title: The use of Vicryl mesh in a porcine model to assess its safety as an adjunct to posterior fascial closure during retromuscular mesh placement.
abstract: BACKGROUND
  Posterior component separation has become a common approach to complex abdominal wall reconstructions. This technique includes creation of an extraperitoneal retromuscular space for subsequent large synthetic mesh reinforcement. In certain cases, when complete restoration of "posterior" layer is precluded by significant tissue loss/damage, one proposed strategy is to replace the posterior fascia with an absorbable synthetic polyglactin (Vicryl) mesh. However, the safety of this strategy to prevent mesh-related visceral complication is unknown. Herein, we aimed to characterize mesh-viscera adhesion profiles and host tissue response of synthetic mesh either exposed directly to the viscera, or protected with Vicryl mesh.
  
  
  METHODS
  Using adult Yorkshire pigs, 5 × 5 cm pieces of mesh were secured to the intact peritoneum in each of the four quadrants (n = 6 pigs, 24 mesh samples). The study groups were Vicryl (V), Marlex (M), Softmesh (S), Marlex + Vicryl construct (MV), Softmesh + Vicryl construct (SV). The self-made composite meshes were then implanted with the Vicryl side facing the exposed viscera. The pigs were survived for 60 days. At necropsy, grossly, the extent and tenacity of visceral adhesions were evaluated using established scales. Histologically, all specimens for fibrous encapsulation on the visceral surface of the mesh were reviewed by an experienced pathologist blind to meshes used.
  
  
  RESULTS
  At necropsy, all Vicryl meshes were completely resorbed. The mean adhesion and tenacity scores for M and MV were 1.8 and 1.1 (P > 0.05), 2.0 and 1.5 (P > 0.05), respectively; while the mean adhesion extent scores and tenacity scores for S and SV were 2.0 and 1.2 (P > 0.05), 2.0 and 1.7 (P > 0.05). No significant difference in adhesion extent and tenacity was observed between Synthetic and Vicryl composite mesh groups. Histologically, Marlex + Vicryl mesh and Softmesh + Vicryl mesh constructs had thicker fibrous capsules than the corresponding unprotected Marlex and Soft mesh implants. Furthermore, visceral adhesions in the composite groups were noted to be to the fibrous capsule and not synthetic mesh itself.
  
  
  CONCLUSIONS
  Utilization of the absorbable polyglactin (Vicryl) mesh as a separating layer between a synthetic mesh and intestines, did not reduce adhesions across various mesh types and composites. Histologically, however, a thick fibrous capsule replaced the Vicryl mesh and may be an important layer to prevent intestinal erosion into retromuscular synthetic meshes.
authors.affiliation: Department of Surgery, Case Comprehensive Hernia Center, University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.|Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: L
authors.initials: L
authors.lastname: Liu
authors.affiliation: Department of Surgery, Case Comprehensive Hernia Center, University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.
authors.forename: C
authors.initials: C
authors.lastname: Petro
authors.affiliation: Department of Surgery, Case Comprehensive Hernia Center, University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.
authors.forename: A
authors.initials: A
authors.lastname: Majumder
authors.affiliation: Department of Surgery, Case Comprehensive Hernia Center, University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.
authors.forename: M
authors.initials: M
authors.lastname: Fayezizadeh
authors.affiliation: Department of Pathology, University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: J
authors.initials: J
authors.lastname: Anderson
authors.affiliation: Department of Surgery, Case Comprehensive Hernia Center, University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44106, USA. yuri.novitsky@uhhospitals.org.
authors.forename: Y W
authors.initials: YW
authors.lastname: Novitsky
mesh_terms: D000818:Animals; D001672:Biocompatible Materials; D005260:Female; D023421:Models, Animal; D010537:Peritoneum / Q000473:pathology / Q000601:surgery*; D011098:Polyglactin 910; D019919:Prosthesis Implantation; D013526:Surgical Mesh; D013552:Swine; D000267:Tissue Adhesions / Q000209:etiology / Q000473:pathology*
chemical_list: D001672:Biocompatible Materials; D011098:Polyglactin 910
keywords: Absorbable mesh; Adhesion profile; Hernia; Posterior component separation; Retromuscular; Retrorectus; Synthetic mesh; Transversus abdominis release