Abstract
Introduction
In recent years, laparoscopic repair of abdominal wall hernias has become increasingly established in routine clinical practice thanks to the myriad advantages it confers. Apart from the risk of intestinal damage following adhesiolysis, to date no information is available on the best way of preventing the formation of new adhesions in the vicinity of the implanted meshes. Numerous experimental investigations, mainly conducted on an open small-animal model, have demonstrated the advantages of coating meshes, inter alia with absorbable materials, compared with uncoated polypropylene meshes. In our established laparoscopic porcine model we set about investigating three of these meshes, which are already available on the market.
Materials and methods
In total, 18 domestic pigs underwent laparoscopic surgery and three different composite meshes were tested in each case on six animals (Dynamesh IPOM, Proceed, Parietene Composite). At 4 months, postmortem diagnostic laparoscopy was carried out, followed by full-wall excision of the specimens. Planimetric analysis was conducted to investigate the size of the entire surface area and the extent of adhesions. Histological investigations were performed on five sections for each specimen. These focused on the partial volumes of inflammatory cells, the proliferation marker Ki67, apoptotic index, inflammatory cell marker CD68 and transforming growth factor beta (TGF-β) as a marker of the extracellular matrix.
Results
A similar value of 14% was obtained for shrinkage of Dynamesh IPOM and Parietene Composite, while Proceed showed a 25% reduction in its surface area. Markedly lower values of 12.8% were obtained for Parietene Composite in respect of adhesions to the greater omentum, compared with 31.7% for Proceed and 33.2% for Dynamesh IPOM (p = 0.01). Overall, Parietene Composite performed best in the histological and immunhistochemistry tests.
Conclusions
On the whole, all composite meshes showed evidence of good biocompatibility. However, none of the coatings was completely able to prevent adhesions. Coating of polypropylene meshes with collagen appears to confer significant advantages compared with other coatings.
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References
Alimoglu O, Akcakaya A, Sahin M, Unlu Y, Ozkan OV, Sanli E, Erylmaz R (2003) Prevention of adhesion formations following repair of abdominal wall defects with prosthetic materials (an experimental study). Hepatogastroenterology 50:725–728
Amid PK, Shulman AG, Lichtenstein IL, Sostrin S, Young J, Hakakha M (1994) Experimental evaluation of a new composite mesh with the selective property of incorporation to the abdominal wall without adhering to the intestines. J Biomed Mater Res 28:373–375
Arnaud JP, Hennekinne-Mucci S, Pessaux P, Tuech JJ, Aube C (2003) Ultrasound detection of visceral adhesion after intraperitoneal ventral hernia treatment: a comparative study of protected versus unprotected meshes. Hernia 7:85–88
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
Baykal A, Yorganci K, Sokemensuer C, Hamaloglu E, Renda N, Sayek I (2000) An experimental study of the adhesive potential of different meshes. Eur J Surg 166:490–494
Bellon JM, Garcia-Carranza A, Jurado F, Garcia-Honduvilla N, Carrera-San Martin A, Bujan J (2001) Peritoneal regeneration after implant of composite prosthesis in the abdominal wall. World J Surg 25:147–152
Bellon JM, Garcia-Honduvilla N, Jurado F, Garcia-Carranza A, Garcia-Moreno F, Martin AC, Bujan J (2001) Use of composite prostheses in the repair of defects in abdominal wall: prosthetic behaviour at the peritoneum. Eur J Surg 167:666–671
Bellon JM, Jurado F, Garcia-Honduvilla N, Lopez R, Carrera-San Martin A, Bujan J (2002) The structure of a biomaterial rather than its chemical composition modulates the repair process at the peritoneal level. Am J Surg 184:154–159
Bellon JM, Rodriguez M, Garcia-Honduvilla N, Pascual G, Bujan J (2007) Partially absorbable meshes for hernia repair offer advantages over nonabsorbable meshes. Am J Surg 194:68–74
Bellon JM, Rodriguez M, Garcia-Honduvilla N, Pascual G, Gomez Gil V, Bujan J (2007) Peritoneal effects of prosthetic meshes used to repair abdominal wall defects: monitoring adhesions by sequential laparoscopy. J Laparoendosc Adv Surg Tech A 17:160–166
Berger D (2007) Prevention of parastomal hernias by prophylactic use of a specially designed intraperitoneal onlay mesh (Dynamesh IPST (R)). epub ahead of print, Hernia
Besim H, Yalcin Y, Hamamci O, Arslan K, Sonisik M, Korkmaz A, Erdogan S (2002) Prevention of intraabdominal adhesions produced by polypropylene mesh. Eur Surg Res 34:239–243
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
Christoforoni PM, Kim YB, Preys Z, Lay RY, Montz FJ (1996) Adhesion formation after incisional hernia repair: a randomized porcine trial. Am Surg 62:935–938
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
Conze J, Rosch R, Klinge U, Weiss C, Anurov M, Titkowa S, Oettinger A, Schumpelick V (2004) Polypropylene in the intra-abdominal position: influence of pore-size and surface area. Hernia 8:365–372
Conze J, Junge K, Klinge U, Weiss C, Polivoda M, Oettinger AP, Schumpelick V (2005) Intraabdominal adhesion formation of polypropylene mesh. Influence of coverage of omentum and polyglactin. Surg Endosc 19:798–803
Dilege E, Coskun H, Gunduz B, Sakiz D, Mihmanli M (2006) Prevention of adhesion to prosthetic mesh in incisional ventral hernias: comparison of different barriers in an experimental model. Eur Surg Res 38:358–364
Dinsmore RC, Calton WC, Harvey SB, Blaney MW (2000) Prevention of adhesions to polypropylene mesh in a traumatized bowel model. J Am Coll Surg 191:131–136
Hogle Duffy AJ, NJ LaPerle KM, Fowler DL (2004) Comparison of two composite meshes using two fixation devices in a porcine laparoscopic ventral hernia repair model. Hernia 8:358–364
Eriksen JR, Gögenur I, Rosenberg J (2007) Choice of mesh for laparoscopic ventral hernia repair. Hernia 11:481–492
Felemovicius I, Bonsack ME, Hagerman G, Delaney JP (2004) Prevention of adhesions to polypropylene mesh. J Am Coll Surg 198:543–548
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
Fitzgibbons RJ Jr (2000) Adding laparoscopy to experimental adhesion study protocols. J Am Coll Surg 190:336–338
Garcia-Ruiz A, Naitoh T, Gagner M (1998) A porcine model for laparoscopc ventral hernia repair. Surg Laparosc Endosc 8:35–39
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 abdominal cavity. Hernia 8:213–219
Gutt CN, Oniu T, Mehrabi A, Büchler W (2004) Fewer adhesions induced by laparoscopic surgery? Surg Endosc 18:898–906
Halm JA, de Wall LL, Steyerberg EW, Jeekel J, Lange JF (2006) Intraperitoneal polypropylene mesh hernia repair complicates subsequent abdominal surgery. World J Surg 31:423–429
Harrell AG, Novitsky YW, Peindl RD, Cobb WS, Austin CE, Cristiano JA, Norton JH, Kercher KW, Heniford BT (2006) Prospective evaluation of adhesion formation and shrinkage of intraabdominal prosthetics in a rabbit model. Am Surg 72:808–813
Hengirmen S, Cete M, Soran A, Aksoy F, Sencer H, Olcay E (1998) Comparison of meshes for the repair of abdominal wall defects. J Invest Surg 11:315–325
Jacob BP, Hogle NJ, Durak E, Kim T, Fowler DL (2007) Tissue ingrowth and bowel adhesion formation in an animal comparative study: polypropylene versus Proceed versus Parietex Composite. Surg Endosc 21:629–633
Judge TW, Parker DM, Dinsmore RC (2007) Abdominal wall hernia repair. A comparison of sepramesh and parietex composite mesh in a rabbit hernia model. J Am Coll Surg 204:276–281
Junge K, Rosch R, Klinge U, Krones C, Klosterhalfen B, Mertens PR, Lynen P, Kunz D, Preiss A, Peltroche-Llacsahuanga H, Schumpelick V (2005) Gentamicin supplementation of polyvinylidenfluoride mesh materials for infection prophylaxis. Biomaterials 26:787–793
Junge K, Klinge U, Rosch R, Lynen P, Binnebösel M, Conze J, Mertens PR, Schwab R, Schumpelick V (2007) Improved collagen I/III ratio at the interface of gentamicin-supplemented polyvinylidenfluoride mesh materials. Langenbeck’s Arch Surg 392:465–471
Kayaoglu HA, Ozkan N, Hazinedaroglu SM, Ersoy OF, Erkek AB, Koseoglu RD (2005) Comparison of adhesive properties of five different prosthetic materials used in hernioplasty. J Invest Surg 18:89–95
Klinge U, Klosterhalfen B, Ottinger AP, Junge K, Schumpelick V (2002) PVDF as a new polymer for the construction of surgical meshes. Biomaterials 23:3487–3493
Koehler RH, Begos D, Berger D, Carey S, LeBlanc K, Park A, Ramshaw B, Smoot R, Voeller G (2003) Minimal Adhesions to ePTFE mesh after laparoscopic ventral incisional hernia repair: reoperative findings in 65 cases. JSLS 7:335–340
McGinty JJ, Hogle NJ, McCarthy H, Fowler DL (2005) A comparative study of adhesion formation and abdominal wall ingrowth after laparoscopic ventral hernia repair in a porcine model using multiple types of mesh. Surg Endosc 19:786–790
Morris-Stiff G, Hughes LE (1998) The outcomes of non-absorbable mesh placed within the abdominal cavity: literature review and clinical experience. J Am Coll Surg 186:352–357
Ozmen MM, Aslar AK, Terzi MC, Albayrak L, Berberoglu M (2002) Prevention of adhesions by bioresorbable tissue barrier following laparoscopic intraabdominal mesh insertion. Surg Laparosc Endosc Percutan Tech 12:342–346
Robinson TN, Clarke JH, Schoen J, Walsh MD (2005) Major-related complications following hernia repair: events reported to the Food and Drug Administration. Surg Endosc 19:1556–1560
Rudmik LR, Schieman C, Dixon E, Debru E (2006) Laparoscopic incisional hernia repair: a review of the literature. Hernia 10:110–119
Schug-Pass C, Tamme C, Tannapfel A, Köckerling F (2006) A lightweight polypropylene mesh (TiMesh) for laparoscopic intraperitoneal repair of abdominal wall hernias–comparison of biocompatibility with the DualMesh in an experimental study using the porcine model. Surg Endosc 20:402–409
Schug-Pass C, Sommerer F, Tannapfel A, Lippert H, Köckerling (2008) Does the additional application of a polylactide film (SurgiWrap®) to a lightweight mesh (TiMesh) reduce adhesions in laparoscopic intraperitoneal implantation procedures? Experimental results obtained in the laparoscopic porcine model. Surg Endosc 2008 Apr 24 (Epub ahead of print)
Sikkink CJJM, Vries de Reilingh TS, Malyar AW, Jansen JA, Bleichrodt RP, van Goor H (2006) Adhesion formation and reherniation differ between meshes used for abdominal wall reconstruction. Hernia 10:218–222
Thompson J (1998) Pathogenesis and prevention of adhesion formation. Dig Surg 15:153–157
van’t Riet M, van Steenwijk PJ, Bonthuis F, Marquet RL, Steyerberg EW, Jeekel J, Bonjer HJ (2003) Prevention of adhesion to prosthetic mesh: comparison of different barriers using an incisional hernia model. Ann Surg 237:123–128
van’t Riet M, Burger WA, Bonthuis F, Jeekel J, Bonjer HJ (2004) Prevention of adhesion formation to polypropylene mesh by collagen coating: a randomized controlled study in a rat model of ventral hernia repair. Surg Endosc 18:681–685
Vrijland WW, Bonthuis F, Steyerberg EW, Marquet RL, Jeekel J, Bonjer HJ (2000) Peritoneal adhesions to prosthetic materials: choice of mesh for incisional hernia repair. Surg Endosc 14:960–963
Weyhe D, Belyaev O, Müller C, Meurer K, Bauer KH, Papapostou G, Uhl W (2007) Improving outcomes in hernia repair by the use of light meshes—a comparison of different implant constructions based on a critical appraisal of the literature. Word J Surg 31:234–244
Winslow ER, Diaz S, Desai K, Meininger T, Soper NJ, Klingensmith ME (2004) Laparoscopic incisional hernia repair in a porcine model: what do transfixation sutures add? Surg Endsoc 18:529–535
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Schug-Pass, C., Sommerer, F., Tannapfel, A. et al. The use of composite meshes in laparoscopic repair of abdominal wall hernias: are there differences in biocompatibily?. Surg Endosc 23, 487–495 (2009). https://doi.org/10.1007/s00464-008-0085-8
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DOI: https://doi.org/10.1007/s00464-008-0085-8