A “self adhering” prosthesis for hernia repair: experimental study

Abstract

Background

Prosthetic reinforcement is now routine in the management of inguinal and incisional hernia, and it significantly reduces the risk of recurrence. After surgery, chronic pain is often attributed to the characteristics of the mesh and to the method of fixation in the wound, with a potential risk of nerve or muscle injuries.

Aim

To evaluate the properties of a new “self adhering” prosthesis in an experimental animal study.

Materials and methods

The self adhering prosthesis, a lightweight (40 mg/m²) polypropylene mesh coated with a synthetic glue on one side, was implanted laparoscopically in pigs. Removal of the prosthesis was performed at one day, one week and one month post operatively. A macroscopic and microscopic evaluation was performed. The results, using a quantitative score, were compared to those of a control group using the same polypropylene mesh without glue, but fixed by staples.

Results

The operative time was significantly lower in the self adhering group: 23 min (15–32) versus 31 min (21–40) (P = 0.01). The average time interval from the introduction of the mesh into the preperitoneal space until the appearance of the first tough adhesion was 3 min (2–4). In the control group, the mesh handling time was 8.3 min (5–14) (P = 0.01). At the time of implantation, the score was at a maximum value in all cases for the self adhering prostheses, especially concerning handling and adhesiveness. Upon removal, this score was noted to be good or very good in 90–100% of the cases. There was a good integration in the muscle confirmed histologically, and there was no shrinkage, no mobilisation and no migration. At one month, the thickness of the fibrosis at the limits of the meshes was significantly higher for the self adhering prostheses (P = 0.02).

Conclusion

In this experimental study, the self adhering prosthesis demonstrated its adhesive properties and its ability to be well tolerated, with a good macroscopic and microscopic integration into the abdominal wound. This should allow us to perform a clinical prospective study in an open and laparoscopic approach with the double objective of reducing post operative pain induced by mechanical fixation and decreasing the cost of these procedures by reducing the operative time and by eliminating staple fixation.