Page 98 - Postoperative Intra-Abdominal Adhesions- New insights in prevention and consequences

Chapter 6
Abstract
Background
In laparoscopic incisional hernia repair direct contact between prosthesis and abdominal viscera is inevitable, which may lead to an inflammatory reaction resulting in abdominal adhesion formation. In this study we compared five different synthetic and biological meshes on adhesion formation, shrinkage, incorporation and histological characteristics after a period of 30 and 90 days
Methods
In 85 rats a mesh was positioned intraperitoneally in direct contact with the viscera. Five different meshes were implanted: Prolene® (polypropylene), Parietex CompositeTM (collagen coated polyester), StratticeTM (porcine dermis, non-cross-linked), Surgisis® (porcine small intestine submucosa, non-cross-linked) and Permacolä (porcine dermis, cross-linked). The meshes were tested on adhesion formation, shrinkage and incorporation after a period of 30 and 90 days. Additionally, collagen formation after 90 days was determined.
Results
A significant lower adhesion formation was observed on Parietex Composite (5%; IQR2-5%) and Strattice (5%; IQR4-10%) on the long term. In contrast, organs were attached to Permacol in 4 out of 7 (57%) meshes and adhesion coverage of Surgisis meshes was present in 66% (IQR0-100%). After 90 days best incorporation was seen in the Parietex Composite mesh (79%; IQR61-83%). After 90 days major alterations in adhesion formation were seen compared to 30 days. Histologically Strattice and Parietex Composite showed a new mesothelial layer on the visceral side of the mesh. Microscopical degradation and new collagen formation were seen in the Surgisis group.
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