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Intraperitoneal Polypropylene Mesh in Clean, Potentially Septic, and Controlled Contamination Fields: An Experimental

Apostolos Makrantonakis1, Ioannis Mantzoros1, Orestis Ioannidis1

  • 14th Surgical Clinic, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece.

Medicina (Kaunas, Lithuania)
|May 27, 2026
PubMed
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This summary is machine-generated.

Intraperitoneal onlay mesh (IPOM) showed similar responses in clean and potentially septic environments. However, controlled contamination with bacteria significantly increased adhesion formation and inflammation, indicating caution in septic surgical fields.

Area of Science:

  • Surgical innovation
  • Biomaterials science
  • Inflammatory response

Background:

  • Intraperitoneal onlay mesh (IPOM) is effective for ventral/incisional hernia repair but poses risks of adhesions and infection.
  • The impact of contamination severity on the peritoneal response to IPOM requires further investigation.
  • Understanding mesh behavior in contaminated environments is crucial for surgical safety.

Purpose of the Study:

  • To evaluate how varying degrees of contamination affect the peritoneal tissue's response to intraperitoneal polypropylene mesh.
  • To compare adhesion formation and histological changes in response to mesh placement under clean, potentially septic, and controlled contamination conditions.
  • To provide evidence-based guidance on the selective use of IPOM in contaminated surgical fields.

Main Methods:

Keywords:
adhesionsanastomosiscontaminated surgical fieldintraperitoneal meshpolypropylenerat modelsepsisventral/incisional hernia repair

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  • Prospective, randomized, blinded rat study involving 60 Wistar rats.
  • Three groups: clean mesh placement, mesh with potential contamination from bowel resection, and mesh with controlled bacterial inoculation (E. coli, S. aureus).
  • Assessment at postoperative days 4 and 8, evaluating adhesion severity and histological parameters (neutrophil infiltration, fibroblast proliferation, neoangiogenesis, collagen deposition).

Main Results:

  • No significant difference in adhesion severity between clean and potentially septic (bowel resection) groups.
  • Controlled contamination group exhibited significantly higher adhesion scores (grades 2-3) compared to clean and potentially septic groups (p < 0.001).
  • Histological analysis revealed significantly increased neutrophil infiltration, fibroblast proliferation, neoangiogenesis, and collagen deposition in the controlled contamination group (p < 0.001).

Conclusions:

  • Intraperitoneal polypropylene mesh elicits comparable early biological responses in clean and potentially septic conditions.
  • Established intra-abdominal sepsis significantly escalates inflammation, fibroproliferation, and adhesion formation around the mesh.
  • Selective use of synthetic intraperitoneal mesh may be feasible in controlled contamination scenarios, but caution is advised in frankly septic environments.