Page 305 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

Introduction
The number of patients undergoing elective abdominal wall hernia repair with mesh in the United States was approximately 48,000 in 2010(1). The subsequent economic burden is justi ed by the increased quality of life and core physiology after hernia repair(2, 3). Many di erent mesh types have been introduced on the market with di erent indications. Synthetic meshes are suggested to be contraindicated in clean-contaminated and contaminated elds following reports on increased susceptibility to infection, stula formation and adhesion formation. Biological meshes were introduced aiming to reduce infectious complications by complete integration in the host tissue and ingrowth of mononucleair cells. Early short term results after implantation of biological meshes were promising, although mainly investigated in a clean environment. Thereafter reviews concluded that biological meshes should be incorporated in the surgeons armentarium which resulted in widespread implantation of these grafts(4-7).
The Ventral Hernia Working Group of the European Hernia Society recommended use of biological mesh in case of a potentially contaminated or infected wound due to the risk of infectious complications. Consensus on the use of biological meshes has not been reached and surgeons over the world struggle with these recommendations in daily practice(8-10). In clinical studies with Strattice and Surgisis meshes recurrence of hernia was high which could be due to use of non-crosslinked meshes(11, 12). In a previous animal model infection rate was increased in crosslinked meshes and incorporation of all biological meshes was poor in a contaminated environment(13). Sustainable hernia repair and low rates of mesh infection when using biological meshes is essential to compete with synthetic meshes in a clean environment.
Long-term follow-up on biological meshes in clinical and animal 15 studies is still scarce. This study aimed to compare two commercially available
crosslinked with two non-cross-linked biological meshes in intra-peritoneal
position in a rat model. The meshes were tested on infectious complications,
adhesion formation, shrinkage and incorporation after a period of 90 and 180 days.
Incorporation of biological meshes
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