Intraabdominal adhesion formation of polypropylene mesh. Influence of coverage of omentum and polyglactin.

Abstract

BACKGROUND:

Adhesions after intraabdominal surgical procedures are related to high morbidity and mortality. Biomaterials, particularly those made of polypropylene, in the intraabdominal position have to be considered as pathophysiological cofactor in a multifactorial process of adhesion formation. To investigate the adhesive potential induced by the biomaterial, an animal model was performed. In addition, the influence of coverage by omentum or a polyglactin barrier was investigated.

METHODS:

In, 18 Chinchilla rabbits the biomaterial was placed laparoscopically using the intraperitoneal onlay mesh technique. Using this model, a polypropylene-polyglactin mesh compound (PPMC) was used with three different implantation techniques: group 1, PPMC implantation without coverage (PPMC): group 2, PPMC implantation with additional omentum coverage (PPMC-O): and group 3, PPMC implantation with coverage of an absorbable polyglactin mesh (PPMC-V). The degree of adhesion formation was measured 90 days after implantation by computer-assisted planimetry. Morphometric examination followed the explantation analyzing the amount of foreign body response.

RESULTS:

We found a significant reduction of adhesion formation for the PPMC and PPMC-O groups compared to the PPMC-V group, in which dense adhesions were found. Morphometric investigations of the perifilamental granulomas of the pure (PPMC) group revealed a typical foreign body reaction with a mild to moderate fibrosis around all mesh fibers. However, tissue specimens of the PPMC-O and PPMC-V groups indicated a similar inflammatory reaction but significantly increased connective tissue formation around the polymer fibers compared to the pure PPMC group.

CONCLUSION:

The intraabdominal placement of a pure PPMC shows a neoperitonealization and perifilamental collagenous ingrowth with almost no adhesions. Coverage with omentum (PPMC-O) or polyglactin mesh (PPMC-V) resulted in a significant increase in inflammation and perifilamentary connective tissue formation.

• Authors: J Conze, K Junge, U Klinge, C Weiss, M Polivoda, A P Oettinger, V Schumpelick
• Journal: Surgical endoscopy (Surg Endosc) Vol. 19 Issue 6 Pg. 798-803 (Jun 2005) ISSN: 1432-2218 [Electronic] Germany
• PMID: 15868269 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Polypropylenes
• Polyglactin 910

Topics

• Animals
• Female
• Omentum
• Polyglactin 910 (adverse effects)
• Polypropylenes (adverse effects)
• Postoperative Complications (etiology)
• Rabbits
• Surgical Mesh (adverse effects)
• Surgical Procedures, Operative (methods)
• Tissue Adhesions (etiology)