In vivo studies comparing the biocompatibility of various polypropylene meshes and their handling properties during endoscopic total extraperitoneal (TEP) patchplasty: an experimental study in pigs.
BACKGROUND
Polypropylene (PP) meshes are currently being used in millions of operations for hernial repair. We tested several recently modified PP meshes to evaluate them in terms of their biocompatibility and handling characteristics during minimally invasive procedures.


METHODS
Four different PP meshes (a heavyweight PP, Atrium; a lightweight PP incorporating absorbable polyglactic acid, Vypro II; a lightweight PP, Parietene; and a titanium-coated lightweight PP, Ti-Mesh Extralight), all implanted using the endoscopic total extrapreperitoneal (TEP) technique, were investigated in groups comprising 11 pigs each. After 94 +/- 5 days, the animals were autopsied and tissue samples were studied histologically, immunohistochemically, and electron-microscopically.


RESULTS
Whereas endoscopic handling of the Vypro II mesh proved difficult, the already good properties of the Atrium mesh were significantly improved on by Parietene and the Ti-Mesh. Clear differences were also found in the shrinkage characteristics of the implant materials. In comparison with Atrium (12%), Vypro II mesh shrinkage was significantly greater (28%), whereas Parietene (7%) and Ti-Mesh (5%) incurred less shrinkage. With regard to the chronic inflammatory reaction, the titanium-coated mesh showed a significantly lower inflammatory activity (13.1% partial volume [%PV] vs 34.1%PV and 29.0%PV) than the lightweight meshes Vypro II and Parietene, but-with the exception of the monocytic (0.2 vs 9.1, 5.1, and 7.9) and B-lymphocytic reaction (1.1 vs 18.0, 11.7, and 12.2)-no significant difference was seen in comparison with Atrium. The various mediators in the extracellular matrix (matrix metalloproteinases 1 [MMP-1 transforming growth factor beta [TGF-beta], urokinase plasminogen activator [uPA], and type I collagen) tended to show the highest expression with Vypro II (13.6, 113.2, 132.7, and 139.5, respectively) and the lowest expression with Ti-Mesh (11.9, 68.5, 92.8, and 75.0, respectively). With regard to cell proliferation, Parietene and Ti-Mesh appeared to have slight advantages, but no differences were observed in the apoptotic rate.


CONCLUSIONS
In our opinion, despite a reduction in material, Vipro II, on account of the inflammatory reaction, does not represent a true improvement over the meshes currently used for hernia repair. In comparison, the two lightweight PP patches are characterized by a more favorable foreign body reaction, with the titanium coating of the Ti-Mesh providing an additional advantage in terms of its biocompatibility.
Scheidbach
H
H
Department of Surgery, Otto von Guericke University-Magdeburg, Leipziger Strasse 44, D-39120 Magdeburg, Germany.
Tamme
C
C
Tannapfel
A
A
Lippert
H
H
Köckerling
F
F
D034861:Abdominal Wall / Q000601:surgery*; D000818:Animals; D001402:B-Lymphocytes / Q000473:pathology; D001672:Biocompatible Materials / Q000009:adverse effects; D020099:Coated Materials, Biocompatible / Q000009:adverse effects; D024042:Collagen Type I / Q000032:analysis; D005260:Female; D005549:Foreign-Body Reaction / Q000209:etiology / Q000378:metabolism / Q000473:pathology; D020007:Implants, Experimental; D010535:Laparoscopy; D008297:Male; D008422:Materials Testing; D020781:Matrix Metalloproteinase 1 / Q000032:analysis; D008854:Microscopy, Electron; D019060:Minimally Invasive Surgical Procedures; D009000:Monocytes / Q000473:pathology; D011126:Polypropylenes / Q000009:adverse effects; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000379:methods; D013526:Surgical Mesh / Q000009:adverse effects; D013552:Swine; D014025:Titanium; D016212:Transforming Growth Factor beta / Q000032:analysis; D014568:Urokinase-Type Plasminogen Activator / Q000032:analysis
D001672:Biocompatible Materials; D020099:Coated Materials, Biocompatible; D024042:Collagen Type I; D011126:Polypropylenes; D016212:Transforming Growth Factor beta; D014025:Titanium; D014568:Urokinase-Type Plasminogen Activator; D020781:Matrix Metalloproteinase 1