Preliminary assessment of postoperative adhesion formation after laser-assisted mesh fixation to the peritoneal surface.
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.
Lanzafame
Raymond J
RJ
Rochester General Hospital Laser Center, Rochester, New York 14621-3095, USA. ray.lanzafame@viahealth.org
Stadler
Istvan
I
Brondon
Philip
P
Soltz
Barbara A
BA
Devore
Dale P
DP
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
D011098:Polyglactin 910; D003094:Collagen