Long-term evaluation of adhesion formation and foreign body response to three new meshes

Abstract

Introduction

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.

Methods

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.

Results

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.

Conclusion

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.

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Acknowledgments

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.

Disclosure

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.

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Correspondence to R. R. M. Vogels or N. D. Bouvy.

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Vogels, R.R.M., van Barneveld, K.W.Y., Bosmans, J.W.A.M. et al. Long-term evaluation of adhesion formation and foreign body response to three new meshes. Surg Endosc 29, 2251–2259 (2015). https://doi.org/10.1007/s00464-014-3936-5

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Keywords

  • Ventral hernia
  • Adhesions
  • Rat model
  • Foreign body reaction
  • Mesh