Abstract
Purpose
There is still some concern about the use of polypropylene in case of infection or contamination. The biocompatibility of the recently introduced light-weight polypropylene meshes seems to be promising. This experimental study was designed to evaluate three different weights and pore sizes of polypropylene meshes in a contamination model.
Methods
Thirty rabbits were operated through a pararectal incision. The abdomen, wound and mesh were contaminated with faecal fluid aspirated from the appendix. Groups of ten animals were studied according to three different pore sizes of polypropylene mesh implanted as an inlay technique: very large pore, large pore and medium pore. Five animals of each group were sacrificed on days 21 and 90. Incisional surgical site infection and microbiologic cultures on the 21st and 90th days were the main outcome measures. Tissue integration, shrinkage and biomechanical properties were also tested.
Results
Two rabbits died on day 1. There were six incisional surgical site infections (21.4%). Four animals had positive cultures with no macroscopic infection. None of the surviving rabbits with very large pore mesh had clinical infection or positive microbiologic cultures. Very large pore meshes shrank significantly more on day 21. There were no differences in the tensiometric test results.
Conclusions
In our experimental model, low-weight, very large pore polypropylene meshes seem to be the best polypropylene mesh in case of intestinal contamination. These results encourage clinical investigation on the use of low-weight, very large pore polypropylene meshes in the treatment and prevention of hernias in the presence of clean-contaminated or contaminated fields.
Similar content being viewed by others
References
Campanelli G, Nicolosi FM, Pettinari D, Avesani EC (2004) Prosthetic repair, intestinal resection, and potentially contaminated areas: safe and feasible? Hernia 8:190–192
Alaedeen DI, Lipman J, Medalie D, Rosen MJ (2007) The single-staged approach to the surgical management of abdominal wall hernias in contaminated fields. Hernia 11:41–45
Engelsman AF, van Dam GM, van der Mei HC, Busscher HJ, Ploeg RJ (2010) In vivo evaluation of bacterial infection involving morphologically different surgical meshes. Ann Surg 251:133–137
Ott R, Hartwig T, Tannapfel A, Blatz R, Rodloff AC, Madaj-Sterba P, Möbius Ch, Köckerling F (2007) Biocompatibility of bacterial contaminated prosthetic meshes and porcine dermal collagen used to repair abdominal wall defects. Langenbecks Arch Surg 392:473–478
Kelly ME, Behrman SW (2002) The safety and efficacy of prosthetic hernia repair in clean-contaminated and contaminated wounds. Am Surg 68:524–528
Aydinuraz K, Ağalar C, Ağalar F, Ceken S, Duruyürek N, Vural T (2009) In vitro S. epidermidis and S. aureus adherence to composite and lightweight polypropylene grafts. J Surg Res 157:e79–e86
Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG (1992) CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Am J Infect Control 20:271–274
Weyhe D, Schmitz I, Belyaev O, Grabs R, Müller KM, Uhl W, Zumtobel V (2006) Experimental comparison of monofile light and heavy polypropylene meshes: less weight does not mean less biological response. World J Surg 30:1586–1591
Gonzalez R, Fugate K, McClusky D 3rd, Ritter EM, Lederman A, Dillehay D, Smith CD, Ramshaw BJ (2005) Relationship between tissue ingrowth and mesh contraction. World J Surg 29:1038–1043
Klinge U, Junge K, Stumpf M, AP AP, Klosterhalfen B (2002) Functional and morphological evaluation of a low-weight, monofilament polypropylene mesh for hernia repair. J Biomed Mater Res 63:129–136
Klinge U, Klosterhalfen B, Birkenhauer V, Junge K, Conze J, Schumpelick V (2002) Impact of polymer pore size on the interface scar formation in a rat model. J Surg Res 103:208–214
Cobb WS, Kercher KW, Heniford BT (2005) The argument for lightweight polypropylene mesh in hernia repair. Surg Innov 12:63–69
Earle DB, Mark LA (2008) Prosthetic material in inguinal hernia repair: how do I choose? Surg Clin North Am 88:179–201
Falagas ME, Kasiakou SK (2005) Mesh-related infections after hernia repair surgery. Clin Microbiol Infect 11:3–8
Strzelczyk JM, Szymański D, Nowicki ME, Wilczyński W, Gaszynski T, Czupryniak L (2006) Randomized clinical trial of postoperative hernia prophylaxis in open bariatric surgery. Br J Surg 93:1347–1350
Wysocki A, Pozniczek M, Krzywon J, Bolt L (2001) Use of polypropylene prostheses for strangulated inguinal and incisional hernias. Hernia 5:105–106
Pans A, Desaive C, Jacquet N (1997) Use of a preperitoneal prosthesis for strangulated groin hernia. Br J Surg 84:310–312
Vix J, Meyer Ch, Rohr S, Bourtoul Ch (1997) The treatment of incisional and abdominal hernia with a prosthesis in potentially infected tissues—a series of 47 cases. Hernia 1:157–161
Geisler DJ, Reilly JC, Vaughan SG, Glennon EJ, Kondylis PD (2003) Safety and outcome of use of nonabsorbable mesh for repair of fascial defects in the presence of open bowel. Dis Colon Rectum 46:1118–1123
Kasperk R, Klinge U, Schumpelick V (2000) The repair of large parastomal hernias using a midline approach and a prosthetic mesh in the sublay position. Am J Surg 179:186–188
Serra-Aracil X, Bombardo-Junca J, Moreno-Matias J, Darnell A, Mora-Lopez L, Alcantara-Moral M, Ayguavives-Garnica I, Navarro-Soto S (2009) Randomized, controlled, prospective trial of the use of a mesh to prevent parastomal hernia. Ann Surg 249:583–587
Jänes A, Cengiz Y, Israelsson LA (2009) Preventing parastomal hernia with a prosthetic mesh: a 5-year follow-up of a randomized study. World J Surg 33:118–121
Franklin ME Jr, Treviño JM, Portillo G, Vela I, Glass JL, González JJ (2008) The use of porcine small intestinal submucosa as a prosthetic material for laparoscopic hernia repair in infected and potentially contaminated fields: long-term follow-up. Surg Endosc 22:1941–1946
Guirao X, Arias J, Badía JM, García-Rodríguez JA, Mensa J, Alvarez-Lerma F, Borges M, Barberán J, Maseda E, Salavert M, Llinares P, Gobernado M, García Rey C (2010) Recommendations in the empiric anti-infective agents of intra-abdominal infection. Cir Esp 87:63–81
Bleichrodt RP, Simmermacher RK, van der Lei B, Schakenraad JM (1993) Expanded polytetrafluoroethylene patch versus polypropylene mesh for the repair of contaminated defects of the abdominal wall. Surg Gynecol Obstet 176:18–24
Klinge U, Junge K, Spellerberg B, Piroth C, Klosterhalfen B, Schumpelick V (2002) Do multifilament alloplastic meshes increase the infection rate? Analysis of the polymeric surface, the bacteria adherence, and the in vivo consequences in a rat model. J Biomed Mater Res 63:765–771
Scheidbach H, Tamme C, Tannapfel A, Lippert H, Köckerling F (2004) In vivo studies comparing the biocompatibility of various polypropylene meshes and their handling properties during endoscopic total extraperitoneal (TEP) patchplasty: an experimental study in pigs. Surg Endosc 18:211–220
Cobb WS, Burns JM, Peindl RD, Carbonell AM, Matthews BD, Kercher KW, Heniford BT (2006) Textile analysis of heavy weight, mid-weight, and light weight polypropylene mesh in a porcine ventral hernia model. J Surg Res 136:1–7
Stone HH, Fabian TC, Turkleson ML, Jurkiewicz MJ (1981) Management of acute full-thickness losses of the abdominal wall. Ann Surg 193:612–618
Schmitt HJ Jr, Grinnan GL (1967) Use of Marlex mesh in infected abdominal war wound. Am J Surg 113:825–828
Coda A, Bendavid R, Botto-Micca F, Bossotti M, Bona A (2003) Structural alterations of prosthetic meshes in humans. Hernia 7:29–34
Bellón JM, García-Carranza A, García-Honduvilla N, Carrera-San Martín A, Buján J (2004) Tissue integration and biomechanical behaviour of contaminated experimental polypropylene and expanded polytetrafluoroethylene implants. Br J Surg 91:489–494
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 89B:448–455
Acknowledgments
We thank Jose P. Novalbos, M.D., Cádiz University, for his advice on the evaluation of the results and Jose M. Báez, M.D., Ph.D., Cádiz University for the pathologic examination.
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
Supplementary material 1 (MPG 15572 kb)
Rights and permissions
About this article
Cite this article
Díaz-Godoy, A., García-Ureña, M.Á., López-Monclús, J. et al. Searching for the best polypropylene mesh to be used in bowel contamination. Hernia 15, 173–179 (2011). https://doi.org/10.1007/s10029-010-0762-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10029-010-0762-0