120-Day Comparative Analysis of Adhesion Grade and Quantity,Mesh Contraction,and Tissue Response to a Novel Omega-3 Fatty Acid Bioabsorbable Barrier Macroporous Mesh After Intraperitoneal Placement

Abstract

Purpose. This study aimed to evaluate adhesion formation, mesh contraction, and tissue response to an omega-3 fatty acid barrier—coated lightweight polypropylene mesh (C-Qur) after intra-abdominal placement, and compare these properties to those of other commercially available meshes. Materials and methods. After randomization, 3 × 3 cm pieces of Atrium C-Qur, Mesh ProLite Ultra, Composix, Parietex, Proceed, Sepramesh, and DualMesh were sewn to the intact peritoneum on either side of a midline incision in 41 New Zealand white rabbits. Necropsy was performed at 120 days, and explants were evaluated for adhesion grade, adhesion amount, and mesh contraction. Histologic evaluation included extent of capsule formation, abdominal wall tissue ingrowth, degrees of inflammation and vascularization of the surrounding tissue, and the presence of mesothelialization. Results. There were no significant differences between the C-Qur mesh and the commercially available meshes tested with regard to adhesion grade or amount, although percentage adhesion coverage for the C-Qur mesh was much less than for Composix and Proceed. The C-Qur mesh contracted less than all meshes, significantly less (P < .05) than DualMesh or Proceed. DualMesh exhibited the greatest amount of capsule formation and inflammation on its parietal side as compared with the other meshes. Conclusions. Placing lightweight polypropylene mesh with an omega-3 fatty acid barrier coating intraperitoneally results in more favorable adhesion characteristics compared with Composix and Proceed meshes at 120-day explantation after intraperitoneal placement. The minimal amount of contraction and favorable tissue response in comparison to other commercially available meshes makes C-Qur mesh a practical alternative for laparoscopic and open ventral hernia repair.

Keywords

ventral hernia laparoscopy surgical mesh omega-3 fatty acids abdominal adhesions peritoneum

Get full access to this article

View all access options for this article.

References

Winslow ER , Fleshman JW , Birnbaum EH , Brunt LM Wound complications of laparoscopic vs open colectomy. Surg Endosc. 2002;16:1420-1425.

Sorensen LT , Hemmingsen UB , Kirkeby LT , Kallehave F. , Jorgensen LN Smoking is a risk factor for incisional hernia. Arch Surg . 2005;140:119-123.

DeMaria EJ , Moss JM , Sugerman HJ Laparoscopic intraperitoneal polytetrafluoroethylene (PTFE) prosthetic patch repair of ventral hernia. Prospective comparison to open prefascial polypropylene mesh repair. Surg Endosc. 2000;14:326-329.

Earle D. , Seymour N. , Fellinger E. , Perez A. Laparoscopic versus open incisional hernia repair: a single-institution analysis of hospital resource utilization for 884 consecutive cases. Surg Endosc. 2006;20:71-75.

Luijendijk RW , Hop WC , van den Tol MP , et al. A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med. 2000;343:392-938.

Luijendijk RW , Lemmen MH , Hop WC , Wereldsma JC Incisional hernia recurrence following "vest-over-pants" or vertical Mayo repair of primary hernias of the midline. World J Surg. 1997;21:62-65.

Anthony T. , Bergen PC , Kim LT , et al. Factors affecting recurrence following incisional herniorrhaphy . World J Surg. 2000;24:95-100.

Burger JW , Luijendijk RW , Hop WC , Halm JA , Verdaasdonk EG , Jeekel J. Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg. 2004 ;240:578-583.

Stoppa RE The treatment of complicated groin and incisional hernias. World J Surg. 1989;13:545-554.

10.

LeBlanc KA , Booth WV Laparoscopic repair of incisional abdominal hernias using expanded polytetrafluoroethylene: preliminary findings. Surg Laparosc Endosc. 1993;3:39-41.

11.

Pierce RA , Spitler JA , Frisella MM , Matthews BD , Brunt LM Pooled data analysis of laparoscopic vs. open ventral hernia repair: 14 years of patient data accrual. Surg Endosc. 2007 ;21:378-386.

12.

Joels CS , Matthews BD , Kercher KW , et al. Evaluation of adhesion formation, mesh fixation strength, and hydroxyproline content after intraabdominal placement of polytetrafluoroethylene mesh secured using titanium spiral tacks, nitinol anchors, and polypropylene suture or polyglactin 910 suture. Surg Endosc. 2005;19:780-785.

13.

Matthews BD , Mostafa G. , Carbonell AM , et al. Evaluation of adhesion formation and host tissue response to intraabdominal polytetrafluoroethylene mesh and composite prosthetic mesh. J Surg Res. 2005;123:227-234.

14.

Matthews BD , Pratt BL , Backus CL , Kercher KW , Heniford BT Comparison of adhesion formation to intra-abdominal mesh after laparoscopic adhesiolysis in the New Zealand white rabbit. Am Surg. 2002;68: 936-940.

15.

Garrard CL , Clements RH , Nanney L. , Davidson JM , Richards WO Adhesion formation is reduced after laparoscopic surgery. Surg Endosc. 1999;13:10-13.

16.

Heniford BT , Park A. , Ramshaw BJ , Voeller G. Laparoscopic ventral and incisional hernia repair in 407 patients. J Am Coll Surg. 2000 ;190:645-650.

17.

Park A. , Birch DW , Lovrics P. Laparoscopic and open incisional hernia repair: a comparison study. Surgery. 1998;124:816-821.

18.

Cobb WS , Burns JM , Kercher KW , Matthews BD , James NH , Heniford BT Normal intraabdominal pressure in healthy adults. J Surg Res . 2005;129:231-235.

19.

van't Riet M. , de Vos van Steenwijk PJ , Kleinrensink GJ , Steyerberg EW , Bonjer HJ Tensile strength of mesh fixation methods in laparoscopic incisional hernia repair. Surg Endosc. 2002;16:1713-1716.

20.

Winslow ER , Diaz S. , Desai K. , Meininger T. , Soper NJ , Klingensmith ME Laparoscopic incisional hernia repair in a porcine model: what do transfixion sutures add? Surg Endosc. 2004;18:529-535.

21.

Majercik S. , Tsikitis V. , Iannitti DA Strength of tissue attachment to mesh after ventral hernia repair with synthetic composite mesh in a porcine model. Surg Endosc. 2006;20:1671-1674.

22.

Matthews BD , Pratt BL , Pollinger HS , et al. Assessment of adhesion formation to intra-abdominal polypropylene mesh and polytetrafluoroethylene mesh. J Surg Res. 2003;114:126-132.

23.

Topart P. , Ferrand L. , Vandenbroucke F. , Lozac'h P. Laparoscopic ventral hernia repair with the Goretex Dualmesh: long-term results and review of the literature. Hernia. 2005;9:348-352.

24.

Bellón JM , Rodríguez M. , García-Honduvilla N. , Pascual G. , Gómez Gil V. , Buján J. Peritoneal effects of prosthetic meshes used to repair abdominal wall defects: monitoring adhesions by sequential laparoscopy. J Laparoendosc Adv Surg Tech A. 2007;17:160-166.

25.

Deligiannidis N. , Papavasiliou I. , Sapalidis K. , Kesisoglou I. , Papavramidis S. , Gamvros O. The use of three different mesh materials in the treatment of abdominal wall defects. Hernia. 2002;6:51-55.

26.

Ferrucci L. , Cherubini A. , Bandinelli S. , et al. Relationship of plasma polyunsaturated fatty acids to circulating inflammatory markers. J Clin Endocrinol Metab. 2006;91:439-446.

27.

Arita M. , Bianchini F. , Aliberti J. , et al. Stereochemical assignment, antiinflammatory properties, and receptor for the omega-3 lipid mediator resolvin E1. J Exp Med. 2005;201:713-722.

28.

Arita M. , Yoshida M. , Hong S. , et al. Resolvin E1, an endogenous lipid mediator derived from omega-3 eicosapentaenoic acid, protects against 2,4,6-trinitrobenzene sulfonic acid-induced colitis. Proc Natl Acad Sci U S A. 2005;102:7671-7676.

29.

Calder PC Use of fish oil in parenteral nutrition: rationale and reality. Proc Nutr Soc. 2006;65:264-277.

30.

Calder PC n-3 Fatty acids, inflammation, and immunity- relevance to postsurgical and critically ill patients. Lipids. 2004;39:1147-1161.

31.

Hudert CA , Weylandt KH , Lu Y. , et al. Transgenic mice rich in endogenous omega-3 fatty acids are protected from colitis. Proc Natl Acad Sci U S A. 2006 ;103: 11276-11281.