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Abdominal wall hernias can often be
repaired by suture approximation of the edges of the defect.
But this approach is followed by a high incidence of recurrent
herniation.1
The use of permanent synthetic prosthetic
mesh materials provides a more secure repair, particularly for
large defects.1,2
Frequently, there is no viable tissue available to separate the
synthetic material from direct contact with the abdominal viscera,
in which circumstance, adhesions of omentum and intestine always
develop. One potential complication of such adhesions is intestinal
obstruction. A more serious problem is
that of intestinal fistulization through the junction of the
prosthetic material with the abdominal wall.3-5
The most commonly used meshes are knitted,
are macroporous, are synthesized from polypropylene or polyethylene,
and share the potential for causing intestinal complications.3,5,6
An ideal prosthesis would not induce intraabdominal adhesions
but at the same time would firmly incorporate into the abdominal
wall. Smooth-surfaced impermeable materials, such as silicone,
which effectively resist adhesion formation, do not develop the
necessary fixation to the adjacent fascia and muscle.
Several experimental models have been
used to investigate these issues.7-9
Time intervals for observation after prosthesis installation
have varied from hours to months, but always involved a single
observation per animal. We suggest here that adhesion formation
is better studied by sequential observations than at a single
arbitrary time.
The purpose of this article is to describe the dynamics of
visceral adhesion formation to polypropylene mesh. The major
innovation reported here is the use of repeated peritoneoscopy
to allow serial observations and surgical manipulations of adhesions.
The first set of experiments addressed the questions: 1) What
role does omentum play in adhesion formation? and 2) What is
the significance of the tissue backing the porous prosthesis,
ie, peritoneum versus subcutaneous tissue? These observations
were made at necropsy. The second group of studies involved repeated
laparoscopy to determine adhesion dynamics, and timed sacrifice
to obtain tissues for scanning electron microscopy of the prosthetic
surface.
Introduction | Methods
| Results
| Discussion
| References
JACS |
