Page 165 - Postoperative Intra-Abdominal Adhesions- New insights in prevention and consequences

Naturally, shortened hospitalizations, less pain, cosmetics and the rate of wound infections are important, but the patient should also be properly informed about the possibility of adhesions or bowel adherence to the mesh and the potential hazards of it.
A composite mesh is, on the basis of our results described in Chapter 6, a reasonable option when laparoscopic hernia repair is performed. Evidence for the use of biological meshes for this indication is still very limited [14]. Biologicals are very expensive and there are doubts about the strength of the meshes over the long term. Our outcomes suggest that a non-cross-linked mesh would be the best biological option from an antiadhesive point of view. However, incorporation of this mesh was disappointing, as was the case in multiple other rat studies [15- 17]. One explanation might be found in the dimension of the mesh. It is proportionally thicker in rats than in humans when compared to the thickness of the abdominal wall [17]. Another hypothesis is that lower mammals have an immune response against Strattice. The mesh is designed for humans and not for rats or mice. Smaller proteins such as proteoglycans are different across species, possibly resulting in an immune response that leads to poor ingrowth of the mesh [18, 19].
Hence, it can be concluded that for simple abdominal hernia repair the use of biological meshes is not recommended. However, large abdominal wall defects can be challenging to close and in addition to a component separation technique sometimes a bridging technique with an intra- abdominally placed mesh is necessary. In other cases the fascia can be closed, but only using biological mesh assisted traction with the mesh placed in intra-peritoneal position [20]. For these indications, with or without a contaminated environment, the use of a biological mesh seems to be the right choice. However, this is a relatively new development and it will be very interesting to investigate adhesion formation to the abdominal wall after a longer follow-up when re-operation is necessary.
Chronic abdominal pain and adhesions
One of the main issues in adhesion-related research is demonstrating adhesions without a second-look procedure. From this perspective the
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Future perspectives
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