Adhesion formation and reherniation differ between meshes used for abdominal wall reconstruction

Area of Science:

• Biomaterials Science
• Surgical Innovation
• Tissue Engineering

Background:

• Incisional hernia repair commonly utilizes prosthetic mesh, but ideal mesh properties conflict: promoting fascial ingrowth while preventing visceral adhesions.
• Developing meshes that balance ingrowth and antiadhesion is crucial for effective hernia repair.

Purpose of the Study:

• To evaluate composite meshes and antiadhesive treatments for preventing adhesions and promoting ingrowth in an incisional hernia model.
• To identify a mesh material that best satisfies the conflicting demands of an ideal surgical mesh.

Main Methods:

• Sixty rats with abdominal wall defects underwent repair with underlay mesh.
• Groups received polypropylene mesh (PPM) alone, PPM with auto-cross-linked polymers (ACP) gel, PPM with fibrinogen glue (FG), or composite meshes: PPM/ePTFE, PPM/HA/CMC, and PPM-CPGG.
• Outcomes assessed included mesh infection, adhesions, reherniations, and mesh-tissue tensile strength at 2 months.

Main Results:

• The PPM/HA/CMC group showed significantly reduced adhesions and the highest tensile strength.
• Mesh infection occurred in 6 rats, with half in the PPM/ePTFE group.
• The PPM/ACP group exhibited a high reherniation rate (50%).

Conclusions:

• The polypropylene/sodium hyaluronate/carboxymethylcellulose (HA/CMC) mesh demonstrated superior antiadhesive properties and high tensile strength.
• PPM/HA/CMC effectively prevented adhesions, reherniation, and infection in this rat model.
• This composite mesh shows promise as an ideal solution for incisional hernia repair.