Intraabdominal adhesion formation of polypropylene mesh. Influence of coverage of omentum and polyglactin

• Published in: Surgical endoscopy Vol. 19; no. 6; pp. 798 - 803
• Main Authors: Conze, J, Junge, K, Klinge, U, Weiss, C, Polivoda, M, Oettinger, A P, Schumpelick, V
• Format: Journal Article
• Language: English
• Published: Germany Springer Nature B.V 01-06-2005
• Subjects: Adhesion; Animals; Biomedical materials; Connective tissue; Female; Foreign bodies; Hernias; Laboratory animals; Laparoscopy; Omentum; Polyglactin 910 - adverse effects; Polypropylenes - adverse effects; Postoperative Complications - etiology; Rabbits; Surgeons; Surgery; Surgical Mesh - adverse effects; Surgical Procedures, Operative - methods; Tissue Adhesions - etiology; Aachen Germany; Germany
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-004-2192-5

Adhesions after intraabdominal surgical procedures are related to high morbidity and mortality. Biomaterials, particularly those made of polypropylene, in the intraabdominal position have to be considered as pathophysiological cofactor in a multifactorial process of adhesion formation. To investigate the adhesive potential induced by the biomaterial, an animal model was performed. In addition, the influence of coverage by omentum or a polyglactin barrier was investigated.
In, 18 Chinchilla rabbits the biomaterial was placed laparoscopically using the intraperitoneal onlay mesh technique. Using this model, a polypropylene-polyglactin mesh compound (PPMC) was used with three different implantation techniques: group 1, PPMC implantation without coverage (PPMC): group 2, PPMC implantation with additional omentum coverage (PPMC-O): and group 3, PPMC implantation with coverage of an absorbable polyglactin mesh (PPMC-V). The degree of adhesion formation was measured 90 days after implantation by computer-assisted planimetry. Morphometric examination followed the explantation analyzing the amount of foreign body response.
We found a significant reduction of adhesion formation for the PPMC and PPMC-O groups compared to the PPMC-V group, in which dense adhesions were found. Morphometric investigations of the perifilamental granulomas of the pure (PPMC) group revealed a typical foreign body reaction with a mild to moderate fibrosis around all mesh fibers. However, tissue specimens of the PPMC-O and PPMC-V groups indicated a similar inflammatory reaction but significantly increased connective tissue formation around the polymer fibers compared to the pure PPMC group.
The intraabdominal placement of a pure PPMC shows a neoperitonealization and perifilamental collagenous ingrowth with almost no adhesions. Coverage with omentum (PPMC-O) or polyglactin mesh (PPMC-V) resulted in a significant increase in inflammation and perifilamentary connective tissue formation.