title: Biologic meshes are not superior to synthetic meshes in ventral hernia repair: an experimental study with long-term follow-up evaluation.
abstract: BACKGROUND
  In laparoscopic incisional hernia repair, direct contact between the prosthesis and the abdominal viscera is inevitable, which may lead to an inflammatory reaction resulting in abdominal adhesion formation. This study compared five different synthetic and biologic meshes in terms of adhesion formation, shrinkage, incorporation, and histologic characteristics after a period of 30 and 90 days.
  
  
  METHODS
  In 85 rats, a mesh was positioned intraperitoneally in direct contact with the viscera. Five different meshes were implanted: Prolene (polypropylene), Parietex composite (collagen-coated polyester), Strattice (porcine dermis, non-cross-linked), Surgisis (porcine small intestine submucosa, non-cross-linked), and Permacol (porcine dermis, cross-linked). The meshes were tested in terms of adhesion formation, shrinkage, and incorporation after a period of 30 and 90 days. Additionally, collagen formation after 90 days was determined.
  
  
  RESULTS
  Significantly less adhesion formation was observed with Parietex composite (5 %; interquartile range [IQR], 2-5 %) and Strattice (5 %; IQR, 4-10 %) in the long term. In contrast, organs were attached to Permacol with four of seven meshes (57 %), and adhesion coverage of Surgisis mesh was present in 66 % (IQR, 0-100 %) of the cases. After 90 days, the best incorporation was seen with the Parietex composite mesh (79 %; IQR, 61-83 %). After 90 days, major alterations in adhesion formation were seen compared with 30 days. Histologically, Strattice and Parietex composite showed a new mesothelial layer on the visceral side of the mesh. Microscopic degradation and new collagen formation were seen in the Surgisis group.
  
  
  CONCLUSIONS
  Parietex composite mesh demonstrated the best long-term results compared with all the other meshes. The biologic non-cross-linked mesh, Strattice, showed little adhesion formation and moderate shrinkage but poor incorporation. Biologic meshes are promising, but varying results require a more detailed investigation and demonstrate that biologic meshes are not necessarily superior to synthetic meshes. The significant changes that take place between 30 and 90 days should lead to careful interpretation of short-term experimental results.
authors.affiliation: Department of Surgery, Erasmus University Medical Center Rotterdam, Dr. Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands, m.ditzel@erasmusmc.nl.
authors.forename: M
authors.initials: M
authors.lastname: Ditzel
authors.forename: E B
authors.initials: EB
authors.lastname: Deerenberg
authors.forename: N
authors.initials: N
authors.lastname: Grotenhuis
authors.forename: J J
authors.initials: JJ
authors.lastname: Harlaar
authors.forename: K
authors.initials: K
authors.lastname: Monkhorst
authors.forename: Y M
authors.initials: YM
authors.lastname: Bastiaansen-Jenniskens
authors.forename: J
authors.initials: J
authors.lastname: Jeekel
authors.forename: J F
authors.initials: JF
authors.lastname: Lange
mesh_terms: D034861:Abdominal Wall / Q000473:pathology; D000818:Animals; D001672:Biocompatible Materials / Q000009:adverse effects; D020099:Coated Materials, Biocompatible / Q000009:adverse effects; D003094:Collagen / Q000009:adverse effects / Q000096:biosynthesis; D005549:Foreign-Body Reaction / Q000209:etiology; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D020007:Implants, Experimental / Q000009:adverse effects; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D011091:Polyesters / Q000009:adverse effects; D011126:Polypropylenes / Q000009:adverse effects; D011897:Random Allocation; D051381:Rats; D017208:Rats, Wistar; D013047:Specific Pathogen-Free Organisms; D013526:Surgical Mesh / Q000009:adverse effects*; D000267:Tissue Adhesions / Q000209:etiology
chemical_list: D001672:Biocompatible Materials; D020099:Coated Materials, Biocompatible; C422414:Permacol; D011091:Polyesters; D011126:Polypropylenes; C588279:parietex; C568444:strattice; C588278:surgisis; D003094:Collagen
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