Comet-tail-like inflammatory infiltrate to polymer filaments develops in tension-free conditions

Mesh reinforcement in hiatal hernia repair becomes more frequent but is charged by complications such as erosion or stenosis of the oesophagus. These complications are accompanied by an intense inflammatory infiltrate around the polymer fibres. To characterize this effect, the response to polypropylene fibres in the absence of tension was examined.

In rats, polypropylene sutures (USP size 1, 3-0 and 7-0) were placed in the subcutis of the abdominal wall without knot or tension. On postoperative days 3, 7 and 21, specimens were excised. The expressions of c-myc, β-catenin, Notch3, COX-2, CD68 and Ki-67 were measured by immunohistochemistry.

In the absence of tension, sutures were surrounded by a foreign body granuloma with an inflammatory infiltrate not encircling the fibre but forming almost symmetric comet-tail-like infiltrates on opposite sides. The expression of c-myc, β-catenin, Notch3, COX-2, CD68 and Ki-67 was significantly reduced over time in the comet tail, but not in the granuloma.

Even in tension-free conditions, surgical sutures cause a foreign body response with infiltrates of inflammatory cells. This reaction is shaped like a comet tail, and its extension depends on the diameter of the used fibre. Therefore, for reduction of perifilamental infiltrates, not only absence of tension is required, but also a small-sized fibre textile.