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Comparison of a lightweight polypropylene mesh (Optilene® LP) and a large-pore knitted PTFE mesh (GORE® INFINIT® mesh)—Biocompatibility in a standardized endoscopic extraperitoneal hernia model

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Abstract

Purpose

The use of a mesh with good biocompatibility properties is of decisive importance for the avoidance of recurrences and chronic pain in endoscopic hernia repair surgery. As we know from numerous experiments and clinical experience, large-pore, lightweight polypropylene meshes possess the best biocompatibility. However, large-pore meshes of different polymers may be used as well and might be an alternative solution.

Methods

Utilizing a totally extraperitoneal technique in an established animal model, 20 domestic pigs were implanted with either a lightweight large-pore polypropylene (PP) mesh (Optilene® LP) or a medium-weight large-pore knitted polytetrafluorethylene (PTFE) mesh (GORE® INFINIT® mesh). After 94 days, the pigs were sacrificed and postmortem diagnostic laparoscopy was performed, followed by explantation of the specimens for macroscopic, histological and immunohistochemical evaluation.

Results

The mean mesh shrinkage rate was 14.2% for Optilene® LP vs. 24.7% for INFINIT® mesh (p = 0.017). The partial volume of the inflammatory cells was 11.2% for Optilene® LP vs. 13.9% for INFINIT (n.s.). CD68 was significantly higher for INFINIT (11.8% vs. 5.6%, p = 0.007). The markers of cell turnover, namely Ki67 and the apoptotic index, were comparable at 6.4% vs. 12.4% (n.s.) and 1.6% vs. 2.0% (n.s.). In the extracellular matrix, TGF-β was 35.4% for Optilene® LP and 31.0% for INFINIT® (n.s.). Collagen I (pos/300 μm) deposits were 117.8 and 114.9, respectively.

Conclusion

In our experimental examinations, Optilene® LP and INFINIT® showed a comparable biocompatibility in terms of chronic inflammatory reaction; however, the shrinkage rate was significantly higher for INFINIT® after 3 months. The higher shrinkage rate of INFINIT® should be taken into account when choosing the mesh size for an adequate hernia overlap.

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Acknowledgement

This study was supported by a research grant from W.L. Gore & Associates, Inc. (Flagstaff, AZ, USA) and BBD Aesculap GmbH (Tuttlingen, Germany).

Authors' contributions

D.J. was responsible for analysis and interpretation of data and drafting of manuscript. C.S-P. was responsible for study conception and design, acquisition of data, analysis and interpretation of data, and drafting of manuscript. F.S. and A. T. were responsible for acquisition, analysis and interpretation of data. H.L was responsible for study conception and critical revision of manuscript. F.K. was responsible for study conception and design, acquisition of data, analysis and interpretation of data, and drafting of manuscript.

Conflicts of interest

None.

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Authors and Affiliations

  1. Department of Surgery and Center for Minimally Invasive Surgery, Vivantes Hospital Spandau, Neue Bergstr. 6, 13585, Berlin, Germany

    Dietmar A. Jacob, Christine Schug-Paß & Ferdinand Köckerling

  2. Institute of Pathology, Ruhr-University of Bochum, Bürkle-de-la-Camp-Pl. 1, 44789, Bochum, Germany

    Florian Sommerer & Andrea Tannapfel

  3. Department of Surgery, Otto-von-Guericke-University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany

    Hans Lippert

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  1. Dietmar A. Jacob
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Correspondence to Dietmar A. Jacob.

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Jacob, D.A., Schug-Paß, C., Sommerer, F. et al. Comparison of a lightweight polypropylene mesh (Optilene® LP) and a large-pore knitted PTFE mesh (GORE® INFINIT® mesh)—Biocompatibility in a standardized endoscopic extraperitoneal hernia model. Langenbecks Arch Surg 397, 283–289 (2012). https://doi.org/10.1007/s00423-011-0858-8

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