title: Preliminary assessment of postoperative adhesion formation after laser-assisted mesh fixation to the peritoneal surface.
abstract: OBJECTIVE
  This study evaluated the incidence and persistence of adhesions following intraperitoneal onlay mesh fixation with tissue soldering in an experimental model.
  
  
  METHODS
  Anesthetized New Zealand white rabbits (n = 21), weighing 2.8-3.2 kg, underwent laparotomy. Controls (group 1 [n = 3]) had 2 x 2 cm Mersilene (Ethicon, Somerville, New Jersey) polyester mesh segments fixed to the peritoneum with staples (USSC, Norwalk, Connecticut). Group 2 (n = 7) rabbits had Mersilene mesh affixed by melting 55% collagen solder using a prototype laser (1.43 micro, 2.5 W CW, 4 mm spot size, 60 degrees C set temperature) over mesh. Group 3 (n = 6) rabbits had Vicryl (Ethicon, Somerville, New Jersey) polyglactin mesh embedded in 60% collagen solder placed onto the peritoneum and fixed with identical laser parameters as group 2. Group 4 (n = 5) rabbits had 55% collagen solder placed and Mersilene pressed into it after melting. Four segments were placed in each experimental animal. Animals were euthanized at 2, 4, or 6 weeks. Adhesions were graded (0 = none; I = filmy adhesions; II = omental; III = bowel adhesions gently lysed; IV = dense adhesions requiring sharp dissection).
  
  
  RESULTS
  Grade III adhesions were observed in both control and group 4 animals at 2 weeks, persisting in group 4 animals at 6 weeks, but having lysed in controls at 6 weeks. No adhesions were present in group 3 specimens at any interval. Grade I adhesions were present in group 2 at 2 weeks at exposed mesh areas, and declined in frequency at 6 weeks. Evidence of reabsorption of the polyglactin mesh-solder composite was apparent in the group 3 specimens at 4 weeks, and complete resorption had occurred by 6 weeks postoperatively.
  
  
  CONCLUSIONS
  Laser-assisted solder fixation caused minimal adhesion formation when mesh was covered by solder. Adhesions were observed if Mersilene mesh material was exposed to the abdominal contents. Vicryl mesh-solder composites reabsorbed without inflammation, scarring, or adhesions at the sites of mesh fixation.
  
  
  CONCLUSIONS
  Further development of this technology is warranted.
authors.affiliation: Rochester General Hospital Laser Center, Rochester, New York 14621-3095, USA. ray.lanzafame@viahealth.org
authors.forename: Raymond J
authors.initials: RJ
authors.lastname: Lanzafame
authors.forename: Istvan
authors.initials: I
authors.lastname: Stadler
authors.forename: Philip
authors.initials: P
authors.lastname: Brondon
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Soltz
authors.forename: Dale P
authors.initials: DP
authors.lastname: Devore
mesh_terms: D000818:Animals; D003094:Collagen / Q000627:therapeutic use; D059685:Herniorrhaphy; D007813:Laparotomy; D053685:Laser Therapy; D010537:Peritoneum / Q000473:pathology*; D011098:Polyglactin 910 / Q000627:therapeutic use; D011183:Postoperative Complications; D011817:Rabbits; D013526:Surgical Mesh; D000267:Tissue Adhesions
chemical_list: D011098:Polyglactin 910; D003094:Collagen