Introduction of polyethylene terephthalate mesh (KoSa hochfest) for abdominal hernia repair: an animal experimental study.
BACKGROUND
Nowadays the surgical treatment of abdominal hernias includes the use of synthetic meshes in most cases. Due to chronic foreign body reactions, however, the most commonly used polypropylene meshes can lead to material hardening and recurrent hernias. As a proven cruciate ligament replacement polyethylene terephthalate (KoSa hochfest showed only little foreign body reactions and provided excellent clinical outcomes. In an animal trial it was therefore tested as mesh implant for hernia treatment and compared with Prolene.


METHODS
The study was carried out in 12 mini-pigs. 10 x 10 cm of the musculofascial abdominal layer was resected, the peritoneum was preserved. A 15 x 15 cm synthetic mesh was implanted in sublay-technique (either KoSa hochfest, Telos GmbH, Marburg, Germany or Prolene, Ethicon, Norderstedt, Germany), mainly to test for chronic foreign body reactions. An independent pathologist tested the mesh size and foreign body reaction at 2 and 6 months, analysing the number of foreign body giant cells.


RESULTS
No significant differences in mesh size were observed, neither between the compared groups nor with respect to the time periods. Compared to KoSa hochfest the foreign body reaction was significantly stronger in the Prolene implants, both at 2 and at 6 months (number of foreign body giant cells at 2 months: Prolene/KoSa hochfest: 2.2 +/- 0.4/0.8 +/- 0.2, at 6 months: 4.6 +/- 1.3/1.1 +/- 0.5). In contrast to KoSa hochfest, Prolene still showed significant foreign body reactions at 6 months as well as calcifications of all samples.


CONCLUSIONS
The animal trials revealed that due to its high biocompatibility and little foreign body reaction KoSa hochfest is a promising implant for the treatment of hernias.
Zieren
Jürgen
J
Department of General Surgery, Charité, Humboldt University Berlin, Germany. juergen.zieren@charite.de
Neuss
Heiko
H
Paul
Marco
M
Müller
Joachim
J
D000818:Animals; D001672:Biocompatible Materials / Q000009:adverse effects; D002114:Calcinosis / Q000209:etiology / Q000473:pathology; D004195:Disease Models, Animal; D005549:Foreign-Body Reaction / Q000209:etiology* / Q000473:pathology*; D006555:Hernia, Ventral / Q000473:pathology* / Q000601:surgery*; D008422:Materials Testing; D011093:Polyethylene Terephthalates; D011126:Polypropylenes; D013526:Surgical Mesh / Q000009:adverse effects*; D013552:Swine; D013556:Swine, Miniature; D016896:Treatment Outcome
D001672:Biocompatible Materials; D011093:Polyethylene Terephthalates; D011126:Polypropylenes