Foreign body reaction to meshes used for the repair of abdominal wall hernias.
OBJECTIVE
To investigate the local tissue reactions to meshes that had been removed from humans.


METHODS
Open study


METHODS
Surgical department of the technical University, Aachen, Germany.


METHODS
Samples of 17 non-absorbable meshes (1 polyester, 10 polypropylene, 2 reduced polypropylene, and 4 polytetrafluorethylene, PTFE) and 1 absorbable mesh (polyglactin 910) that had been implanted for repair of abdominal wall defects.


METHODS
Light and transmission electron microscopy, immunohistochemistry, and histological examination.


METHODS
Signs of inflammatory response.


RESULTS
Light microscopy showed chronic inflammatory tissue reaction, even after years, with pronounced differences among materials. Partial volume of inflammatory cells (%) varied from 32 in polypropylene, to 12 in expanded PTFE, 8 in polyester, and 7 in reduced polypropylene. Formation of connective tissue correlated significantly with the extent of the inflammatory reaction (p<0.01). In meshes implanted for long periods there were still numerous macrophages at the interface between tissue and polypropylene (45%), polyester (45%), expanded PTFE (25%), and reduced polypropylene (22%). There was no difference in time dependent tissue reactions (p = 0.19).


CONCLUSIONS
Inflammation around alloplastic materials used to repair defects in the abdominal wall persists for many years. There was evidence of long term wound complications as a result of persistent foreign body reactions. Further studies are required to evaluate the long term tissue response to these materials.
Klinge
U
U
Department of Surgery, IZKF-Biomat, The University of Technology, RWTH, Aachen, Germany.
Klosterhalfen
B
B
Müller
M
M
Schumpelick
V
V
D000009:Abdominal Muscles / Q000378:metabolism / Q000601:surgery* / Q000648:ultrastructure; D000328:Adult; D000368:Aged; D005260:Female; D005549:Foreign-Body Reaction / Q000209:etiology* / Q000378:metabolism / Q000473:pathology; D006555:Hernia, Ventral / Q000150:complications* / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008854:Microscopy, Electron; D008875:Middle Aged; D012086:Reoperation; D013526:Surgical Mesh / Q000009:adverse effects* / Q000706:statistics & numerical data