Tissue response to polypropylene meshes used in the repair of abdominal wall defects

doi:10.1016/S0142-9612(97)00162-2

Biomaterials

Volume 19, Issues 7–9, April 1998, Pages 669-675

https://doi.org/10.1016/S0142-9612(97)00162-2 Get rights and content

Abstract

Synopsis

The degree of integration of biomaterials used in the repair of abdominal wall defects seems to depend upon the structure of the prosthesis. Several polypropylene (PP) prostheses are currently available which differ in the number of PP filaments, the type of weave and the porosity. The aim of this study was to evaluate the integration, adhesion formation and resistance to traction of three types of PP prostheses (Marlex^®, Trelex^® and Prolene^®) used in the partial or total repair of abdominal wall defects. Abdominal wall defects (7×5 cm) were created in 54 New Zealand rabbits involving all the tissue layers (total substitutions (TS); n=27) or all layers excluding the parietal peritoneum (partial substitutions (PS); n=27). The defects were repaired with PP monofilament prostheses of different weave (1 mm porosity) (Marlex, n=18; Trelex, n=18) or bifilament (2 mm porosity) (Prolene; n=18). They were placed in contact on one side with subcutaneous tissue and on the other with abdominal viscera or parietal peritoneum. Animals were killed at 30, 60 and 90 days and samples of prosthesis and scar tissue processed for light and scanning microscopy. The adhesion formation with viscera was evaluated. Resistance to traction was measured with a tensiometer using strips including the prosthesis and anchorage tissue. Adhesions were detected in all the TS and in four PS. Microscopic analysis revealed total integration of the TS samples by fibrous and disorganized tissue. Prostheses used for PS were integrated by white adipose tissue with the exception of the areas around the mesh nodes and anchorage zones. The foreign body reaction could be seen as a moderate accumulation of white blood cells. Tensiometric analysis showed an increase in resistance to traction with time (P<0.001) in each type of prosthesis, but no differences were detected (P>0.001) between them. We concluded that: (a) the formation of adhesions was almost inhibited when the parietal peritoneum was left intact; (b) in both TS and PS, polypropylene prostheses integrated completely although the composition of the scar tissue was seem to differ; and (c) resistance to traction was similar in both TS and PS.

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Cited by (81)

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2020, Journal of the Mechanical Behavior of Biomedical Materials
Foreign Body Reaction (FBR) is a critical issue to be addressed when polyethylene terephthalate (PET) textile implants are considered in the medical field to treat pathologies involving hernia repair, revascularization strategies in arterial disease, and aneurysm or heart valve replacement. The natural porosity of textile materials tends to induce exaggerated tissue ingrowth which may prevent the implants from remaining flexible. One hypothesized way to limit the FBR process is to increase the material surface roughness at the yarn level. Supercritical N₂ (ScN₂) jet particle projection is a technique that provides enough velocity to particles in order to induce plastic deformation on the impacted surface. This work investigates the influence of ScN₂ jet projection parameters like standoff distance or particle size on the roughness that can be obtained on medical polymer yarns of various diameters (100 and 400 μm) and woven textile surfaces obtained from a 100 μm yarn. Moreover, the mechanical and biological performances of the obtained modified textile material are assessed. Results bring out that with appropriate testing conditions (500 bars jet/500 mm distance between nozzle and PET textile) and particle size around 50 μm, it is possible to generate 20 μm large and 4 μm deep craters on a 100 μm monofilament PET yarn and fabric. Regarding the strength of the textile material, it is only slightly modified with the treatment process, as the tenacity of the yarns decreases by only 10%. Moreover, It is shown that the obtained structures tend to limit the adhesion and slow down the proliferation of human fibroblasts.
Effects of suture tecnique on mesh shrinkage
2019, Asian Journal of Surgery
Citation Excerpt :
Recurrence and pain after hernia repairs using meshes are results of mesh shrinkage due to inflammatory responses observed as foreign body reactions. It is well known that inflammatory reactions also vary between different polypropylene meshes and also between individuals.6,13,14 In a study comparing shrinking of PP meshes with or without fixation after 90 days, the fixation group shrank less and retained their original shapes.15
Polypropylene meshes are one of the most frequently used patches in inguinal hernia repairs. This material was proved to be not completely inert, and may cause inflammatory responses like foreign body reactions. One of the physical results of these inflammatory reactions against the mesh is mesh shrinkage which is responsible for recurrence and pain. In this study, we aimed to investigate the effects of the suture technique on mesh shrinkage.
36 animals were used for the study. Subjects were divided into 3 groups. In the first group the mesh (onlay) was not fixated by any means. In the second group, mesh was placed on the abdomen wall, after which the mesh was fixated with interrupted suturing. In the third group, continuous suturing was applied after the placement of the mesh. Mesh shrinkage was measured macroscopically, and the mesh site reaction was evaluated microscopically. At the end of the second month, 18 subjects were sacrificed again to conduct the same procedure.
When meshes are used for hernia repairs, shrinkage may be observed in meshes placed on fascia. In the first group without mesh fixation, mesh shrinkage was more significant in the second month compared to the first month. The amount of shrinkage of without fixation group was found to significantly differ during the second month from interrupted and continuous suture groups. Even though statistically not significant, fixation of the mesh with interrupted sutures seems to be more advantageous compared to fixation with continuous sutures.
Reliable complex abdominal wall hernia repairs with a narrow, well-fixed retrorectus polypropylene mesh: A review of over 100 consecutive cases
2016, Surgery (United States)
Citation Excerpt :
For a full midline repair, this mesh is inset as a high-tension, taught construct utilizing 40–45 points of suture fixation. Use of a macroporous mesh (pore size >1 mm) ensures incorporation, minimizes fibrosis that can lead to poor abdominal wall compliance and pain, and is associated with less wrinkling and shrinkage.9-11 We orient the blue lines of the mesh in a craniocaudal direction to maintain its effective porosity under lateral tension.
Our objective was to determine outcomes for complex ventral hernia repairs in a large cohort of patients utilizing an operative construct employing retrorectus placement of a narrow, macroporous polypropylene mesh with up to 45 suture fixation points for force distribution. No consensus exists on the optimal technique for repair of complex ventral hernias. Current trends emphasize large meshes with wide overlaps and minimal suture fixation, though reported complications and recurrence remain problematic.
A retrospective review was performed for all patients undergoing ventral hernia repair with retrorectus placement of midweight, uncoated, soft polypropylene mesh by a single surgeon (GAD) between the years of 2010 and 2015. Patient characteristics, operative history, operative data, and postoperative course were reviewed.
A total of 101 patients with a mean age of 56 years and a mean body mass index of 29 m/kg² (range 18–51 m/kg²) underwent hernia repair. Patients had a median of 3 prior abdominal operations (range 0–9), with 44 patients presenting with recurrent hernias. A total of 42 patients were Ventral Hernia Working Group grade 1, 40 grade 2, 17 grade 3, and 2 grade 4. There were no recurrences at a mean follow-up of almost 400 days for the 93 patients with long-term follow-up. The surgical site occurrence rate was 7.9% (3 surgical site infections, 2 seromas, 2 hematomas, and 4 instances of delayed wound healing in 8 patients). One patient required reoperation for hematoma drainage; 5 patients required readmission within 30 days.
An operative construct employing a retrorectus placement of a narrow, macroporous polypropylene mesh with up to 45 suture fixation points for force distribution can achieve significantly better outcomes across a spectrum of Ventral Hernia Working Group grade, risk-stratified patients compared to rates reported in the literature for current strategies that employ wide meshes with minimal fixation.
Uniform tricalcium phosphate beads with an open porous structure for tissue engineering
2013, Colloids and Surfaces B: Biointerfaces
Citation Excerpt :
For several decades, bone grafts from inorganic materials (e.g., hydroxyapatite and calcium phosphate) and metals (e.g., titanium and aluminum) have been needed in orthopedic surgery to treat bone defects [20–22]. One of the many materials widely used for bone defects is tricalcium phosphate (TCP) due to approval by the Food and Drug Administration for clinical applications [23,24] as well as its excellent biocompatibility, biodegradability, and bone regeneration properties [25–27]. Here, we demonstrated the fabrication of uniform porous TCP beads with a large and open porous structure using a simple fluidic device based on emulsion templating.
Uniform tricalcium phosphate (TCP) porous beads with micro and macro pore sizes were fabricated using a simple fluidic device. For micro-porous TCP beads, an aqueous gelatin mixture containing TCP powder was introduced as the discontinuous phase into the fluidic device, where a toluene phase served as the continuous phase. The resulting aqueous TCP droplets were instantly frozen at −20 °C and freeze-dried, followed by calcination at 1200 °C. An oil-in-water-in-oil (O/W/O) emulsion templating method was employed to fabricate macro-porous TCP beads. An oil-in-water (O/W) emulsion was introduced into the fluidic device as the discontinuous phase with all other experimental conditions the same as for the micro-porous TCP beads. Uniform macro-porous TCP beads with a highly porous structure were finally obtained after freeze-drying and calcination. Large pore size and good interconnectivity of the macro-porous TCP beads were confirmed by scanning electron microscopy and porosimetry. In addition, penetration of host tissue into the macro-pores of the TCP beads was demonstrated by subcutaneously implanting the two types of porous TCP beads into mice and histologically analyzing stained sections at 1–4 weeks post implantation. The macro-porous TCP beads with a highly open porous structure could potentially be used as an injectable material for bone tissue engineering.
Dermolipectomy associated to the surgical treatment of incisional hernias in obese patients
2013, Revista Hispanoamericana de Hernia
Citation Excerpt :
Pensamos que este resultado puede estar relacionado con el empleo sistemático en nuestra serie de mallas de polipropileno y la profilaxis antibiótica. Las prótesis utilizadas tienen un grado de porosidad que condiciona una estructura de colagenización reticular y un tamaño de poro superior a 800 micras que ha demostrado disminuir la incidencia de infecciones24–29. Según este concepto, la infección se puede prevenir utilizando, entre otras medidas, prótesis de tipo III y, sobre todo –como las utilizadas por nosotros– de tipo I de la clasificación de Amid30.
Evaluar los resultados de la reparación quirúrgica de hernias incisionales en pacientes obesos cuando asociamos una dermolipectomía en el mismo procedimiento quirúrgico.
Diseñamos un estudio prospectivo de una serie de 61 pacientes intervenidos de hernia incisional con dermolipectomía asociada. Los criterios de inclusión fueron: defecto herniario periumbilical o infraumbilical igual o superior a 5 cm, presencia de faldón graso abdominal, y un Índice de Masa Corporal superior a 30 kg/m².
La edad media fue de 49 años y todos los pacientes fueron mujeres, excepto tres hombres. El índice de masa corporal medio fue de 33.3 kg/m². El tamaño del defecto herniario fue mayor de 10 cm en 25 pacientes (40.98 %) y entre 5 y 10 cm en el resto (36 pacientes; 59.01 %). Implantamos la malla según la técnica de Rives en 58 casos (95.08 %) y preaponeurótica en 3 casos (4.91 %). La morbilidad general de nuestra serie fue del 29.5 % (18 pacientes): seromas en 6 pacientes (9.8 %); hematomas en 3 pacientes (4.9 %); infección parcial de la prótesis en 1 paciente (1.6 %); lesiones necróticas en la cicatriz en 7 pacientes (11.4 %), y recidiva herniaria en 1 paciente (1.6 %). La estancia hospitalaria media fue de 2.1 días.
La dermolipectomía es un procedimiento seguro, permite una excelente exposición del campo y reduce la tracción lateral por el peso del faldón graso. Todo ello podría reducir el número de recidivas, provocar una mejoría estética y un mayor grado de satisfacción de estos pacientes.
To evaluate the results of the surgical treatment of ventral hernias in obese patients when a dermolipectomy is associated.
A prospective series of cases was design. 61 obese patients with an incisional hernia were treated and a dermolipectomy was associated. The inclusion criteria were: patients with abdominal ventral hernia in the middline, at umbilical or infraumbilical area, with a hernia defect equal or higher than five centimeters, and patients with Body Mass Index higher than 30 kg/m².
The mean age was 49. All patients were female except three men. The mean body mass index was 33.3 kg/m². The hernia defect was higher than 10 cm in 25 patients (40.98%), and between 5 and 10 cm in 36 patients (59.01%). Mesh repair was performed by Rives technique in 58 (95.08%) cases and pre-aponeurotic procedure in 3 cases (4.91%). The morbidity of the series was 25.9% (18 patients): seromas in 6 patients (9.8%), bleeding 3 patients (4.9%), partial infection of the prosthesis in 1 patient (1.6%), partial necrotic lesions in the skin scar in 7 patients (11.4%) and recurrent hernia in 1 patient (1.6%). The mean days in hospital was 2.1.
Dermolipectomy associated to the ventral hernia repair in obese patients with umbilical or infraumbilical defects is an adequate alternative procedure that does not add considerable morbidity, may reduce recurrence rates and improve aesthetic results.
The long-term behavior of lightweight and heavyweight meshes used to repair abdominal wall defects is determined by the host tissue repair process provoked by the mesh
2012, Surgery (United States)
Although heavyweight (HW) or lightweight (LW) polypropylene (PP) meshes are widely used for hernia repair, other alternatives have recently appeared. They have the same large-pore structure yet are composed of polytetrafluoroethylene (PTFE). This study compares the long-term (3 and 6 months) behavior of meshes of different pore size (HW compared with LW) and composition (PP compared with PTFE).
Partial defects were created in the lateral wall of the abdomen in New Zealand White rabbits and then repaired by the use of a HW or LW PP mesh or a new monofilament, large-pore PTFE mesh (Infinit). At 90 and 180 days after implantation, tissue incorporation, gene and protein expression of neocollagens (reverse transcription-polymerase chain reaction/immunofluorescence), macrophage response (immunohistochemistry), and biomechanical strength were determined. Shrinkage was measured at 90 days.
All three meshes induced good host tissue ingrowth, yet the macrophage response was significantly greater in the PTFE implants (P < .05). Collagen 1/3 mRNA levels failed to vary at 90 days yet in the longer term, the LW meshes showed the reduced genetic expression of both collagens (P < .05) accompanied by increased neocollagen deposition, indicating more efficient mRNA translation. After 90–180 days of implant, tensile strengths and elastic modulus values were similar for all 3 implants (P > .05).
Host collagen deposition is mesh pore size dependent whereas the macrophage response induced is composition dependent with a greater response shown by PTFE. In the long term, macroporous meshes show comparable biomechanical behavior regardless of their pore size or composition.

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