Page 155 - Postoperative Intra-Abdominal Adhesions- New insights in prevention and consequences

formation was significantly reduced in the PVA/CMC gel groups and the number of abdominal abscesses did not differ between groups. These results suggested that PVA/CMC can safely and effectively be used in the contaminated environment.
Mesh and adhesions
The superiority of incisional hernia mesh repair in terms of significant reduction in recurrence rates has well been described in literature [18, 19]. However, in laparoscopic hernia repair in most cases it is inevitable to place the mesh in direct contact with the viscera. Serious complications of intra-abdominal mesh repair include enterocutanous fistula, mesh erosion and mesh infection. More commonly, mesh repair may results in adhesion formation, which can induce small bowel obstruction, infertility and difficulties at reoperation. [1, 20-24]. Currently over 100 different types of meshes are available on the market complicating the selection of an appropriate prosthesis [25-27]. These meshes can generally be divided in four different groups: synthetic polymers, composite, biosynthetic and biological meshes [28]. The biosynthetic meshes are relatively new and were not available at the time of the experiment.
In Chapter 6 a commonly used synthetic mesh and a composite mesh
with one cross-linked and two non-cross-linked biologic meshes were compared in a rat model in intraperitoneal position in order to help with
the selection of a suitable prosthesis. The meshes were tested in terms
of adhesion formation, shrinkage, and incorporation after a period of 30 9 and 90 days. Concerning all of these parameters the composite mesh
Parietex Composite (PC) showed the best results. Strattice, a biologic non-cross-linked mesh, showed little adhesion formation and moderate shrinkage but poor incorporation. Remarkable was the formation of adhesions between both bowel and liver and the cross-linked biological Permacol mesh. An explanation may be found in the chemical cross- linking process. The aim of this process is to increase the strength of the scaffold and to restrain the in vivo degradation process. A disadvantage may be that cross-linking results in less biocompatibility, possibly leading to more adhesion formation. Therefore, based on results in this study, when a biological mesh is chosen a non-cross-linked version should be
Summary and discussion
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