Abstract
BackgroundThe acute inflammatory response following mesh implantation has been often evaluated in vitro and in animal models. The aim of this study was to evaluate the acute inflammatory response near the prosthesis in human by analysing some inflammatory indicators.MethodsWe used a cohort of twelve male patients affected by midline incisional hernia, who were admitted for surgical mesh repair. A suction drain was placed between the mesh and rectal muscles whereas, the other one was placed between the subcutaneous tissue and the oblique external sheath. The acute inflammatory response was analyzed by measuring the production of interleukin [IL]-1, IL-10, IL-1ra, C-Reactive Protein (CRP), total proteins, albumin and pH in the drain fluids.ResultsThe dynamics of CRP and ILs production resulted similar in both drainages. Comparing drain over mesh and subcutaneous drain at all times, IL-1 and CRP values always resulted significantly higher in the first one, whereas IL-1ra and IL-10 values were significantly higher in the last one. Total protein and albumin were similar in both drains at all time; only in the drain over mesh fluid, pH values resulted significantly reduced in the fourth post-operative day.ConclusionsOur data showed that an acute inflammatory reaction is present in both sites examined. However, it was significantly higher in the space after mesh implantation.
Highlights
The acute inflammatory response following mesh implantation has been often evaluated in vitro and in animal models
The aim of this study was to evaluate, in the same patient, the acute inflammatory response in drain fluid produced near the prosthesis (DM) and in the subcutaneous space (DS) after prosthetic incisional hernia repair
We evaluated some inflammatory indicators like cytokines[IL]-1, -10 and -1ra, C-Reactive Protein (CRP), total proteins, albumin and pH
Summary
The acute inflammatory response following mesh implantation has been often evaluated in vitro and in animal models. The use of a prostheses in hernia surgery of the abdominal wall has significantly reduced the incidence of recurrence Some complications, such as seroma formation, chronic pain, feeling of foreign body, wound infection, abdominal wall stiffness and nerve entrapment complaints occur more frequently after mesh repair. In order to evaluate the precocious inflammatory response to mesh in vivo in humans, we chose to use a suitable model constituted by patients affected by a large median incisional hernia who underwent prosthetic hernia repair, using a sublay technique. This operation consists in a large dissection of both abdominal rectal muscles and their posterior sheath, in order to place the mesh, as well as a further dissection between subcutaneous tissue and sheath of the external oblique muscle [6]
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