Adhesion formation after incisional hernia repair: a randomized porcine trial

Adhesion formation involving intraperitoneal contents is a significant complication of incisional hernia repair. We evaluated the rate of peritoneal adhesion formation following closure of experimentally induced large ventral fascial defects using selected synthetic prosthetic materials in a well standardized porcine model. Sixty 25 kg hogs had a 4 x 6 cm ventral fascial defect induced and were randomized to repair with either interrupted 0-Prolene suture, Marlex surgical mesh (Mx), GoreTex Dual Mesh (Gore-DM), or an experimental version of the latter having multiple 0.4 mm fenestrations (Gore-DMH). Mx mesh induced significantly more adhesions than did Gore-DM when the two materials were placed in a comparable manner (P < 0.001). Those animals whose defects were closed primarily with Prolene suture alone developed significantly fewer adhesions than either Mx or Gore-DM (with or without holes) when these materials were sutured in an overlaying (i.e., extraperitoneal) manner (Mx, P < 0.0001; Gore-DM, P < 0.05; Gore-DMH, P < 0.01). The intraperitoneal placement of the Gore-DM materials (i.e., underlay manner) resulted in a rate of adhesion formation that was not statistically different from that induced by closure with Prolene alone (P = 0.08 for Gore-DM and P = 0.07 for Gore-DMH). Our findings support the use of Gore-DM biomaterial as the preferred material in the repair of large abdominal fascial defects when the use of a synthetic prosthetic material is necessitated by the defect size.