Page 233 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

Introduction
Mesh reinforcement during ventral hernia repair drastically reduces 10-year recurrence rates(1, 2). Non-absorbable synthetic materials are currently the most commonly used prosthesis for reinforcement of ventral hernias. Advantages of synthetic meshes are low recurrence rates, ease of use and relatively low costs. However, implantation of synthetic meshes can be complicated by mesh infection and adhesion formation. Mesh infection is a feared complication and reported in up to 16% of patients after abdominal wall repair(3). The risk of mesh infection is increased in a contaminated environment, which makes the use of synthetic mesh debatable(4). Mesh infection after implantation often necessitates its removal, which leaves the patient with a contaminated eld and an abdominal wall de cit that is often larger than the original hernia. Macroporous meshes have been preferred because large pores permit in ltration of macrophages and allow rapid broplasia and angiogenesis, with reduced in ltration and growth of bacteria(5, 6). The drawback of macroporous meshes is the increased risk of visceral adhesions to the site of the repair, with associated small bowel obstruction, pain, infertility and enterocutaneous stula formation(5, 7, 8). These adhesions arise as a result of brin deposition in the abdominal cavity, with subsequent formation of adhesions. The presence of contamination increases brin deposition, leading to an increased amount and tenacity of adhesions intra-abdominally and to the mesh(9). In a clean environment antiadhesive coatings have proved to reduce adhesion formation to macroporous meshes(8, 10, 11). The aim of the study was to compare commercially available synthetic and biological meshes in terms of infection rate, adhesion formation, incorporation and shrinkage after implantation in a contaminated environment.
Methods
One hundred and forty-four male Wistar rats weighing 250–350 g were obtained from a licensed breeder (Harlan Laboratories, Boxmeer, The Netherlands). They were bred under speci c pathogen-free conditions, kept under standard laboratory conditions in individually ventilated cages, and fed freely with standard rat chow and water throughout the experiment. The
11
Meshes in a contaminated environment
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