Intraperitoneal behaviour of a new composite mesh (Parietex™ Composite Ventral Patch) designed for umbilical or epigastric hernia repair
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Abstract
Introduction
The most common treatment option for ventral and umbilical hernias is the implant of a prosthetic mesh. This study compares the behaviour of a new mesh, Parietex™ Composite Ventral Patch (Ptx), with two commercially available meshes, Ventralex™ ST Hernia Patch and Proceed™ Ventral Patch.
Materials and methods
The following meshes were tested in a umbilical-hernia repair model using 54 rabbits: Ventralex™ ST Hernia Patch (Vent) (Bard Davol Inc., USA); Proceed™ Ventral Patch (PVP) (Ethicon, USA) and Ptx (Covidien, Sofradim, France) (n = 18 each). At 3, 7 and 14 days postimplantation, peritoneal behaviour and adhesion formation were assessed by sequential laparoscopy. Adhesions were scored for consistency and quantified by image analysis. The animals were euthanized at 2 (n = 27) and 6 weeks (n = 27) postsurgery. Mesothelial cover of meshes and tissue ingrowth were determined by scanning and light microscopy.
Results
Seroma was observed in 1/18 Vent, 7/18 PVP and 4/18 Ptx, mainly between the implant and subcutaneous tissue. Firm omental adhesions between the mesh and parietal peritoneum were noted in 2/9 Vent, 6/9 PVP and 3/9 Ptx at 2 weeks and in 3/9 Vent, 5/9 PVP and 1/9 Ptx at 6 weeks. Three (out of 9) encapsulated PVP implants showed “tissue-integrated” adhesions affecting the intestinal loops. No differences between implants were detected in the surface area occupied by adhesions at 2 weeks, though at 6 weeks, percentages were significantly higher (p < 0.01; Mann–Whitney U test) for PVP compared to Ptx or Vent. At this time point, Ptx and Vent showed good host tissue incorporation and optimal mesothelialization.
Conclusions
The PVP implants showed greater adhesion formation than the other materials. Postimplantation behaviour was comparable for Ptx and Vent including scarce adhesion formation and optimal mesothelialization. Regarding tissue integration, Ptx showed greater long-term collagenization of the neoformed tissue.
Keywords
Umbilical hernia Epigastric hernia Mesh repair Polypropylene Abdominal wall repairNotes
Disclosures
Study sponsored and funded by Covidien – Sofradim Production (Trévoux, France). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors Francisca García-Moreno, Sandra Sotomayor, Paloma Pérez-López, Bárbara Pérez-Köhler, Yves Bayon, Gemma Pascual and Juan M. Bellón declare no conflict of interest.
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