Prospective Evaluation of Adhesion Formation and Shrinkage of Intra-Abdominal Prosthetics in a Rabbit Model

Harrell, Andrew G.; Novitsky, Yuri W.; Peindl, Richard D.; Cobb, William S.; Austin, Catherine E.; Cristiano, Joseph A.; Norton, James H.; Kercher, Kent W.; Heniford, B. Todd
September 2006
American Surgeon;Sep2006, Vol. 72 Issue 9, p808
Academic Journal
Laparoscopic ventral hernia repair requires an intraperitoneal prosthetic; however, these materials are not without consequences. We evaluated host reaction to intraperitoneal placement of various prosthetics and the functional outcomes in an animal model. Mesh (n = 15 per mesh type) was implanted on intact peritoneum in New Zealand white rabbits. The mesh types included ePTFE (DualMesh®), ePTFE and polypropylene (Composix®), polypropylene and oxidized regenerated cellulose (Proceed®), and polypropylene (Marlex®). Adhesion formation was evaluated at 1, 4, 8, and 16 weeks using 2-mm mini-laparoscopy. Adhesion area, adhesion tenacity, prosthetic shrinkage, and compliance were evaluated after mesh explantation at 16 weeks. DualMesh® had significantly less adhesions than Proceed®, Composix®, or Marlex® at 1, 4, 8, and 16 weeks (P < 0.0001). Marlex® had significantly more adhesions than other meshes at each time point (P < 0.0001). There were no statistically significant differences in adhesions between Proceed® and Composix® meshes. After mesh explantation, the mean area of adhesions for Proceed® (4.6%) was less than for Marlex® (21.7%; P = 0.001). The adhesions to Marlex® were statistically more tenacious than the DualMesh® and Composix® groups. Overall prosthetic shrinkage was statistically greater for DualMesh® (34.7%) than for the remaining mesh types (P < 0.01). Mesh compliance was similar between the groups. Prosthetic materials demonstrate a wide variety of characteristics when placed inside the abdomen. Marlex® formed more adhesions with greater tenacity than the other mesh types. DualMesh® resulted in minimal adhesions, but it shrank more than the other mesh types. Each prosthetic generates a varied host reaction. Better understanding of these reactions can allow a suitable prosthetic to be chosen for a given patient in clinical practice.


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