Midline abdominal wall closure: a new prophylactic mesh concept

Despite intense research efforts, incisional hernias continue to be a problem in patients who undergo laparotomy. This study was designed to reinforce the midline laparotomy closure by including a new prosthetic design between the edges of the surgical wound.

A midline incision was made in New Zealand white rabbits and closed by inserting a polypropylene strip, T-shaped in cross-section, between the incisional borders. The T was placed upside down such that the horizontal arm of the T, whose surface is coated with extra-low pore size expanded polytetrafluoroethylene, made contact with the visceral peritoneum. The mesh was secured by a mass polypropylene 3/0 running suture. Surgery outcomes in these animals were compared with those in which the surgical wound was closed by simple suture and with control, nonoperated animals.

The T-mesh induced an increased amount of scar tissue at the midline, where neoformed recipient tissue appeared around the polypropylene mesh filaments. The expanded polytetrafluoroethylene lamina became appropriately mesothelialized. Compared with the simple suture, the T-mesh provided a significant gain in biomechanical strength at postoperative week 6 (43.99+/-4.17 Newtons and 56.96+/-10.94 Newtons, respectively, p < 0.05). At 6 months, the strength of the reinforced wound even surpassed, although not significantly, that of the control intact abdominal wall (82.25+/-7.60 Newtons versus 79.55+/-11.46 Newtons). Data were expressed as mean +/- standard deviation.

The use of a nonabsorbable biomaterial for midline laparotomy closure significantly improves its biomechanical resistance. Used in high-risk patients or even prophylactically, this technique could reduce the incidence of incisional hernia.