Inflammatory reaction as determinant of foreign body reaction is an early and susceptible event after mesh implantation.
OBJECTIVE
To investigate and relate the ultrashort-term and long-term courses of determinants for foreign body reaction as biocompatibility predictors for meshes in an animal model.


METHODS
Three different meshes (TVT, UltraPro, and PVDF) were implanted in sheep. Native and plasma coated meshes were placed bilaterally: (a) interaperitoneally, (b) as fascia onlay, and (c) as muscle onlay (fascia sublay). At 5 min, 20 min, 60 min, and 120 min meshes were explanted and histochemically investigated for inflammatory infiltrate, macrophage infiltration, vessel formation, myofibroblast invasion, and connective tissue accumulation. The results were related to long-term values over 24 months.


RESULTS
Macrophage invasion reached highest extents with up to 60% in short-term and decreased within 24 months to about 30%. Inflammatory infiltrate increased within the first 2 hours, the reached levels and the different extents and ranking among the investigated meshes remained stable during long-term follow up. For myofibroblasts, connective tissue, and CD31+ cells, no activity was detected during the first 120 min.


CONCLUSIONS
The local inflammatory reaction is an early and susceptible event after mesh implantation. It cannot be influenced by prior plasma coating and does not depend on the localisation of implantation.
Department of Urology, Lukas Hospital, Preussenstraße 84, 41464 Neuss, Germany ; German Centre for Assessment and Evaluation of Innovative Techniques in Medicine (DZITM), Germany.
Holger
0000-0003-4160-8074
H
Gerullis
Department of Urology, Lukas Hospital, Preussenstraße 84, 41464 Neuss, Germany.
Evangelos
E
Georgas
Department of Experimental Surgery, University of Szeged, Hungary.
Mihaly
M
Borós
German Centre for Implant-Pathology, Düren, Germany.
Bernd
B
Klosterhalfen
Department of Urology, Lukas Hospital, Preussenstraße 84, 41464 Neuss, Germany.
Christoph
C
Eimer
Department of Urology, Lukas Hospital, Preussenstraße 84, 41464 Neuss, Germany.
Christian
C
Arndt
German Centre for Assessment and Evaluation of Innovative Techniques in Medicine (DZITM), Germany ; Department of Surgery, Clemens Hospital Münster, Germany.
Stephan
S
Otto
Department of Urology, Lukas Hospital, Preussenstraße 84, 41464 Neuss, Germany.
Dimitri
D
Barski
Department of Surgery, Universitair Ziekenhuis, Antwerpen, Belgium.
Dirk
D
Ysebaert
ITERA (International Tissue Engineering Research Association), Belgium.
Albert
A
Ramon
Department of Urology, Lukas Hospital, Preussenstraße 84, 41464 Neuss, Germany ; German Centre for Assessment and Evaluation of Innovative Techniques in Medicine (DZITM), Germany.
Thomas
T
Otto
D000818:Animals; D016207:Cytokines / Q000276:immunology*; D042241:Early Diagnosis; D005260:Female; D005549:Foreign-Body Reaction / Q000150:complications* / Q000175:diagnosis / Q000276:immunology*; D007249:Inflammation / Q000175:diagnosis / Q000209:etiology* / Q000276:immunology*; D008137:Longitudinal Studies; D008262:Macrophage Activation / Q000276:immunology*; D019919:Prosthesis Implantation / Q000009:adverse effects; D012756:Sheep; D013526:Surgical Mesh / Q000009:adverse effects*; D016896:Treatment Outcome
D016207:Cytokines