[Real-time monitoring of the peritoneal behavior of composite prostheses by sequential laparoscopy: applicability in ventral hernia repair].
BACKGROUND
Despite the advantages offered by meshes, their use in abdominal wall repair can promote adhesions and damage the intra-abdominal viscera. This study was designed to assess the behavior at the peritoneal interface of several composite prostheses using sequential laparoscopy to monitor the real-time adhesion formation process.


METHODS
Three composite prostheses, Parietex Composite (n=8), Sepramesh (n=8) and PL-PU 99 (n=8), were used to repair 7 x 5 cm defects created in the abdominal wall of 24 New Zealand white rabbits. The area occupied by adhesions at 3, 7 and 14 days after prosthesis placement was established by tracing the adhesions onto a polyethylene template, using images obtained from sequential laparoscopy, and subjecting it to image analysis. At 14 days, the animals were sacrificed and specimens of the prostheses plus adjacent host tissue were obtained for histological and morphometric tests.


RESULTS
Adhesion formation was laparoscopically observed to stabilize between 7 and 14 days post-implant, with no increase in adhesions produced at 14 days. The Parietex and PL-PU99 meshes showed significantly lower proportions of adhesions (0.55 +/- 0.06% and 0.27 +/- 0.20% respectively) than Sepramesh (18.55 +/- 1.96%). All three composites induced similar host tissue ingrowth and mesothelialization of the peritoneal prosthetic surface.


CONCLUSIONS
a) The three prostheses tested showed optimal behavior at the peritoneal interface; b) the critical period when most adhesions form is the first week after implant; c) these biomaterials are suitable for use in laparoscopic ventral hernia repair.
Bellón
Juan M
JM
Departamento de Cirugía, Facultad de Medicina, Universidad de Alcalá, Alcalá de Henares, Madrid, España. juanm.bellon@uah.es
Rodríguez
Marta
M
García-Honduvilla
Natalio
N
Gómez-Gil
Verónica
V
Pascual
Gemma
G
Buján
Julia
J
D034861:Abdominal Wall / Q000601:surgery*; D000818:Animals; D001672:Biocompatible Materials; D003627:Data Interpretation, Statistical; D006555:Hernia, Ventral / Q000601:surgery*; D010535:Laparoscopy; D008854:Microscopy, Electron; D023421:Models, Animal; D010537:Peritoneum / Q000502:physiology* / Q000648:ultrastructure; D011126:Polypropylenes; D019736:Prostheses and Implants; D011817:Rabbits; D013526:Surgical Mesh; D013997:Time Factors; D000267:Tissue Adhesions
D001672:Biocompatible Materials; D011126:Polypropylenes