Page 38 - Postoperative Intra-Abdominal Adhesions- New insights in prevention and consequences

Chapter 2
treatment for burn wounds as well as coverage of skin grafting areas and split skin donor sites in scarrectification and extensive abrasions [131, 132]. A modified version of Suprathel is represented by Supraseal, which has shown promising early results in experimental studies [38, 133]. However, in a recent rat study Supraseal was assessed as a mild- irritating material, as were Adept and Seprafilm [134]. More studies are needed to prove the suitability of this membrane as an adhesion barrier.
Mesh and adhesions
In laparoscopic ventral hernia repair direct contact of the prosthesis with the abdominal viscera is inevitable. This contact of the mesh may lead to an inflammatory reaction possibly resulting in adhesion formation. Complications of mesh related abdominal adhesions include fistula formation, pain, bowel obstruction or adhesiolysis related complications, such as enterotomy and unplanned bowel resection during subsequent surgical procedure [135]. Currently a wide variety of hernia reinforcement materials is available on the market complicating the selection of an appropriate prosthesis [136-138]. In general four different groups can be distinguished: synthetic polymers, composite, biosynthetic and biological meshes [139]. The adhesion related characteristics of these four groups are discussed.
Synthetic mesh
Synthetics are subdivided in to permanent (nonabsorbable) or absorbable mesh. Among the permanent synthetics are polypropylenes, polyesters, and expanded polytetrafluoroethylene (ePTFE). Absorbable synthetic prostheses, including glycolic acid, polyglycolic acid and carboxycellulose, are generally reserved for temporary abdominal closure or used in conjunction with permanent synthetic [140]. Polypropylene and polyester meshes remain the most commonly used prosthetics due to their strength, ease handling, versatility and relative low costs. However, several studies have demonstrated the propensity of polypropylene to adhere to the bowel wall when placed in direct contact with abdominal viscera. Consequently, polypropylene and polyester should not be used when placing the mesh within the peritoneal cavity and they are also not suitable for laparoscopic ventral hernia repair [140, 141]. Another
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