Self-adhesive hydrogel meshes reduce tissue incorporation and mechanical behavior versus microgrips self-fixation: a preclinical study

Selma Benito-Martínez,Juan Manuel Bellón,Bárbara Pérez-Köhler,Marta Rodríguez,Gemma Pascual,Begoña Calvo,Francisca García-Moreno,Estefanía Peña

doi:10.1007/s10029-021-02552-z

Abstract

PurposeAtraumatic mesh fixation for abdominal hernia repair has been developed to avoid the disadvantages of classical fixation with sutures, which is considered a cause of chronic pain and discomfort. This study was designed to analyze, in the short and medium term, the biological and mechanical behavior of two self-fixing meshes compared to that of a polypropylene (PP) mesh fixed with a cyanoacrylate (CA) tissue adhesive.MethodsPartial abdominal wall defects (6 × 4 cm) were created in New Zealand rabbits (n = 36) and repaired using a self-adhesive hydrogel mesh (Adhesix™), a self-gripping mesh (ProGrip™) or a PP mesh fixed with CA (Surgipro™ CA). After 14 and 90 days, the host tissue incorporation, macrophage response and biomechanical strength were examined.ResultsAt 14 and 90 days, the ProGrip and Surgipro CA meshes showed good host tissue incorporation; however, the Adhesix implants presented poor integration, seroma formation and a higher degree of shrinkage. The Adhesix hydrogel was completely reabsorbed at 14 days, whereas ProGrip microhooks were observed at all study times. The macrophage response was higher in the ProGrip and Surgipro CA groups at 14 and 90 days, respectively, and decreased over time. At 90 days, the ProGrip implants showed the highest tensile strength values and the Adhesix implants showed the highest failure stretch.ConclusionMeshes with mechanical microgrip self-fixation (ProGrip) show better biological and mechanical behavior than those with adhesive hydrogel (Adhesix) in a preclinical model of abdominal hernia repair in rabbits.

Highlights

The implantation of prosthetic materials for the repair of hernial defects in the abdominal wall is one of the most frequent general surgical procedures [1]
In hernia repair processes on the abdominal wall, reinforcement with prosthetic materials in the form of meshes is considered the gold standard. In those cases in which the hernia defect is closed, mesh fixation would not be necessary, but otherwise prosthetic fixation is recommended to prevent the mesh from displacement in the early postoperative course
There are surgeons who leave these defects open ensuring that a 5-cm mesh overlap is adequate, mathematical confirmation has shown that more important defects require greater overlaps to minimize the risk of migration and recurrence [29]

Summary

Introduction

The implantation of prosthetic materials for the repair of hernial defects in the abdominal wall is one of the most frequent general surgical procedures [1]. Polypropylene (PP) meshes continue to be the most often used material for abdominal hernia repair. These PP reticular prostheses, in the surgical implant procedure, when necessary, are usually fixed to the surrounding tissues using penetrating devices, to prevent migration, which can lead to hernia recurrence. The short-term strength of mesh fixation is an undescribed factor in hernia repair but could have significant implications for early recurrence and mesh contraction [7]. Numerous techniques are available for fixation, and the most frequently used classical fixation devices range from

Methods

Results

Conclusion