Page 232 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

Chapter 11
Abstract:
Background
Implantation of meshes in a contaminated environment can be complicated by mesh infection and adhesion formation.
Methods
The caecal ligation and puncture model was used to induce peritonitis in 144 rats. Seven commercially available meshes were implanted intraperitoneally: six non-absorbable meshes, of which three had an absorbable coating, and one biological mesh. Mesh infection, intra-abdominal abscess formation, adhesion formation, incorporation and shrinkage were evaluated after 28 and 90 days. Histological examination with haematoxylin and eosin and picrosirius red staining was performed.
Results
No mesh infections occurred in Sepramesh®, Omyramesh® and Strattice®. One mesh infection occurred in Parietene® and Parietene Composite®. Signi cantly more mesh infections were found in C-Qur® (15 of 16; P ≤ 0.006) and Dualmesh® (7 of 15; P ≤ 0.035). Sepramesh® showed a signi cant increase in adhesion coverage from 12.5 % at 28 days to 60.0 % at 90 days (P = 0.010). At 90 days there was no signi cant di erence between median adhesion coverage of Parietene Composite® (35.0 %), Omyramesh® (42.5 %), Sepramesh® (60.0 %) and Parietene® (72.5 %). After 90 days the adhesion coverage of Strattice® was 5.0 %, and incorporation (13.4 %) was signi cantly poorer than for other non- infected meshes (P ≤ 0.009). Dualmesh® showed shrinkage of 63 % after 90 days.
Conclusion
Parietene Composite® and Omyramesh® performed well in a contaminated environment. Strattice® had little adhesion formation and no mesh infection, but poor incorporation. Some synthetic meshes can be as resistant to infection as biological meshes.
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