Long-term evaluation of adhesion formation and foreign body response to three new meshes
- 719 Downloads
Mesh-related adhesions are a significant clinical problem following intraperitoneal mesh placement. In this study, we evaluated adhesion formation to three relatively new meshes for intraperitoneal use.
Three new meshes for intraperitoneal use (Omyra® mesh, Physiomesh®, and Hi-Tex Endo-IP®) were implanted intraperitoneally in rats and compared with a polypropylene control mesh (Parietene®) after 7 or 90 days. Adhesion formation, incorporation (tensile strength), shrinkage, and foreign body reaction were scored.
Hi-Tex Endo-IP and Physiomesh® showed significantly less adhesion formation when compared to Parietene at both time points (p < 0.05). Shrinkage was highest in Omyra mesh after 90 days, which was significantly more compared to Parietene® (p < 0.001). Physiomesh® only showed a significant reduction in craniocaudal mesh length, compared to Parietene and Hi-Tex Endo-IP (p < 0.05). After 90 days, Hi-Tex Endo-IP® showed significantly higher and Physiomesh® significantly lower incorporation strengths compared to all other groups (p < 0.05). Microscopic evaluation revealed massive foreign body reaction to Hi-Tex Endo-IP®, leading to an extensive and thick collagenous scar adherent to the abdominal wall. Fractioning of the Physiomesh® coating over time led to an increase in interfilamentary granuloma formation, leading to scar plate formation, but with only minimal to no abdominal wall adherence. Both Parietene® and Omyra® showed a mild foreign body response.
Although clear distinctions can be made between meshes and some meshes excel, none of the meshes are superior in all aspects required for effective and safe incisional hernia repair.
KeywordsVentral hernia Adhesions Rat model Foreign body reaction Mesh
We would like to thank B. Braun and Stöpler BV for providing two of the meshes required for this research. Furthermore, we would like to thank S. Hartmans for her assistance to this project.
Two of the meshes were kindly provided by B. Braun (Omyra® mesh) and Stöpler BV (Hi-Tex Endo-IP®). Authors R.R.M. Vogels, K.W.Y. van Barneveld, M.H.F. Schreinemacher, J.W.A.M. Bosmans, G. Beets, M.J.J. Gijbels, and N.D. Bouvy declare no conflict of interest and have no financial ties.
- 7.Jenkins ED, Yom V, Melman L, Brunt LM, Eagon JC, Frisella MM et al (2010) Prospective evaluation of adhesion characteristics to intraperitoneal mesh and adhesiolysis-related complications during laparoscopic re-exploration after prior ventral hernia repair. Surg Endosc 24:3002–3007PubMedCrossRefGoogle Scholar
- 15.Novitsky YW, Harrell AG, Cristiano JA, Paton BL, Norton HJ, Peindl RD et al (2007) Comparative evaluation of adhesion formation, strength of ingrowth, and textile properties of prosthetic meshes after long-term intra-abdominal implantation in a rabbit. J Surg Res 140:6–11PubMedCrossRefGoogle Scholar
- 21.Sanders DL, Waydia S (2013) A systematic review of randomised control trials assessing mesh fixation in open inguinal hernia repair. Hernia 18:165–176Google Scholar
- 24.Zogbi L, Trindade EN, Trindade MRM (2013) Comparative study of shrinkage, inflammatory response and fibroplasia in heavyweight and lightweight meshes. Hernia 17:765–772Google Scholar