Surgical mesh as a scaffold for tissue regeneration in the esophagus

Textiles in the form of surgical meshes are widely used in hernia surgery. Their porous structure allows tissue infiltration to incorporate the fabric for complete healing and device stabilization. This study was aimed to reconstitute the esophageal wall and to investigate the functional and histological consequences of a new, non-absorbable polyvinylidene fluoride (PVDF) mesh and an absorbable polyglactin 910 (Vicryl((R))) mesh.

Semicircular esophageal defects of 0.5 x 1 cm were created 2 cm proximal of the cardia in 10 rabbits. This gap was bridged using either polyglactin 910 or PVDF and additionally covered by omental wrapping. The clinical outcome was observed by clinical observation, regular esophagoscopies and X-ray contrast medium examinations. Local tissue regeneration was verified by light microscopy and immunohistochemistry.

After an observation period of 3 months we found no anastomotic strictures, complete mucosal regeneration, minimal inflammation reaction and initial regeneration of the muscle layer for the PVDF group. Within the polyglactin 910 group, three patch failures with consecutive anastomotic leakage occurred.

The results indicate that PVDF mesh structure gives the opportunity of local tissue regeneration in the esophagus. Though re-epithelialization and muscle cell ingrowth could be detected for absorbable polyglactin 910 mesh, this implant was accompanied by a high and early rate of anastomotic leakage.