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Modified mesh for hernia repair that is adapted to the physiology of the abdominal wall
U Klinge1, B Klosterhalfen, J Conze
1Department of Surgery, RWTH Aachen, Germany.
Objective:
To develop a new mesh for hernia repair that is adapted to the physiological forces.
Design:
Animal experiment.
Setting:
Surgical Department of the RWTH-Aachen.
Animals:
Wistar rats
Main Outcome Measures:
Textile analysis, tensile strength, bending stiffness, histology and morphometry.
Results:
After textile analysis of commercially available meshes in clinical use we defined the physiological forces and constructed a new mesh (Soft Hernia Mesh, SHM) based on a combination of non-absorbable polypropylene and absorbable polyglactin 910. The amount of non-absorbable material could be reduced to < 30% compared with Marlex while still guaranteeing the necessary pulling force of 16 N/cm. Improvements of the hosiery structure improved the symmetrical distribution of the retaining forces in all directions. Compared with the considerable restriction of the abdominal wall mobility by Prolene (polypropylene) and Mersilene (polyester) meshes there was no increase in the bending stiffness after the implantation of the new mesh. Histological examination showed a pronounced reduction of the inflammatory reaction in the tissues, and the collagen bundles were orientated merely around the mesh filaments instead of forming a scar plate that completely embedded the mesh.
Conclusion:
Different meshes caused specific histological reactions with changes of their mechanical properties after implantation in rodents. A new mesh with a reduced amount of polypropylene showed both less inflammation and less restriction in the mobility of the abdominal wall though it exceeded the required tensile strength of 16 N/cm.