Page 290 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

Chapter 14
of adhesions was scored using the Zühlke score, a 4-degree classi cation of adhesions based on histologic and morphologic criteria(21). Pictures of the abdominal wall with the mesh and the present adhesions were taken (5.0 megapixels digital camera, Sony Cybershot, Tokyo, Japan). The abdominal cavity was inspected for abscesses, and when present, scored and cultured at 4 sites of the peritoneum (liver, abdominal wall, bowel, and omentum) using an objective abscess size scoring system(22). Mesh incorporation was de ned as percentage of the mesh edge incorporated into the abdominal wall, taking into account any surface reduction (Figure 1). If only the sutures secured the mesh to the abdominal wall and no ingrowth of the mesh was seen, ingrowth was scored as 0%. Surface reduction was de ned as the relative loss of surface compared with the original size of the implanted mesh measured with a calliper. All measurements were performed by 2 independent observers and disagreements reconciled after discussion. The animals were euthanized by cardiac cut at the end of the experiment during anaesthesia.
Statistical analysis
Mesh infection, tenacity, and percentage of adhesions, abscess formation, survival, and weight were compared using nonparametric tests as the data did not show normal distribution (Kruskal-Wallis, Mann-Whitney, chi-square, and the Fisher exact tests). Therefore, all results are presented using the median and the interquartile range (IQR). In case the overall test showed di erences, the pairwise tests were done to determine the groups causing the overall signi cance.
Figure 1. Example of (absent) incorporation of the edge of biological mesh in the abdominal wall.
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