Advertisement

Prevention of adhesion formation to polypropylene mesh by collagen coating: A randomized controlled study in a rat model of ventral hernia repair

  • M. van’t Riet
  • J. W. A. Burger
  • F. Bonthuis
  • J. Jeekel
  • H. J. BonjerEmail author
Original article

Abstract

Introduction

In laparoscopic incisional hernia repair with intraperitoneal mesh, concern exists about the development of adhesions between bowel and mesh, predisposing to intestinal obstruction and enterocutaneous fistulas. The aim of this study was to assess whether the addition of a collagen coating on the visceral side of a polypropylene mesh can prevent adhesion formation to the mesh.

Method

In 58 rats, a defect in the muscular abdominal wall was created, and a mesh was fixed intraperitoneally to cover the defect. Rats were divided in two groups; polypropylene mesh (control group) and polypropylene mesh with collagen coating (Parieten mesh). Seven and 30 days postoperatively, adhesions and amount and strength of mesh incorporation were assessed. Wound healing was studied by microscopy.

Results

With Parieten mesh, the mesh surface covered by adhesions was reduced after 30 days (42% vs 69%, p = 0.01), but infection rate was increased after both 7 (p = 0.001) and 30 days (p = 0.03), compared to the polypropylene group with no mesh infections. If animals with mesh infection were excluded in the analysis, the mesh surface covered by adhesions was reduced after 7 days (21% vs 76%, p = 0.02), as well as after 30 days (21 vs 69%, p < 0.001). Percentage of mesh incorporation was comparable in both groups. Mean tensile strength of mesh incorporation after 30 days was higher with Parieten mesh.

Conclusion

Although the coated Parieten mesh was more susceptible to mesh infection in the current model, a significant reduction of adhesion formation was still seen with the Parieten mesh after 30 days, with comparable mesh incorporation in the abdominal wall.

Keywords

Adhesion formation Ventral hernia repair Polypropylene mesh Collagen coating 

References

  1. 1.
    Alponat, A, Lakshminarasappa, SR, Yavuz, N, Goh, PM 1997Prevention of adhesions by Seprafilm, an absorbable adhesion barrier: an incisional hernia model in rats.Am Surg63818819PubMedGoogle Scholar
  2. 2.
    Carbajo, MA, Marin Olmo, JC, Blanco, JI, Cuesta, C, Toledano, M, Martin, F, Vaquero, C 1999Laparoscopic treatment versus open surgery in the solution of major incisional and abdominal wall hernias with mesh.Surg Endosc13250252PubMedGoogle Scholar
  3. 3.
    Maria, EJ, Moss, JM, Sugerman, HJ 2000Laparoscopic intraperitoneal polytetrafluoroethylene (PTFE) prosthetic patch repair of ventral hernia.Surg Endosc14326329PubMedGoogle Scholar
  4. 4.
    Dinsmore, RC, Calton WC, Jr, Harvey, SB, Blaney, MW 2000Prevention of adhesions to polypropylene mesh in a traumatized bowel model.J Am Coll Surg191131136CrossRefPubMedGoogle Scholar
  5. 5.
    Ellis, H, Moran, BJ, Thompson, JN, Parker, MC, Wilson, MS, Menzies, D,  et al. 1999Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort study.Lancet35314761480PubMedGoogle Scholar
  6. 6.
    Franklin, ME, Dorman, JP, Glass, JL, Balli, JE, Gonzalez, JJ 1998Laparoscopic ventral and incisional hernia repair.Surg Laparosc Endosc4294299CrossRefGoogle Scholar
  7. 7.
    Hesselink, VJ, Luijendijk, RW, Wilt, JHW, Heide, R, Jeekel, J 1993Incisional hernia recurrence; an evaluation of risk factors.Surg Gynaecol Obstet176228234Google Scholar
  8. 8.
    Holzman, MD, Purut, CM, Reintgen, K, Eubanks, S, Pappas, TN 1997Laparoscopic ventral and incisional herniaplasty.Surg Endosc113235PubMedGoogle Scholar
  9. 9.
    Hooker, GD, Taylor, BM, Driman, DK 1999Prevention of adhesion formation with use of sodium hyaluronate-based bioresorbable membrane in a rat model of ventral hernia repair with polypropylene mesh—a randomized controlled study.Surgery125211216CrossRefPubMedGoogle Scholar
  10. 10.
    Jenkins, SD, Klamer, TW, Parteka, JJ, Condon, RE 1983A comparison of prosthetic materials used to repair abdominal wall defects.Surgery94392398PubMedGoogle Scholar
  11. 11.
    Kaufman, Z, Engelberg, M, Zager, M 1981Fecal fistula: a late complication of marlex mesh repair.Dis Col Rectum245354Google Scholar
  12. 12.
    Klosterhafen, B, Junge, K, Hermanns, B, Klinge, U 2002Influence of implantation interval on the long-termbiocompatibility of surgical mesh.Br J Surg8910431048CrossRefPubMedGoogle Scholar
  13. 13.
    Law, NH, Ellis, H 1988Adhesion formation and peritoneal healing on prosthetic materials.Clin Mater395101Google Scholar
  14. 14.
    Leber, GE, Garb, JL, Alexander, AL, Reed, WP 1998Long-term complications associated with prosthetic repair of incisional hernias.Arch Surg133378382PubMedGoogle Scholar
  15. 15.
    Liakakos, T, Karanikas, I, Panagitidis, H, Dendrinos, S 1994Use of Marlex mesh in the repair of recurrent incisional hernia.Br J Surg81248249PubMedGoogle Scholar
  16. 16.
    Lichtenstein, IL, Shulman, AG, Amid, PK 1991Twenty questions about hernioplasty.Am Surg57730733PubMedGoogle Scholar
  17. 17.
    Luijendijk, RW, Lemmen, MH, Hop, WC, Wereldsma, JC 1997Incisional hernia recurrence following “vest over pants” or vertical Mayo repair of primary hernias of the midline.World J Surg216266PubMedGoogle Scholar
  18. 18.
    Luijendijk, RW, Hop, WC, Tol, MP, Lange, DC, Braaksma, MM, IJzermans, JN,  et al. 2000A comparison of suture repair with mesh repair for incisional hernia.N Engl J Med10392398CrossRefGoogle Scholar
  19. 19.
    Macmillan, JI, Freeman, JB 1984Healing of a gastrocutaneous fistula in the presence of marlex.Can J Surg27159160PubMedGoogle Scholar
  20. 20.
    Morris-stiff, GJ, Hughes, LE 1998The outcomes of nonabsorbable mesh placed within the abdominal cavity: literature review and clinical experience.J Am Coll Surg186352567PubMedGoogle Scholar
  21. 21.
    Mutter, D, Jamali, FR, Moody, DL, Rodeheaver, GT, Therm, M, Marescaux, J 2000The concept of protected mesh to minimize adhesion formation in intraperitoneal abdominal wall reinforcement.Preclinical evaluation of a new composite mesh. Hernia4S39Google Scholar
  22. 22.
    Park, A, Birch, DW, Lovrics, P 1998Laparoscopic and open incisional hernia repair: a comparison study.Surgery124816821PubMedGoogle Scholar
  23. 23.
    Paul, A, Korenkov, M, Peters, S, Kohler, L, Fischer, S, Troidl, H 1998Unacceptable results of the Mayo procedure for repair of abdominal incisional hernias.Eur J Surg164361367CrossRefPubMedGoogle Scholar
  24. 24.
    Ramshaw, BJ, Esartia, P, Schwab, J, Mason, EM, Wilson, RA, Duncan, TD,  et al. 1999Comparison of laparoscopic and open ventral herniorrhaphy.Am Surg65827832PubMedGoogle Scholar
  25. 25.
    Rios, A, Rodriguez, JM, Munitiz, V, Alcaraz, P, Perez Flores, D, Parrilla, P 2001Antibiotic prophylaxis in incisional hernia repair using a prosthesis.Hernia5148152PubMedGoogle Scholar
  26. 26.
    Schmitt, HJ,Jr, Grinnan, GLB 1967Use of marlex mesh in infected abdominal war wound.Am J Surg113825828PubMedGoogle Scholar
  27. 27.
    Turkcapar, AG, Yerdel, MA, Aydinuraz, K, Bayar, S, Kuterdem, E 1998Repair of midline incisional hernias using polypropylene grafts.Surg Today285963CrossRefPubMedGoogle Scholar
  28. 28.
    Riet, M, Vos Steenwijk, PJ, Bonthuis, F, Marquet, RL, Steyerberg, EW, Jeekel, J, Bonjer, HJ 2003Prevention of adhesion to prosthetic mesh: comparison of different barriers, using an incisional hernia model.Ann Surg237123128PubMedGoogle Scholar
  29. 29.
    Walker, PM, Langer, B 1976Marlex mesh for repair of abdominal wall defects.Can J Surg19211213PubMedGoogle Scholar
  30. 30.
    Zühlke, HV, Lorenz, EMP, Straub, EM, Savvas, V 1990Pathophysiologie und Klassifikation von Adhesionen.Langenbecks Arch Chir Suppl II Verh Dtrsch Ges Chir34510091016Google Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • M. van’t Riet
    • 1
  • J. W. A. Burger
    • 1
  • F. Bonthuis
    • 1
  • J. Jeekel
    • 1
  • H. J. Bonjer
    • 1
    Email author
  1. 1.Department of General SurgeryErasmus University Medical Centre Rotterdam—DijkzigtRotterdamThe Netherlands

Personalised recommendations