Preventive midline laparotomy closure with a new bioabsorbable mesh: an experimental study.
BACKGROUND
Incisional hernia formation is one of the most frequent complications of midline laparotomies requiring reoperation. The aim of this study was to evaluate the safety and efficacy of prophylactically placing a biodegradable mesh within the incision site at closure in a rat model.


METHODS
A 4-cm full-thick midline laparotomy was made in Sprague-Dawley rats along the linea alba and closed by inserting a commercially available web of synthetic polymers (polyglycolic acid-trimethylene carbonate) that are slowly degraded by the body. Host tissue reaction was evaluated ex vivo and compared with that obtained in suture-only-treated rats. Specimens were harvested at 1, 3, and 6mo after surgery and divided for histologic and zymographic analyses and uniaxial material testing. A group of intact nonoperated animals were included to serve as a reference.


RESULTS
The excised tissue explants revealed that the performance of the synthetic device was good and resulted in enhanced fibroproliferation, gelatinolytic activity, and angiogenesis within the repair site as compared with the suture-only procedure. Lastly, tensile strength augmented over the suture-only condition.


CONCLUSIONS
The preventive introduction of an absorbable mesh stimulates new tissue ingrowth and performance relative to suture repair without prosthesis, probably contributing to eventually reinforce the tension line. These results have a clinical potential in abdominal wall closure, especially in patients with multiple risk factors such as those treated for aortic reconstructive surgery, without the short- and long-term complications related to permanent grafts. However, data are preliminary and should be confirmed with longer follow-ups.
Department of General Surgery, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain. 27689mlc@comb.cat
Manuel
M
López-Cano
Manel
M
Armengol
Maria Teresa
MT
Quiles
Alex
A
Biel
Janice
J
Velasco
Pere
P
Huguet
Aleix
A
Mestre
Lluís María
LM
Delgado
Francesc Xavier
FX
Gil
Maria Antonia
MA
Arbós
D000818:Animals; D007813:Laparotomy / Q000379:methods*; D008297:Male; D020778:Matrix Metalloproteinase 2 / Q000378:metabolism; D020780:Matrix Metalloproteinase 9 / Q000378:metabolism; D051381:Rats; D017207:Rats, Sprague-Dawley; D013526:Surgical Mesh; D013718:Tensile Strength
D020778:Matrix Metalloproteinase 2; D020780:Matrix Metalloproteinase 9