, Volume 18, Issue 4, pp 563–570 | Cite as

Early and late postoperative inflammatory and collagen deposition responses in three different meshes: an experimental study in rats

  • C. G. Pereira-lucena
  • R. Artigiani Neto
  • D. T. de Rezende
  • G. de J. Lopes-Filho
  • D. Matos
  • M. M. Linhares
Original Article



Although meshes reduce abdominal hernia recurrence, they increase the risk of inflammatory complications. This study aimed to compare the early and late postoperative inflammation and collagen deposition responses induced by three meshes.


Rats were allocated into three groups. In group I, a polypropylene (PP) mesh was implanted in the abdominal wall. In groups II and III, PP + polyglactin (PP + PG) and PP + titanium (PP + TI) meshes were employed, respectively. On the seventh (7th) postoperative day, collagen deposition and inflammation were evaluated, and immunohistochemistry was performed on abdominal wall biopsies. These data were compared with those obtained on the fortieth (40th) postoperative day in a previous study.


The early inflammatory responses were the same in all groups. With time, it decreased in group I (p = 0.047) and increased in group II (p = 0.003). Group I exhibited early elevated VEGF (p < 0.001), COX2 (p < 0.001), and collagen (p = 0.023) levels, and group II exhibited the most severe inflammatory tissue response. On the 40th postoperative day, the VEGF (p < 0.001) and collagen (p < 0.005) were reduced as compared with the 7th postoperative day in all groups.


Belatedly, the inflammatory reaction decreased in PP mesh group and increased in PP + PG mesh group. The PP mesh induced early great elevations in VEGF, COX2 and collagen levels, whereas the PP + PG mesh caused severe tissue inflammation with small elevation in these levels. PP + TI mesh induced inflammatory response levels between the others. In conclusion, the inflammatory response depends on the mesh density and also the mesh material with clinical implications.


Hernia Mesh Inflammatory response Collagen VEGF COX2.INFLAMMATORY 


Conflict of interest

The authors declare no conflict of interest.

Supplementary material

10029_2013_1206_MOESM1_ESM.docx (13 kb)
Supplementary material 1 (DOCX 13 kb)


  1. 1.
    Dubay DA, Wang X, Kuhn A, Robson MC, Franz MG (2004) The prevention of Incisional hernia formation using a delayed-release polymer of basic fibroblast growth factor. Ann Surg 240:179–186PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Whitte MB, Barbul A (1997) General principles of wound healing. Surg Clin N Am 77:509–528CrossRefGoogle Scholar
  3. 3.
    Dubay DA, Wang X, Adamson B, Kuzon WM Jr, Dennis RG, Franz MG (2006) Mesh incisional herniorrhaphy increses abdominal wall elastic properties: a mechanism for decreased hernia recurrences in comparinson with suture repair. Surg 140:14–24CrossRefGoogle Scholar
  4. 4.
    Weyhe D, Belyaev O, Muller C, Meurer K, Bauer K, Papapstolou G, Uhl W (2007) Improving outcomes in hernia repair by the use of the light meshes: a comparison of different implant constructions based on a critical appraisal of the literature. World J Surg 31:234–244PubMedCrossRefGoogle Scholar
  5. 5.
    Asarias JR, Nguyen PT, Jr Mings, Gerrich AP, Pierce LM (2001) Influence of mesh materials on the expression of mediators involved in wound healing. Invest Surg 24:87–98CrossRefGoogle Scholar
  6. 6.
    Pascual G, Hernández-Gascón B, Rodríguez M, Sotomayor S, Peña E, Calvo B, Bellón JM (2012) The long-term behavior of lightweight and heavyweight meshes used to repair abdominal wall defects is determined by host tissue repair process provoked by the mesh. Surgery 152(5):886–895PubMedCrossRefGoogle Scholar
  7. 7.
    Orestein SB, Saberski ER, Kreutzer DL, Novitski YW (2012) Comparative analysis of histopathologic effects of synthetic meshes based on material, weight and pore size in mice. J Surg Res 176:423–429CrossRefGoogle Scholar
  8. 8.
    Laschke MW, Hãufel JM, Scheuer C, Menger MD (2009) Angiogenic and inflammatory host response to surgical meshes of different mesh architecture and polymer composition. J Biomed Res B Appl Biomater 91:497–507CrossRefGoogle Scholar
  9. 9.
    Bellón JM, Rodríguez M, García-Honduvilla N, Gómez-gil V, Pascual G, Buján J (2009) Comparing the behavior of different polypropylene meshes (heavy and lightweight) in an experimental model of ventral hernia repair. J Biomed Mater Res B Appl Biomater 89:448–455PubMedCrossRefGoogle Scholar
  10. 10.
    Pascual G, Rodríguez M, Góez-Gil V, García-Honduvilla N, Buján J, Bellón JM (2008) Early tissue incorporation and collagen deposition in lightweight polypropylene meshes: bioassay in an experimental model of ventral hernia. Surgery 144:427–435PubMedCrossRefGoogle Scholar
  11. 11.
    Klinge U, Klosterhalfen B (2012) Modified classification of surgical meshes for hernia repair based on the analyses of 1,000 explanted meshes. Hernia 16:251–258PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Regis S, Jassal M, Mukherjee N, Bayon Y, Scaborough N, Bhowmick S (2012) Altering surface characteristics of polypropylene mesh via sodium hydroxide treatment. J Biomed Mater Res A 100:1160–1167PubMedCrossRefGoogle Scholar
  13. 13.
    Gao M, Han J, Tian J, Yang K (2010) Vypro II mesh for inguinal hernia repair: a meta-analysis of randomized controlled trials. Ann Surg 251:838–842PubMedCrossRefGoogle Scholar
  14. 14.
    Ladurner R, Chlapponi C, Linhuber Q, Mussack T (2011) Long term outcome and quality of life after open incisional hernia repair: light versus heavy weight meshes. BMC Surg 14:11–25Google Scholar
  15. 15.
    Smietański M, Smietańska IA, Modrzejewski A, Simons MP, Aufenacker TJ (2012) Systematic review and meta-analysis on heavy and lightweight polypropylene mesh in Lichtenstein inguinal hernioplasty. Hernia 16:519–528PubMedCrossRefGoogle Scholar
  16. 16.
    den Hartog D, Dur AH, Tuinebreijer WE, Kreis RW (2008) Open surgical procedures for incisional hernias. Cochrane Database Syst Rev 3:CD006438Google Scholar
  17. 17.
    Peeters E, Spissens C, Oyen R, De wever L, Vanderscheueren D, Pennickx F, Miserez M (2010) Laparoscopic inguinal hernia repair in men with lightweight meshes may significantly impair sperm motility: a randomizes control trial. Ann Surg 252:240–246PubMedCrossRefGoogle Scholar
  18. 18.
    Lintin La, KIngsnorth NA (2012). Mechanical failure of a lightweight polypropylene mesh. Hernia [Epub ahead of print]Google Scholar
  19. 19.
    Pascual G, Rodrigues M, Soromayor S, Pérez-Köhler B, Bellón JM (2012) Inflammatory reaction and neotissue maturation in the early host tissue incorporation of polypropylene prostheses. Hernia 16(6):697–707PubMedCrossRefGoogle Scholar
  20. 20.
    Altınel Y, Oztürk E, Ozkaya G, Akyıldız EU, Ulcay Y, Ozgüç H (2012) The effect of a chitosan coating on the adhesive potential and tensile strength of polypropylene meshes. Hernia 16(6):709–714PubMedCrossRefGoogle Scholar
  21. 21.
    Schug-Pass C, Sommerer F, Tannapfel A, Lippert H, Köckerling F (2008) Does the additional application of a polylactide film (SurgiWrap) to a lightweight mesh (TiMesh) reduce adhesions after laparoscopic intraperitoneal implantation procedures? Experimental results obtained with the laparoscopic porcine model. Surg Endosc 22:2433–2439PubMedCrossRefGoogle Scholar
  22. 22.
    Orenstein SB, Saberski ER, Klueh U, Kreutzer DL, Novitsky YW (2010) Effects of mast cells modulation on early host response to implanted synthetic meshes. Hernia 14:511–516PubMedCrossRefGoogle Scholar
  23. 23.
    Pereira-Lucena CG, Artigiani Neto R, Frazão CVG, Goldenberg A, Lopes-Filho GJ, Matos D, Linhares MM (2010) Experimental study comparing meshes made of polypropylene, polypropylene + polyglactin and polypropylene + titanium: inflammatory cytokines, histological changes and morphometric analysis of collagen. Hernia 14:299–304PubMedCrossRefGoogle Scholar
  24. 24.
    Madhusudan A, Asha J, Gayathri R, Rashmi M (2012) Expression of vascular endothelial growth factor and microvessel density in oral tumorigenesis. J Oral Maxillofac Pathol 16:22–26CrossRefGoogle Scholar
  25. 25.
    Wang D, DuBois RN (2010) The role of COX-2 in intestinal inflammation and colorectal cancer. Oncogene 29:781–788PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Di Vita G, D′Agostinho P, Patti R, Arcara, Caruso G, Davi, Cillari E (2005) Acute inflammatory response after inguinal and incisional hernia repair with implatation of polypropylene mesh of different size. Langenbeecks Arch Surg 390:306–311CrossRefGoogle Scholar
  27. 27.
    Brittner R, Schmedt CG, Leibi BJ, Schwartz J (2011) Early postoperative and 1 year results of a randomized controlled trial comparing the impact of extralight titanized polypropylene mesh and traditional heavyweight polypropylene mesh on pain and seroma production in laparoscopic hernia repair (TAPP). World J Surg 35:1791–1797CrossRefGoogle Scholar
  28. 28.
    Baktir A, Dogru O, Girgin M, Aygen E, Kanat BH, Dabak DO, Kuloglu T (2012) The effects of different prosthetic materials on the formation of collagen types in incisional hernia. Hernia 17(2):249–253PubMedCrossRefGoogle Scholar
  29. 29.
    Vaz M, Krebs RK, Trindade EN, Trindade MR (2009) Fibroplasia after polypropylene mesh implantation for abdominal wall hernia repair in rats. Acta Cir Bras 24:19–25PubMedCrossRefGoogle Scholar
  30. 30.
    Quinn R (2005) Comparing rat’s to human’s age: How old is my rat in people years? Nutrition 21:775–777 Editorial opinionPubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag France 2013

Authors and Affiliations

  • C. G. Pereira-lucena
    • 1
    • 2
  • R. Artigiani Neto
    • 1
  • D. T. de Rezende
    • 1
  • G. de J. Lopes-Filho
    • 1
  • D. Matos
    • 1
  • M. M. Linhares
    • 1
  1. 1.Pós-Graduação em Ciência Cirúrgica InterdisciplinarUniversidade Federal de São PauloSão PauloBrazil
  2. 2.Rua Volney Loureiro TavaresAracajuBrazil

Personalised recommendations