Page 245 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

incorporation can possibly result in loss of the prosthesis and hernia recurrence(34). Until evidence of biomechanical strength after hernia repair with biological meshes has been provided, synthetic meshes are preferred for primary repair.
Translation of experimental results to the clinical situation should be done with caution. However, the CLP model is suitable for studying the behaviour of synthetic and biological meshes experimentally in a contaminated environment. In this model, as in clinical infections, peritonitis arises from a complex interaction of the immune system with in ammatory, haemodynamic and biochemical alterations similar to human sepsis, with a consistent increase in cytokine levels(35-38). Another advantage of this experimental model is the use of rats of the same age and sex, and speci ed pathogen-free bacterial status. This minimizes biological and microbiological variability, and makes it suitable for comparing characteristics of di erent meshes in a similar contaminated environment(38). A limitation of the model is the size of the mesh and mesh pores in relation to the abdominal wall, which is di erent between rats and humans. This might lead to an overestimation of shrinkage. The meshes in this experiment were xated with six sutures. In humans the number of xation points in relation to the mesh size would be much higher. This might have in uenced incorporation, as described in previous experimental mesh studies(8, 11). Finally, the concentration of the antiadhesive coatings and its systemic e ects during breakdown in this model might be di erent from the human situation.
The experimental results of synthetic mesh implantation in a contaminated environment make strict contraindication in humans questionable. Although there are no meshes without disadvantages, certain permanent synthetic meshes might be somewhat infection-resistant and therefore useful for permanent hernia repair in a contaminated environment.
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Meshes in a contaminated environment
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