Page 311 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

Correlation between adhesion formation and incorporation
At 90 days CollamendFM showed a signi cant correlation between adhesion coverage of the mesh and incorporation of the mesh edge (ρ=-0.973; P=0.01). At 180 days there was no correlation. When the animals in group 90 days and 180 days were combined CollamendFM showed a correlation coe cient of ρ=-0.612; P=0.05. This correlation coe cient indicates that in CollamendFM meshes increase of adhesion formation was correlated with a decrease of incorporation.
Discussion
Based on the results of our long-term animal study we advocate more reluctance on implantation of biological meshes for abdominal wall repair. When biological meshes are implanted in an intraperitoneal position, incorporation in the abdominal wall is poor and adhesion formation and infection susceptibility remain a problem. The best results in our study were found with implantation of non-crosslinked Strattice. Adhesion coverage was low as 5%, but incorporation after 180 days was only 13.7%. Crosslinked Permacol had the better long-term incorporation (20.7%) but adhesion coverage of 15%. Worst results were found with crosslinked CollaMend and non-crosslinked Surgisis. After implantation of CollaMend infection of the mesh occurred in over 60% leading to a very low incorporation and increased adhesion formation. Non-crosslinked Surgisis dissolved completely within 180 days but induced substantial adhesion formation. These characteristics of biological meshes at long-term follow-up make the strength of the abdominal wall repair questionable. Moreover the adverse e ects are comparable to intraperitoneally used (coated) synthetic meshes.
It is a recurrent phenomenon in research where initial studies on new 15 technology describe positive results (whether or not industry driven) and subsequently critical reviews are published only after years of trial and error.
The rst studies on biological meshes were mainly case series with large
variation in sample size, mesh material, implantation technique, follow-up and study endpoints(7, 15). Although the majority of cases were implanted in a non-contaminated environment they have also led to recommendations for the use in contaminated surgical elds. In recent years authors have started to publish their doubts on biological meshes(15, 16).
Incorporation of biological meshes
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