Page 295 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

Tenacity of adhesions was higher after 90 days for CollaMendFM (median Zühlke score, 4; IQR, 3 to 4) compared with Permacol (median Zühlke score, 3; 3 to 3) and Strattice groups (median Zühlke score, 3; IQR, 3 to 3, respectively; P = 0.012 and P = 0.031). After 180 days, the tenacity of adhesions decreased and was lowest for Strattice (median Zühlke score, 2; IQR, 2 to 3), which was signi cantly lower than that for Permacol (median Zühlke score, 3; IQR, 3 to 3), CollaMendFM (median Zühlke score, 3; IQR, 3 to 4) and Surgisis (median Zühlke score, 3; IQR, 3 to 3, respectively; P = 0.013, P = 0.007, and P = 0.008, respectively). After grouping the sca olds by crosslinking, the percentage of the mesh covered with adhesions and the tenacity of the adhesions to the mesh were found to be higher in the crosslinked group (P = 0.01 and P = 0.024, respectively).
Comments
Crosslinked biological meshes were found to have a signi cantly higher percentage of mesh infection (70% vs 4%; P < 0.001) and intra-abdominal abscesses (P = 0.011) than non-crosslinked biological meshes. Infectious complications required euthanasia before the intended time point in almost half of animals in the crosslinked CollaMendFM group, as described in previous animal experiments(23-27).These results are in accordance with clinical reports of infectious complications of biological meshes instigating the debate on the indications for their clinical use(12-15, 17, 28, 29). The development of infection in crosslinked meshes seems comparable to mesh infection in microporous synthetic meshes by preclusion of immune cells(30). Crosslinking appears to decrease the pore size of biological meshes to a pore size small enough to provide a suitable housing for bacteria while preventing access of macrophages, broblasts, blood vessels, and collagen bers into the pores(31, 32). This may lead to encapsulation rather than remodelling of the mesh(33, 34).
However, not all crosslinked meshes have similar densities of crosslinking because of di erences in processing. Another interference of mesh integration could be the sterilization technique. CollaMendFM and Surgisis inhibiting tissue integration and reducing tensile strengths(35, 36).
However, the in uence of sterilization techniques on these parameters is still largely untested. This could be of importance considering the di erences
14
Infection susceptibility of biological meshes
293