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Intraperitoneal mesh devices for small midline hernias: mesh behavior in a porcine model

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Abstract

Purpose

Although clinical data on long-term efficacy are lacking, the use of self-expanding devices for intraperitoneal placement in the management of small midline hernias has been popularized. In the present experimental study, two different devices were investigated regarding tissue ingrowth, adhesion formation and solid mesh placement.

Methods

Two devices of 4.3 cm diameter, one ePTFE-containing small pore polypropylene mesh (PP/ePTFE) and a multi-layered large-pore polypropylene patch with an oxidized cellulose anti-adhesive barrier (PP/ORC), both containing a self-deployment system, were placed intraperitoneally at the linea alba of 24 female pigs. A first laparoscopy was performed to evaluate mesh positioning against the abdominal wall. 1 (n = 6), 2 (n = 6), 4 (n = 6) and 12 weeks (n = 6) later, mesh appearance was inspected and adhesion formation was assessed. All meshes were excised for histological evaluation.

Results

Folding of the patch was more frequently observed at PP/ePTFE, yet no excessive cupping was noticed. Adhesions predominantly presented at short-term evaluation. Overall adhesion formation at all samples was significantly more extensive for PP/ORC (p = 0.048). Massive shrinkage was observed for PP/ORC: after a 12-week period 22 % residual surface was preserved, compared to 83 % for PP/ePTFE (p < 0.001). While at short-term inflammatory reaction was comparable, at long-term PP/ORC induced a significant more pronounced inflammatory and foreign body reaction.

Conclusions

Although a strong deployment system provides adequate initial placement, shrinkage and excessive adhesion formation are much more prominent in the large-pore multi-layered restorbable devices compared to the ePTFE patch. This might influence long-term clinical outcome and caution seems warranted.

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References

  1. Halm JA, Heisterkamp J, Veen HF, Weidema WF (2005) Long-term follow-up after umbilical hernia repair: are there risk factors for recurrence after simple and mesh repair. Hernia: J hernias Abdom Wall Surg 9:334–337

    Article  CAS  Google Scholar 

  2. Arroyo A, Garcia P, Perez F, Andreu J, Candela F, Calpena R (2001) Randomized clinical trial comparing suture and mesh repair of umbilical hernia in adults. Br J Surg 88:1321–1323

    Article  CAS  PubMed  Google Scholar 

  3. Aslani N, Brown CJ (2010) Does mesh offer an advantage over tissue in the open repair of umbilical hernias? A systematic review and meta-analysis. Hernia: J Hernias Abdom wall Surg 14:455–462

    Article  CAS  Google Scholar 

  4. Sanjay P, Reid TD, Davies EL, Arumugam PJ, Woodward A (2005) Retrospective comparison of mesh and sutured repair for adult umbilical hernias. Hernia: J Hernias Abdom wall Surg 9:248–251

    Article  CAS  Google Scholar 

  5. Hadi HI, Maw A, Sarmah S, Kumar P (2006) Intraperitoneal tension-free repair of small midline ventral abdominal wall hernias with a Ventralex hernia patch: initial experience in 51 patients. Hernia: J Hernias Abdom wall Surg 10:409–413

    Article  CAS  Google Scholar 

  6. Iversen E, Lykke A, Hensler M, Jorgensen LN (2010) Abdominal wall hernia repair with a composite ePTFE/polypropylene mesh: clinical outcome and quality of life in 152 patients. Hernia: J Hernias Abdom wall Surg 14:555–560

    Article  CAS  Google Scholar 

  7. Martin DF, Williams RF, Mulrooney T, Voeller GR (2008) Ventralex mesh in umbilical/epigastric hernia repairs: clinical outcomes and complications. Hernia: J Hernias Abdom wall Surg 12:379–383

    Article  CAS  Google Scholar 

  8. Vychnevskaia K, Mucci-Hennekinne S, Casa C, Brachet D, Meunier K, Briennon X, Hamy A, Arnaud JP (2010) Intraperitoneal mesh repair of small ventral abdominal wall hernias with a Ventralex hernia patch. Diges Surg 27:433–435

    Article  Google Scholar 

  9. Berrevoet F (2011) Intraperitoneal mesh repair of small ventral abdominal wall hernias with a Ventralex hernia patch: a critical note. Diges Surg 28:372

    Article  Google Scholar 

  10. Berrevoet F, D’Hont F, Rogiers X, Troisi R, de Hemptinne B (2011) Open intraperitoneal versus retromuscular mesh repair for umbilical hernias less than 3 cm diameter. Am J Surg 201:85–90

    Article  PubMed  Google Scholar 

  11. Berrevoet F, Van den Bossche B, de Baerdemaeker L, de Hemptinne B (2010) Laparoscopic evaluation shows deficiencies in memory ring deployment during small ventral hernia repair. World J Surg 34:1710–1715

    Article  PubMed  Google Scholar 

  12. Muysoms FE, Bontinck J, Pletinckx P (2011) Complications of mesh devices for intraperitoneal umbilical hernia repair: a word of caution. Hernia: J Hernias Abdom wall Surg 15:463–468

    Article  CAS  Google Scholar 

  13. Tollens T, Topal H, Ovaere S, Beunis A, Vermeiren K, Aelvoet C (2013) Prospective analysis of ventral hernia repair using the ventralight ST hernia patch. Surg Technol Int 23:113–116

    PubMed  Google Scholar 

  14. Martin-Cartes J, Morales-Conde S, Suarez-Grau J, Lopez-Bernal F, Bustos-Jimenez M, Cadet-Dussort H, Socas-Macias M, Alamo-Martinez J, Tutosaus-Gomez JD, Morales-Mendez S (2008) Use of hyaluronidase cream to prevent peritoneal adhesions in laparoscopic ventral hernia repair by means of intraperitoneal mesh fixation using spiral tacks. Surg Endosc 22:631–634

    Article  PubMed  Google Scholar 

  15. Clarke T, Katkhouda N, Mason RJ, Cheng BC, Algra J, Olasky J, Sohn HJ, Moazzez A, Balouch M (2011) Fibrin glue for intraperitoneal laparoscopic mesh fixation: a comparative study in a swine model. Surg Endosc 25:737–748

    Article  PubMed  Google Scholar 

  16. Deeken CR, Faucher KM, Matthews BD (2012) A review of the composition, characteristics, and effectiveness of barrier mesh prostheses utilized for laparoscopic ventral hernia repair. Surg Endosc 26:566–575

    Article  PubMed  Google Scholar 

  17. Burger JW, Halm JA, Wijsmuller AR, ten Raa S, Jeekel J (2006) Evaluation of new prosthetic meshes for ventral hernia repair. Surg Endosc 20:1320–1325

    Article  CAS  PubMed  Google Scholar 

  18. ten Broek RPSM, Strik C, van Laarhoven CJ, Keus F, van Goor H (2014) Benefits and harms of adhesion barriers for abdominal surgery: a systematic review and meta-analysis. Lancet 383:48–59

    Article  PubMed  Google Scholar 

  19. Schreinemacher MH, Emans PJ, Gijbels MJ, Greve JW, Beets GL, Bouvy ND (2009) Degradation of mesh coatings and intraperitoneal adhesion formation in an experimental model. British J Surg 96:305–313

    Article  CAS  Google Scholar 

  20. Schoenmaeckers EJ, van der Valk SB, van den Hout HW, Raymakers JF, Rakic S (2009) Computed tomographic measurements of mesh shrinkage after laparoscopic ventral incisional hernia repair with an expanded polytetrafluoroethylene mesh. Surg Endosc 23:1620–1623

    Article  PubMed  Google Scholar 

  21. Carter PR, LeBlanc KA, Hausmann MG, Whitaker JM, Rhynes VK, Kleinpeter KP, Allain BW (2012) Does expanded polytetrafluoroethylene mesh really shrink after laparoscopic ventral hernia repair? Hernia: J hernias Abdom wall Surg 16:321–325

    Article  CAS  Google Scholar 

  22. de Vries Reilingh TS, van Goor H, Koppe MJ, Bodegom ME, Hendriks T, Bleichrodt RP (2007) Interposition of polyglactin mesh does not prevent adhesion formation between viscera and polypropylene mesh. J Surg Res 140:27–30

    Article  PubMed  Google Scholar 

  23. Tollens T, Struyve D, Aelvoet C, Vanrijkel JP (2010) Introducing the proceed ventral patch as a new device in surgical management of umbilical and small ventral hernias: preliminary results. Surg Technol Int 19:99–103

    PubMed  Google Scholar 

  24. Ambe P, Meyer A, Kohler L (2013) Repair of small and medium size ventral hernias with a proceed ventral patch: a single center retrospective analysis. Surg Today 43:381–385

    Article  PubMed  Google Scholar 

  25. Bontinck J, Kyle-Leinhase I, Pletinckx P, Vergucht V, Beckers R, Muysoms F (2013) Single centre observational study to evaluate the safety and efficacy of the proceed ventral patch to repair small ventral hernias. Hernia : J hernias Abdom wall Surg 18:671–680

    Article  Google Scholar 

  26. Bensaadi H, Paolino L, Valenti A, Polliand C, Barrat C, Champault G (2014) Intraperitoneal tension-free repair of a small midline ventral abdominal wall hernia: randomized study with a mean follow-up of 3 years. Am Surg 80:57–65

    PubMed  Google Scholar 

  27. Garcia-Moreno F, Sotomayor S, Perez-Lopez P, Perez-Kohler B, Bayon Y, Pascual G, Bellon JM (2014) Intraperitoneal behaviour of a new composite mesh (Parietex Composite Ventral Patch) designed for umbilical or epigastric hernia repair. Surg Endosc 28:3479–3488

    Article  CAS  PubMed  Google Scholar 

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Conflict of interest

ER declares conflict of interest related to this work. Following companies funded for research and used material of the present experimental study: Bard Davol Company and Ethicon, Johnson & Johnson Company. KC: No conflicts of interest. IVO: No conflicts of interest. RT: No conflict of interest. FB: declares conflict of interest not directly related to this work.

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Authors and Affiliations

  1. Department of General and Hepatobiliary Surgery and Liver Transplantation Service, Ghent University Hospital and Medical School, De Pintelaan 185 2K12-IC, 9000, Ghent, Belgium

    E. Reynvoet, R. Troisi & F. Berrevoet

  2. Department of Pathology, Bacteriology and Poultry Diseases, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium

    K. Chiers

  3. Department of Animal Facility, Ghent University Hospital and Medical School, Ghent, Belgium

    I. Van Overbeke

Authors
  1. E. Reynvoet
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  2. K. Chiers
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  3. I. Van Overbeke
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  4. R. Troisi
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  5. F. Berrevoet
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Correspondence to E. Reynvoet.

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Reynvoet, E., Chiers, K., Van Overbeke, I. et al. Intraperitoneal mesh devices for small midline hernias: mesh behavior in a porcine model. Hernia 19, 955–963 (2015). https://doi.org/10.1007/s10029-015-1368-3

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  • DOI: https://doi.org/10.1007/s10029-015-1368-3

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