Comparison of prosthetic materials in incisional hernia repair.
OBJECTIVE
Incisional hernias are not uncommon after abdominal surgery, but their repair is associated with a high risk of complications, including adhesions and recurrence. Many different types of meshes and adhesion barriers have been developed in an attempt to overcome these problems, some of which we have assessed in a rat model.


METHODS
We made a full-thickness 1.5 x 2.5-cm abdominal wall defect in 30 Sprague-Dawley rats, which were divided into three groups according to the materials used for repair: 2 x 3-cm polypropylene mesh (group 1); expanded polytetrafluoroethylene (PTFE) with double-layer polypropylene mesh (group 2); or polypropylene mesh with oxidized cellulose adhesion barriers (group 3). We assessed adhesion formation, tensile strength, and histopathologic findings.


RESULTS
The mean adhesion scores were 3.3, 1.3, and 0.7, in groups 1, 2, and 3, respectively (P < 0.001). The area involved by adhesions was significantly greater in group 1 than in groups 2 or 3 (P < 0.01, P < 0.05), but there was no significant difference between groups 2 and 3 (P < 0.05). The tensile strength in group 2 was less than that in groups 1 or 3 (P < 0.01, P < 0.05), but there was no significant difference between groups 1 and 3 (P > 0.05).


CONCLUSIONS
Although there was less adhesion formation with PTFE and oxidized cellulose, PTFE not only impaired the tensile strength, but also induced fibrosis and inflammation. An oxidized cellulose adhesion barrier can be safely used in incisional hernia repair to prevent intra-abdominal adhesions.
Demir
Uygar
U
Department of General Surgery, Sisli Etfal Training and Research Hospital, Istanbul, Turkey.
Mihmanli
Mehmet
M
Coskun
Halil
H
Dilege
Ece
E
Kalyoncu
Ali
A
Altinli
Ediz
E
Gunduz
Burhan
B
Yilmaz
Banu
B
D000818:Animals; D001672:Biocompatible Materials / Q000494:pharmacology; D002483:Cellulose, Oxidized / Q000494:pharmacology*; D004195:Disease Models, Animal; D006555:Hernia, Ventral / Q000601:surgery*; D008297:Male; D008422:Materials Testing; D011126:Polypropylenes / Q000494:pharmacology*; D011138:Polytetrafluoroethylene / Q000494:pharmacology*; D011183:Postoperative Complications; D011336:Probability; D011897:Random Allocation; D051381:Rats; D017207:Rats, Sprague-Dawley; D012680:Sensitivity and Specificity; D013526:Surgical Mesh; D013718:Tensile Strength; D014945:Wound Healing / Q000502:physiology
D001672:Biocompatible Materials; D002483:Cellulose, Oxidized; D011126:Polypropylenes; D011138:Polytetrafluoroethylene