Page 39 - Postoperative Intra-Abdominal Adhesions- New insights in prevention and consequences
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Current status postoperative abdominal adhesions
synthetic, nonabsorbable prosthetic, ePTFE, differs from polyester and polypropylene and has been used intraperioneally on a wide scale. One
side is textured with pore sizes conductive to tissue ingrowth, whereas
the other side has a smooth texture and a closed structure to prevent 2 adhesions [142]. However, in 72 patients who needed reoperation for
different reasons adhesion formation to the PTFE mesh was seen in 83% of the cases [143]. Additionally, the development of a persistent posterior seroma has been described [144].
Composite mesh
Composite meshes consist of a synthetic material and an anti-adhesive layer or coating on the visceral side of the mesh. A variety of composite barrier prostheses have been developed and can be divided into two basic categories: those with permanent barrier layers, and those with absorbable (temporary) barrier layers or coatings [142]. These layers and coatings are resolved over the course of 30 days with some components lasting up to 240 days [145-148]. How this affects the antiadhesive characteristic on the long-term depends on the mesh used, but in general adhesions to intraperitoneal meshes are present to some degree [149, 150]. This should always be considered before proceeding with laparoscopic ventral hernia repair [151].
Biosynthetic meshes
Recently biosynthetic meshes were introduced for abdominal wall repair. They are fabricated from a natural polymer, which is absorbed by the human body in approximately 180-545 days depending on the type of biosynthetic mesh used [152]. In general this is longer than most pure biological meshes suggesting that these meshes by remodeling will provide more strength in ventral hernia repair [138]. Additionally, the biosynthetic characteristics should give the opportunity to use them in an infected environment. First results are promising although stronger evidence is necessary to fully understand the indications for this type of mesh. At this moment no evidence exists for the use of this mesh intraperitoneally [153].
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