Abstract
Background
In hernia repair, particularly laparoscopic hernia repair, direct contact between mesh and abdominal organs cannot always be avoided. Several mesh materials and composite meshes have been developed to decrease subsequent adhesion formation. Recently, new meshes have been introduced. In an experimental rat study, their value was established and compared with that of meshes already available on the market.
Methods
In 200 rats, eight different meshes were placed intraperitoneally and in direct contact with abdominal viscera. The following meshes were tested: polypropylene (Prolene), e-PTFE (Dualmesh), polypropylene– polyglecaprone composite (Ultrapro), titanium–polypropylene composite (Timesh), polypropylene with carboxymethylcellulose–sodium hyaluronate coating (Sepramesh), polyester with collagen-polyethylene glycol–glycerol coating (Parietex Composite), polypropylene–polydioxanone composite with oxidized cellulose coating (Proceed), and bovine pericardium (Tutomesh). At 7 and then at 30 days postoperatively, adhesion formation, mesh incorporation, tensile strength, shrinkage, and infection were scored by two independent observers.
Results
Parietex Composite, Sepramesh, and Tutomesh resulted in decreased surface coverage with adhesions, whereas Prolene, Dualmesh, Ultrapro, Timesh, and Proceed resulted in increased adhesion coverage. Parietex Composite, Prolene, Ultrapro, and Sepramesh resulted in the most mesh incorporation. Dualmesh and Tutomesh resulted in significantly increased shrinkage. There were no differences in mesh infection. Parietex Composite and Dualmesh resulted in a moderate inflammatory reaction, as compared with the mild reaction the other meshes exhibited.
Conclusion
Parietex Composite and Sepramesh combine minimal adhesion formation with maximum mesh incorporation and tensile strength. The authors recommend the use of these meshes for hernia repair in which direct contact with the abdominal viscera cannot be avoided.
Similar content being viewed by others
References
Alimoglu O, Akcakaya A, Sahin M, Unlu Y, Ozkan OV, Sanli E, Eryilmaz R (2003) Prevention of adhesion formations following repair of abdominal wall defects with prosthetic materials (an experimental study). Hepatogastroenterology 50: 725–728
Alponat A, Lakshminarasappa SR, Yavuz N, Goh PM (1997) Prevention of adhesions by Seprafilm, an absorbable adhesion barrier: an incisional hernia model in rats. Am Surg 63: 818–819
Bageacu S, Blanc P, Breton C, Gonzales M, Porcheron J, Chabert M, Balique JG (2002) Laparoscopic repair of incisional hernia: a retrospective study of 159 patients. Surg Endosc 16: 345–348
Baptista ML, Bonsack ME, Felemovicius I, Delaney JP (2000) Abdominal adhesions to prosthetic mesh evaluated by laparoscopy and electron microscopy. J Am Coll Surg 190: 271–280
Borrazzo EC, Belmont MF, Boffa D, Fowler DL (2004) Effect of prosthetic material on adhesion formation after laparoscopic ventral hernia repair in a porcine model. Hernia 8: 108–112
Burger JW, Luijendijk RW, Hop WC, Halm JA, Verdaasdonk EG, Jeekel J (2004) Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg 240: 578–583, discussion 583–575
Demir U, Mihmanli M, Coskun H, Dilege E, Kalyoncu A, Altinli E, Gunduz B, Yilmaz B (2005) Comparison of prosthetic materials in incisional hernia repair. Surg Today 35: 223–227
diZerega GS (1997) Biochemical events in peritoneal tissue repair. Eur J Surg Suppl 577:10–16
Drollette CM, Badawy SZ (1992) Pathophysiology of pelvic adhesions: modern trends in preventing infertility. J Reprod Med 37: 107–121, discussion 121–102
Duffy AJ, Hogle NJ, LaPerle KM, Fowler DL (2004) Comparison of two composite meshes using two fixation devisces in a porcine laparoscopic ventral hernia repair model. Hernia 8(4): 358–364
Duffy DM, diZerega GS (1996) Adhesion controversies: pelvic pain as a cause of adhesions, crystalloids in preventing them. J Reprod Med 41: 19–26
Ellis H (1997) The clinical significance of adhesions: focus on intestinal obstruction. Eur J Surg Suppl 577: 5–9
Fitzgibbons RJ Jr, Salerno GM, Filipi CJ, Hunter WJ, Watson P (1994) A laparoscopic intraperitoneal onlay mesh technique for the repair of an indirect inguinal hernia. Ann Surg 219: 144–156
Franz MG, Kuhn MA, Nguyen K, Wang X, Ko F, Wright TE, Robson MC (2001) Transforming growth factor beta-2 lowers the incidence of incisional hernias. J Surg Res 97: 109–116
Gonzalez R, Rodeheaver GT, Moody DL, Foresman PA, Ramshaw BJ (2004) Resistance to adhesion formation: a comparative study of treated and untreated mesh products placed in the abdominal cavity. Hernia 8: 213–219
Goodney PP, Birkmeyer CM, Birkmeyer JD (2002) Short-term outcomes of laparoscopic and open ventral hernia repair: a meta-analysis. Arch Surg 137: 1161–1165
Hengirmen S, Cete M, Soran A, Aksoy F, Sencer H, Olcay E (1998) Comparison of meshes for the repair of experimental abdominal wall defects. J Invest Surg 11: 315–325
Hodgson NC, Malthaner RA, Ostbye T (2000) The search for an ideal method of abdominal fascial closure: a meta-analysis. Ann Surg 231: 436–442
Hoer J, Lawong G, Klinge U, Schumpelick V (2002) Factors influencing the development of incisional hernia: a retrospective study of 2,983 laparotomy patients over a period of 10 years. Chirurg 73: 474–480
Hooker GD, Taylor BM, Driman DK (1999) Prevention of adhesion formation with use of sodium hyaluronate–based bioresorbable membrane in a rat model of ventral hernia repair with polypropylene mesh: a randomized, controlled study. Surgery 125: 211–216
Klosterhalfen B, Klinge U, Henze U, Bhardwaj R, Conze J, Schumpelick V (1997) Morphologic correlation of functional abdominal wall mechanics after mesh implantation. Langenbecks Arch Chir 382: 87–94
Law NH, Ellis H (1988) Adhesion formation and peritoneal healing on prosthetic materials. Clin Materials 3: 95–101
Leber GE, Garb JL, Alexander AI, Reed WP (1998) Long-term complications associated with prosthetic repair of incisional hernias. Arch Surg 133: 378–382
Lewis RT, Wiegand FM (1989) Natural history of vertical abdominal parietal closure: prolene versus Dexon. Can J Surg 32: 196–200
Luijendijk RW, de Lange DC, Wauters CC, Hop WC, Duron JJ, Pailler JL, Camprodon BR, Holmdahl L, van Geldorp HJ, Jeekel J (1996) Foreign material in postoperative adhesions. Ann Surg 223: 242–248
Luijendijk RW, Hop WC, van den Tol MP, de Lange DC, Braaksma MM, JN IJ, Boelhouwer RU, de Vries BC, Salu MK, Wereldsma JC, Bruijninckx CM, Jeekel J (2000) A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med 343: 392–398
Matthews BD, Mostafa G, Carbonell AM, Joels CS, Kercher KW, Austin C, Norton HJ, Heniford BT (2005) Evaluation of adhesion formation and host tissue response to intraabdominal polytetrafluoroethylene mesh and composite prosthetic mesh. J Surg Res 123: 227–234
Matthews BD, Pratt BL, Pollinger HS, Backus CL, Kercher KW, Sing RF, Heniford BT (2003) Assessment of adhesion formation to intraabdominal polypropylene mesh and polytetrafluoroethylene mesh. J Surg Res 114: 126–132
Menzies D (1993) Postoperative adhesions: their treatment and relevance in clinical practice. Ann R Coll Surg Engl 75: 147–153
Menzies D, Ellis H (1990) Intestinal obstruction from adhesions: how big is the problem? Ann R Coll Surg Engl 72: 60–63
Monk BJ, Berman ML, Montz FJ (1994) Adhesions after extensive gynecologic surgery: clinical significance, etiology, and prevention. Am J Obstet Gynecol 170: 1396–1403
Mudge M, Hughes LE (1985) Incisional hernia: a 10-year prospective study of incidence and attitudes. Br J Surg 72: 70–71
National Center for Health Statistics (1996) Combined Surgery Data (NHDS and NSAS) Data Highlights. Accessed at http://www.cdc.gov/nchs/about/major/hdasd/combtab.htm on May 2003
Prismant (2002) National Medical Registration, Utrecht, The Netherlands
Schug-Pass C, Tamme C, Tannapfel A, Kockerling F (2004) Biocompatibility of laparoscopically placed intraabdominal meshes. In: Köckerling F (ed) Surgical techniques. Science Med dr. Sperber, Hanover, pp 1–9
Sugerman HJ, Kellum JM Jr, Reines HD, DeMaria EJ, Newsome HH, Lowry JW (1996) Greater risk of incisional hernia with morbidly obese than steroid-dependent patients and low recurrence with prefascial polypropylene mesh. Am J Surg 171: 80–84
Suslavich FJ, Turner NA, King PS, Brown HK (1989) Intraabdominal adhesions: intraoperative US. Radiology 172: 387–388
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Burger, J.W.A., Halm, J.A., Wijsmuller, A.R. et al. Evaluation of new prosthetic meshes for ventral hernia repair. Surg Endosc 20, 1320–1325 (2006). https://doi.org/10.1007/s00464-005-0706-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-005-0706-4