Page 297 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

related to foreign body reaction to the mesh and sutures and the presence of mesh infection in the present experiment. The amount of adhesions found in this experiment is consistent with earlier experimental reports(19, 26, 27). One clinical study evaluated adhesions by laparoscopic re-exploration after ventral hernia repair and found similar surface area and tenacity of adhesions in the biological meshes compared with synthetic meshes(43).
To create a contaminated environment, we used the cecal ligation puncture model, which was originally designed as a sepsis model. In this model, as in clinical infections, peritonitis arises from a complex interaction of the immune system with in ammatory, hemodynamic, and biochemical alterations with a consistent increase of cytokine levels(44-47). Additionally, in this model genetically identical rats were used of the same age and sex and speci ed pathogen-free bacterial status. This minimalizes biological and microbiological variability and makes the model suitable for comparing the behaviour of various meshes in a contaminated environment but does not re ect daily practice(46).
A limitation of the model in this experiment is that only a single dose of aminoglycoside is administrated, where this does not re ect the treatment of humans with abdominal sepsis. Administration of antibiotics in rats with fecal peritonitis does reduce bacteremia, bacteria concentration, and mortality rates(48). But previous experiments proposed a drawback regarding the use of antibiotics because of the possible marked bacterial cell death causing the release of toxic components against the immunologic system and the triggering of uncontrolled activation of this system(49-51). Previous animal experiments found that when antibiotics were added to the surgical treatment, the in ammatory response is minimized, but there is no di erence in survival or amount of intra-abdominal abscesses(52, 53). Therefore, surgical control of the source of infection remains the most important treatment in abdominal sepsis. However, the adjunct of systemic antibiotics to surgical treatment is rmly established in the postoperative period in humans because it reduces the systemic e ects of peritonitis and could in uence late complications like abscess or stula formation(54). Therefore, translation of experimental results to the clinic situation should be done with caution.
In the clinical setting, biological meshes are often implanted in the intraperitoneal or sublay position. A limitation of the present animal study is that thickness and size of the mesh in relation to the abdominal wall is dissimilar
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Infection susceptibility of biological meshes
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