title: Long-term evaluation of adhesion formation and foreign body response to three new meshes.
abstract: BACKGROUND
  Mesh-related adhesions are a significant clinical problem following intraperitoneal mesh placement. In this study, we evaluated adhesion formation to three relatively new meshes for intraperitoneal use.
  
  
  METHODS
  Three new meshes for intraperitoneal use (Omyra(®) mesh, Physiomesh(®), and Hi-Tex Endo-IP(®)) were implanted intraperitoneally in rats and compared with a polypropylene control mesh (Parietene(®)) after 7 or 90 days. Adhesion formation, incorporation (tensile strength), shrinkage, and foreign body reaction were scored.
  
  
  RESULTS
  Hi-Tex Endo-IP and Physiomesh(®) showed significantly less adhesion formation when compared to Parietene at both time points (p < 0.05). Shrinkage was highest in Omyra mesh after 90 days, which was significantly more compared to Parietene(®) (p < 0.001). Physiomesh(®) only showed a significant reduction in craniocaudal mesh length, compared to Parietene and Hi-Tex Endo-IP (p < 0.05). After 90 days, Hi-Tex Endo-IP(®) showed significantly higher and Physiomesh(®) significantly lower incorporation strengths compared to all other groups (p < 0.05). Microscopic evaluation revealed massive foreign body reaction to Hi-Tex Endo-IP(®), leading to an extensive and thick collagenous scar adherent to the abdominal wall. Fractioning of the Physiomesh(®) coating over time led to an increase in interfilamentary granuloma formation, leading to scar plate formation, but with only minimal to no abdominal wall adherence. Both Parietene(®) and Omyra(®) showed a mild foreign body response.
  
  
  CONCLUSIONS
  Although clear distinctions can be made between meshes and some meshes excel, none of the meshes are superior in all aspects required for effective and safe incisional hernia repair.
authors.affiliation: Department of Surgery, Research Institute NUTRIM, Maastricht University Medical Centre, Maastricht, The Netherlands, r.vogels@maastrichtuniversity.nl.
authors.forename: R R M
authors.initials: RR
authors.lastname: Vogels
authors.forename: K W Y
authors.initials: KW
authors.lastname: van Barneveld
authors.forename: J W A M
authors.initials: JW
authors.lastname: Bosmans
authors.forename: G
authors.initials: G
authors.lastname: Beets
authors.forename: M J J
authors.initials: MJ
authors.lastname: Gijbels
authors.forename: M H F
authors.initials: MH
authors.lastname: Schreinemacher
authors.forename: N D
authors.initials: ND
authors.lastname: Bouvy
mesh_terms: D000818:Animals; D004146:Dioxanes; D005549:Foreign-Body Reaction / Q000473:pathology*; D006555:Hernia, Ventral / Q000601:surgery; D008422:Materials Testing; D023421:Models, Animal; D011091:Polyesters; D011126:Polypropylenes; D011138:Polytetrafluoroethylene; D017208:Rats, Wistar; D013526:Surgical Mesh; D000267:Tissue Adhesions / Q000473:pathology*
chemical_list: D004146:Dioxanes; D011091:Polyesters; D011126:Polypropylenes; C095495:glycolide E-caprolactone copolymer; D011138:Polytetrafluoroethylene