Optimal prosthetic for acute replacement of the abdominal wall

To compare two prostheses for use in acute abdominal wall replacement in the presence and absence of peritonitis.

Forty male Sprague-Dawley rats underwent full-thickness removal of a 2 x 3 cm portion of their anterior abdominal wall. Twenty rats had intraperitoneal contamination with stool slurry. Ten rats in each group (contaminated and noncontaminated) had a 2 x 3 cm piece of Gore-Tex dual-mesh expanded polytetrafluoroethylene (PTFE) sewn full-thickness to cover the abdominal wall defect. The remaining 10 rats in each group had replacement with a 2 x 3 cm piece of Dexon polyglycolic acid mesh (PGA). The rats were then awakened and returned to their cages. Rats were humanely killed at the end of a 3-week observation period or at the time of fistula formation or evisceration. At necropsy, the density of intraabdominal adhesions was graded on a scale of 0 to 3, and the extent of reepithelialization was noted. Results were analyzed with the Student's t test or Fisher's exact method of chi2 test as indicated.

Nineteen PTFE rats and 10 PGA rats survived the observation period, The PTFE rats had significantly fewer adhesions (0.10+/-0.30 vs. 1.27+/-1.49,p < 0.005) and significantly more reepithelialization of their wounds (78.2+/-23.4% vs. 43.6+/-50.4%,p < 0.05) than the PGA rats. Evisceration and fistula formation occurred more frequently in the PGA group. The mortality in the PTFE rats was significantly less than the PGA rats (5% vs. 50%,p < 0.001.) Notably, the contaminated PGA rats had a significantly higher mortality (90%,p < 0.001) than any of the other subgroups.

PTFE is superior to PGA as a replacement prosthesis for acute abdominal wall defects. There are significantly fewer adhesions, improved epithelialization of the wound, and less morbidity and mortality when PTFE is used. This finding is especially true in the presence of intraperitoneal fecal soilage.