledano M, de la CC, Ferreras C, Vaquero C (2003) Laparoscopic approach to incisional hernia. Surg Endosc 17:118–122

    Article  CAS  PubMed  Google Scholar 

  12. Cassar K, Munro A (2002) Surgical treatment of incisional hernia. Br J Surg 89:534–545

    Article  CAS  PubMed  Google Scholar 

  13. Cobb WS, Kercher KW, Matthews BD, Burns JM, Tinkham NH, Sing RF, Heniford BT (2006) Laparoscopic ventral hernia repair: a single center experience. Hernia 10:236–242

    Article  CAS  PubMed  Google Scholar 

  14. Heniford BT, Park A, Ramshaw BJ, Voeller G (2003) Laparoscopic repair of ventral hernias: nine years’ experience with 850 consecutive hernias. Ann Surg 238:391–399

    PubMed  Google Scholar 

  15. Korenkov M, Sauerland S, Arndt M, Bograd L, Neugebauer EA, Troidl H (2002) Randomized clinical trial of suture repair, polypropylene mesh or autodermal hernioplasty for incisional hernia. Br J Surg 89:50–56

    Article  CAS  PubMed  Google Scholar 

  16. Luijendijk RW, Hop WC, van den Tol MP, de L, Braaksma MM, IJzermans JN, Boelhouwer RU, de Vries BC, Salu MK, Wereldsma JC, Bruijninckx CM, Jeekel J (2000) A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med 343:392–398

    Article  CAS  PubMed  Google Scholar 

  17. Olmi S, Magnone S, Erba L, Bertolini A, Croce E (2005) Results of laparoscopic versus open abdominal and incisional hernia repair. JSLS 9:189–195

    PubMed  Google Scholar 

  18. Olmi S, Scaini A, Cesana GC, Erba L, Croce E (2007) Laparoscopic versus open incisional hernia repair: an open randomized controlled study. Surg Endosc 21:555–559

    Article  CAS  PubMed  Google Scholar 

  19. Ramshaw BJ, Esartia P, Schwab J, Mason EM, Wilson RA, Duncan TD, Miller J, Lucas GW, Promes J (1999) Comparison of laparoscopic and open ventral herniorrhaphy. Am Surg 65:827–831

    CAS  PubMed  Google Scholar 

  20. Sanchez LJ, Bencini L, Moretti R (2004) Recurrences after laparoscopic ventral hernia repair: results and critical review. Hernia 8:138–143

    Article  CAS  PubMed  Google Scholar 

  21. van GH (2007) Consequences and complications of peritoneal adhesions. Colorectal Dis 9(Suppl 2):25–34

    Google Scholar 

  22. Tingstedt B, Andersson E, Isaksson K, Andersson R (2008) Clinical impact of abdominal adhesions: what is the magnitude of the problem? Scand J Gastroenterol 43:255–261

    Article  PubMed  Google Scholar 

  23. Becker JM, Dayton MT, Fazio VW, Beck DE, Stryker SJ, Wexner SD, Wolff BG, Roberts PL, Smith LE, Sweeney SA, Moore M (1996) Prevention of postoperative abdominal adhesions by a sodium hyaluronate-based bioresorbable membrane: a prospective, randomized, double-blind multicenter study. J Am Coll Surg 183:297–306

    CAS  PubMed  Google Scholar 

  24. Conze J, Junge K, Klinge U, Weiss C, Polivoda M, Oettinger AP, Schumpelick V (2005) Intraabdominal adhesion formation of polypropylene mesh. Influence of coverage of omentum and polyglactin. Surg Endosc 19:798–803

    Article  CAS  PubMed  Google Scholar 

  25. Vant RM, De Vos Van Steenwijk PJ, Bonthuis F, Marquet RL, Steyerberg EW, Jeekel J, Bonjer HJ (2003) Prevention of adhesion to prosthetic mesh: comparison of different barriers using an incisional hernia model. Ann Surg 237:123–128

    Article  Google Scholar 

  26. Amid PK (2001) Bioabsorbable membrane prevents adhesions to polypropylene in rats. Hernia 5:56

    Article  CAS  PubMed  Google Scholar 

  27. Kiudelis M, Jonciauskiene J, Deduchovas O, Radziunas A, Mickevicius A, Janciauskas D, Petrovas S, Endzinas Z, Pundzius J (2007) Effects of different kinds of meshes on postoperative adhesion formation in the New Zealand white rabbit. Hernia 11:19–23

    Article  CAS  PubMed  Google Scholar 

  28. Harrell AG, Novitsky YW, Peindl RD, Cobb WS, Austin CE, Cristiano JA, Norton JH, Kercher KW, Heniford BT (2006) Prospective evaluation of adhesion formation and shrinkage of intra-abdominal prosthetics in a rabbit model. Am Surg 72:808–813

    PubMed  Google Scholar 

  29. Demir U, Mihmanli M, Coskun H, Dilege E, Kalyoncu A, Altinli E, Gunduz B, Yilmaz B (2005) Comparison of prosthetic materials in incisional hernia repair. Surg Today 35:223–227

    Article  PubMed  Google Scholar 

  30. Matthews BD, Mostafa G, Carbonell AM, Joels CS, Kercher KW, Austin C, Norton HJ, Heniford BT (2005) Evaluation of adhesion formation and host tissue response to intra-abdominal polytetrafluoroethylene mesh and composite prosthetic mesh. J Surg Res 123:227–234

    Article  CAS  PubMed  Google Scholar 

  31. Borrazzo EC, Belmont MF, Boffa D, Fowler DL (2004) Effect of prosthetic material on adhesion formation after laparoscopic ventral hernia repair in a porcine model. Hernia 8:108–112

    Article  CAS  PubMed  Google Scholar 

  32. Schug-Pass C, Tamme C, Tannapfel A, Kockerling F (2006) A lightweight polypropylene mesh (TiMesh) for laparoscopic intraperitoneal repair of abdominal wall hernias: comparison of biocompatibility with the DualMesh in an experimental study using the porcine model. Surg Endosc 20:402–409

    Article  CAS  PubMed  Google Scholar 

  33. Schug-Pass C, Sommerer F, Tannapfel A, Lippert H, Kockerling F (2009) The use of composite meshes in laparoscopic repair of abdominal wall hernias: are there differences in biocompatibily? Experimental results obtained in a laparoscopic porcine model. Surg Endosc 23:487–495

    Article  PubMed  Google Scholar 

  34. Morales-Conde S, Cadet H, Cano A, Bustos M, Martin J, Morales-Mendez S (2005) Laparoscopic ventral hernia repair without sutures–double crown technique: our experience after 140 cases with a mean follow-up of 40 months. Int Surg 90:S56–S62

    PubMed  Google Scholar 

  35. TheSurgical Membrane Study Group (1992) Prophylaxis of pelvic sidewall adhesions with Gore-Tex surgical membrane: a multicenter clinical investigation. Fertil Steril 57:921–923

    Google Scholar 

  36. Schreinemacher MH, Emans PJ, Gijbels MJ, Greve JW, Beets GL, Bouvy ND (2009) Degradation of mesh coatings and intraperitoneal adhesion formation in an experimental model. Br J Surg 96:305–313

    Article  CAS  PubMed  Google Scholar 

  37. diZerega GS, Campeau JD (2001) Peritoneal repair and post-surgical adhesion formation. Hum Reprod Update 7:547–555

    Article  CAS  PubMed  Google Scholar 

  38. Duron JJ (2007) Postoperative intraperitoneal adhesion pathophysiology. Colorectal Dis 9(Suppl 2):14–24

    Article  PubMed  Google Scholar 

  39. Holmdahl L (1997) The role of fibrinolysis in adhesion formation. Eur J Surg 163(Suppl 577):24–31

    Google Scholar 

  40. Ellis H (1971) The cause and prevention of postoperative intraperitoneal adhesions. Surg Gynecol Obstet 133:497–511

    CAS  PubMed  Google Scholar 

  41. Curfman GD, Morrissey S, Drazen JM (2009) The medical device safety act of 2009. N Engl J Med 360:1550–1551

    Article  CAS  PubMed  Google Scholar 

  42. Ladurner R, Drosse I, Seitz S, Plitz W, Barbaryka G, Siebeck M, Burklein D, Kirchhoff C, Buhman S, Mutschler W, Schieker M, Mussack T (2008) Tissue attachment strength and adhesion formation of intraabdominal fixed meshes with cyanoacrylat glues. Eur J Med Res 13:185–191

    PubMed  Google Scholar 

  43. Morales-Conde S (2008) Tissell in open and laparooscopic venttral hernia repair. Abstract book. 30th E.H.S congress, Sevilla, Spain

    Google Scholar 

  44. Olmi S, Scaini A, Erba L, Croce E (2008) Use of fibrin glue (tissucol) in laparoscopic repair of abdominal wall defects: preliminary experience. Abstract book. 30th E.H.S congress, Sevilla, Spain

    Google Scholar 

  45. Schug-Pass C, Lippert H, Kockerling F (2009) Fixation of mesh to the peritoneum using a fibrin glue: investigations with a biomechanical model and an experimental laparoscopic porcine model. Surg Endosc 23:2809–2815

    Article  Google Scholar 

Download references

Acknowledgments

This study was supported by the Aase and Ejnar Danielsen Foundation, Johnson & Johnson, Kebo Med A/S and Covidien A/S, Denmark. The funders and manufacturers were not involved in the study design, data extraction or analysis. The authors wish to acknowledge help from the staff of Aarhus University’s farm for experimental animal studies.

Conflict of interest statement

The authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Surgical Department, Horsens Regional Hospital, Sundvej 30, 8700, Horsens, Denmark

    N. B. Zinther & H. Friis-Andersen

  2. Scientific Unit, Horsens Regional Hospital, Sundvej 30, 8700, Horsens, Denmark

    N. B. Zinther

  3. Surgical Department P, Aarhus University Hospital, Tage Hansens Gade 2, 8000, Århus C, Denmark

    P. Wara

Authors
  1. N. B. Zinther
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Wara
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. H. Friis-Andersen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to N. B. Zinther.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zinther, N.B., Wara, P. & Friis-Andersen, H. Intraperitoneal onlay mesh: an experimental study of adhesion formation in a sheep model. Hernia 14, 283–289 (2010). https://doi.org/10.1007/s10029-009-0622-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10029-009-0622-y

Keywords

Search

Navigation