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Updated: Apr 25, 2026
Application of a New Mesh Fixation Method in Laparoscopic Incisional Hernia Repair
Published on: December 23, 2022
Effects of macroporous monofilament mesh on infection in a contaminated field
Kamil Bury1, Maciej Smietański, Bigda Justyna
1Department of Cardiac and Vascular Surgery, Medical University of Gdansk, Gdansk, Poland, kamilbury@me.com.
Background:
The aim of this study was to evaluate whether the type of the mesh and proper surgical technique can influence the outcome of a tension-free hernia repair in a contaminated filed.
Materials And Methods:
This study was based on the model of bacterial peritonitis in rats induced with a mixture composed of Escherichia coli and Bacteroides fragilis. Two animals were used as a control group without induced peritonitis and 10 animals with mesh implanted inside of the peritoneal cavity. For the 20 animals in the studied group, bacterial fluid was applied into the abdominal cavity together with the mesh implantation. In 10 cases, the mesh was fixed flatly upon the surface of the peritoneum; in the other 10, the mesh was rolled and then fixed within the peritoneal cavity. After 5 weeks, the animals were operated on again, and the meshes, the peritoneal fluid and, if present, any granulomas were taken for bacterial cultivation.
Results:
The results of the bacterial cultivation of the material from the control group (without mesh) and from the rats with flatly fixed mesh were almost completely negative (0/10 and 1/10, respectively). In 9 out of 10 rats that were exposed to the rolled mesh for 5 weeks, the colonisation of meshes with both B. fragilis and E. coli was found (p < 0.0198).
Conclusions:
When properly fixed, flat mesh, even in a contaminated field, may allow for a proper mesh healing and does not influence the ability to cure bacterial peritonitis in an animal model. A bad surgical technique, such as inadequately positioned or rolled mesh, may cause persistent peritoneal bacteraemia.
Insights
Properly fixed flat mesh in contaminated fields aids hernia repair healing. Poor surgical technique, like rolled mesh, can lead to persistent bacterial peritonitis, impacting outcomes.
Area of Science:
- Surgical Innovation
- Infectious Disease Research
- Biomaterials Science
Background:
- Tension-free hernia repair outcomes can be affected by mesh type and surgical technique, especially in contaminated surgical fields.
- Evaluating mesh performance in contaminated environments is crucial for improving surgical success rates.
Purpose of the Study:
- To assess the impact of mesh type and surgical technique on hernia repair outcomes in a contaminated field using a rat model.
- To determine if mesh fixation method influences infection and healing in the presence of bacterial peritonitis.
Main Methods:
- A rat model of bacterial peritonitis was established using Escherichia coli and Bacteroides fragilis.
- Mesh was implanted in the peritoneal cavity, with groups receiving either flat fixation or rolled fixation.
- Bacterial cultures of mesh, peritoneal fluid, and granulomas were performed after 5 weeks.
Main Results:
- Flatly fixed meshes showed minimal bacterial colonization (1/10), similar to controls (0/10).
- Rolled meshes exhibited significant bacterial colonization with both E. coli and B. fragilis in 90% of cases (p < 0.0198).
- Flat mesh implantation did not impede the resolution of bacterial peritonitis.
Conclusions:
- Properly fixed, flat mesh can achieve successful healing even in contaminated surgical fields.
- Inadequate surgical techniques, such as using rolled mesh, may result in persistent peritoneal infection (bacteremia).
- Surgical technique is a critical factor in managing contaminated fields during mesh-based hernia repair.
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