Page 350 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

Chapter 18
T-cells and macrophages, and these cells were still found after 90 days. Both PTFE-based meshes (Omyramesh® and Dualmesh®) were mostly surrounded by T-cells, indicative of a chronic in ammatory reaction. Polypropylene meshes (Parietene® and Parietene composite®) had the lowest number of T-cells, indicative of resolution of the in ammatory reaction.
In Chapter 13, an in vitro model to study the biomaterial-dependent reaction of macrophages in an in ammatory environment is presented. The results are compared to an in vivo experiment with polypropylene mesh implantation in a contaminated environment. Macrophages were found to react in a similar biomaterial-dependent manner in the in vitro model as in the in vivo model.
In Chapter 14, the investigation of several biological meshes for infection susceptibility in a contaminated environment animal model, is presented. Crosslinked biological meshes (Permacol® and CollaMendFM®) demonstrated an infection rate of 70% compared to 4% in non-crosslinked biological meshes (Strattice® and Surgisis®). Incorporation in the abdominal wall after 180 days was poor in all meshes, and no residue of non-crosslinked Surgisis® could be found.
In Chapter 15, the study of long-term incorporation of biological meshes in a clean environment is presented. Even in this clean environment, cross-linked CollaMendFM® demonstrated a high infection rate, and only non- crosslinked Strattice® did not show any mesh infection. Incorporation of the non-infected meshes into the abdominal wall after 180 days was poor: 14% in Strattice® and 21% in Permacol®. No residue of any Surgisis® meshes could be identi ed at 180 days.
Chapter 16 of this thesis describes the relatively new phenomenon of mesh-bulging. A clinical case is presented in which a bulging Parietex composite® mesh was explanted and measured, and compared to the original implanted mesh. A striking expansion of the pores as the cause of bulging is demonstrated.
Conclusion
To prevent the development of IH, the abdominal wall can best be closed with a continuous ‘small bites’ suture technique, using a slowly-absorbable suture. Reducing the rates of PSH will likely reduce the incidence of IH. When
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