Prevention of adhesion to prosthetic mesh: comparison of different barriers using an incisional hernia model.
OBJECTIVE
To assess whether use of antiadhesive liquids or coatings could prevent adhesion formation to prosthetic mesh.


BACKGROUND
Incisional hernia repair frequently involves the use of prosthetic mesh. However, concern exists about development of adhesions between viscera and the mesh, predisposing to intestinal obstruction or enterocutaneous fistulas.


METHODS
In 91 rats, a defect in the muscular abdominal wall was created, and mesh was fixed intraperitoneally to cover the defect. Rats were divided in five groups: polypropylene mesh only (control group), addition of Sepracoat or Icodextrin solution to polypropylene mesh, Sepramesh (polypropylene mesh with Seprafilm coating), and Parietex composite mesh (polyester mesh with collagen coating). Seven and 30 days postoperatively, adhesions were assessed and wound healing was studied by microscopy.


RESULTS
Intraperitoneal placement of polypropylene mesh was followed by bowel adhesions to the mesh in 50% of the cases. A mean of 74% of the mesh surface was covered by adhesions after 7 days, and 48% after 30 days. Administration of Sepracoat or Icodextrin solution had no influence on adhesion formation. Coated meshes (Sepramesh and Parietex composite mesh) had no bowel adhesions. Sepramesh was associated with a significant reduction of the mesh surface covered by adhesions after 7 and 30 days. Infection was more prevalent with Parietex composite mesh, with concurrent increased mesh surface covered by adhesions after 30 days (78%).


CONCLUSIONS
Sepramesh significantly reduced mesh surface covered by adhesions and prevented bowel adhesion to the mesh. Parietex composite mesh prevented bowel adhesions as well but increased infection rates in the current model.
van 't Riet
Martijne
M
Department of General Surgery, Erasmus University Medical Centre, Rotterdam-Dijkzigt, The Netherlands. vantriet@hlkd.azr.nl
de Vos van Steenwijk
Peggy J
PJ
Bonthuis
Fred
F
Marquet
Richard L
RL
Steyerberg
Ewout W
EW
Jeekel
Johannes
J
Bonjer
H Jaap
HJ
D000818:Animals; D001672:Biocompatible Materials / Q000494:pharmacology*; D020099:Coated Materials, Biocompatible; D004195:Disease Models, Animal; D005936:Glucans / Q000494:pharmacology*; D005947:Glucose / Q000494:pharmacology*; D006555:Hernia, Ventral / Q000601:surgery*; D006820:Hyaluronic Acid; D000077607:Icodextrin; D007420:Intestine, Large / Q000473:pathology; D007421:Intestine, Small / Q000473:pathology; D008297:Male; D011126:Polypropylenes; D011183:Postoperative Complications / Q000517:prevention & control; D011336:Probability; D051381:Rats; D017208:Rats, Wistar; D012016:Reference Values; D012680:Sensitivity and Specificity; D013526:Surgical Mesh; D000267:Tissue Adhesions / Q000517:prevention & control*; D016896:Treatment Outcome
D001672:Biocompatible Materials; D020099:Coated Materials, Biocompatible; D005936:Glucans; D011126:Polypropylenes; C118198:Seprafilm; D000077607:Icodextrin; D006820:Hyaluronic Acid; D005947:Glucose