Experimental study on synthetic and biological mesh implantation in a contaminated environment

• Published in: British journal of surgery Vol. 99; no. 12; pp. 1734 - 1741
• Main Authors: Deerenberg, E. B., Mulder, I. M., Grotenhuis, N., Ditzel, M., Jeekel, J., Lange, J. F.
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01-12-2012; Wiley; Oxford University Press
• Subjects: Abdominal Abscess - etiology; Abdominal Abscess - prevention & control; Animals; Biological and medical sciences; Equipment Contamination; Equipment Failure; Fibrosis - etiology; General aspects; Infections; Intraabdominal Infections - etiology; Intraabdominal Infections - prevention & control; Ligation; Male; Medical sciences; Peritonitis - etiology; Rats; Rats, Wistar; Surgical Mesh - standards; Surgical Wound Infection - etiology; Surgical Wound Infection - prevention & control; Tissue Adhesions - etiology; Tissue Adhesions - prevention & control; Medicine; Treatment; Surgery; Synthetic mesh; Environment; Implantation; Biology; Experimental study; Contamination
• ISSN: 0007-1323; 1365-2168
• DOI: 10.1002/bjs.8954

Background:
Implantation of meshes in a contaminated environment can be complicated by mesh infection and adhesion formation.
Methods:
The caecal ligation and puncture model was used to induce peritonitis in 144 rats. Seven commercially available meshes were implanted intraperitoneally: six non‐absorbable meshes, of which three had an absorbable coating, and one biological mesh. Mesh infection, intra‐abdominal abscess formation, adhesion formation, incorporation and shrinkage were evaluated after 28 and 90 days. Histological examination with haematoxylin and eosin and picrosirius red staining was performed.
Results:
No mesh infections occurred in Sepramesh®, Omyramesh® and Strattice®. One mesh infection occurred in Parietene® and Parietene Composite®. Significantly more mesh infections were found in C‐Qur® (15 of 16; P ≤ 0·006) and Dualmesh® (7 of 15; P ≤ 0·035). Sepramesh® showed a significant increase in adhesion coverage from 12·5 per cent at 28 days to 60·0 per cent at 90 days (P = 0·010). At 90 days there was no significant difference between median adhesion coverage of Parietene Composite® (35·0 per cent), Omyramesh® (42·5 per cent), Sepramesh® (60·0 per cent) and Parietene® (72·5 per cent). After 90 days the adhesion coverage of Strattice® was 5·0 per cent, and incorporation (13·4 per cent) was significantly poorer than for other non‐infected meshes (P ≤ 0·009). Dualmesh® showed shrinkage of 63 per cent after 90 days.
Conclusion:
Parietene Composite® and Omyramesh® performed well in a contaminated environment. Strattice® had little adhesion formation and no mesh infection, but poor incorporation. Some synthetic meshes can be as resistant to infection as biological meshes. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
Infection rate differed