Surface Area Of Mesh Research Articles

Prospective cohort study on mesh shrinkage measured with MRI after robot-assisted minimal invasive retrorectus ventral hernia repair using an iron-oxide-loaded polyvinylidene fluoride mesh

BackgroundMesh-reinforced ventral hernia repair is considered the gold standard treatment for all but the smallest of hernias. Human data on mesh shrinkage in the retrorectus mesh position is lacking. A prospective observational cohort study was performed to measure mesh shrinkage in robot-assisted minimal invasive retrorectus repair of ventral hernias.MethodsA cohort of 20 patients underwent a robot-assisted minimal invasive retrorectus repair of their ventral hernia. Magnetic resonance imaging (MRI) imaging was performed one month and thirteen months after implantation of an iron-oxide-impregnated polyvinylidene fluoride (PVDF) mesh to assess the decrease in mesh surface area. Inter-rater reliability among three radiologists regarding measurement of the mesh dimensions was analyzed. Quality of Life scoring was evaluated.ResultsThe inter-rater reliability between the radiologists reported as the intra-class correlations proved to be excellent for mesh width (ICC 0.95), length (ICC 0.98) and surface area (ICC 0.99). Between MRI measurements at one month and thirteen months postoperatively, there was a significant increase in mesh surface area (+ 12.0 cm2, p = 0.0013) and mesh width (+ 0.8 cm, p < 0.001), while the length of the mesh remained unchanged (−0.1 cm, p = 0.754). Quality of Life Scoring showed a significant improvement in Quality of Life after one month and a further improvement at thirteen months (p < 0.001).ConclusionThere was an excellent inter-rater reliability between three radiologists when measuring width, length, and surface area of an iron-oxide-impregnated PVDF mesh using MRI visualization. Mesh shrinkage was not observed, instead the effective mesh surface area and width of the mesh increased.

P-076 PROSPECTIVE COHORT STUDY ON MESH SHRINKAGE MEASURED WITH MRI AFTER ROBOT ASSISTED MINIMAL INVASIVE RETRORECTUS VENTRAL HERNIA REPAIR USING AN IRON OXIDE LOADED PVDF MESH

Abstract Aim Mesh-reinforced ventral hernia repair is considered the gold standard treatment for all but the smallest of hernias. Human data on mesh shrinkage in the retrorectus mesh position is lacking. A prospective observational cohort study was performed to measure mesh shrinkage in robot assisted minimal invasive retrorectus repair of ventral hernias. Methods A cohort of 20 patients underwent a robot assisted minimal invasive retrorectus repair of their ventral hernia. Magnetic resonance imaging (MRI) imaging was performed one month and thirteen months after implantation of an iron-oxide-impregnated polyvinylidene fluoride (PVDF) mesh to assess the decrease in mesh surface area. Inter-rater reliability among three radiologists regarding measurement of the mesh dimensions was analyzed. Quality of Life scoring was evaluated. Results The inter-rater reliability between the radiologists reported as the intra-class correlations proved to be excellent for mesh width (ICC 0.95), length (ICC 0.98) and surface area (ICC 0.99). Between MRI measurements at one month and thirteen months postoperatively, there was a significant increase in mesh surface area (+12.0 cm2, p=0.0013) and mesh width (+0.8 cm, p&amp;lt;0.001), while the length of the mesh remained unchanged (-0.1 cm, p=0.754). Quality of Life Scoring showed a significant improvement in Quality of Life after one month and a further improvement at thirteen months (p&amp;lt;0.001). Conclusion There was an excellent inter-rater reliability between three radiologists when measuring width, length and surface area of an iron-oxide-impregnated PVDF mesh using MRI visualization. Mesh shrinkage was not observed, instead the effective mesh surface area and width of the mesh increased.

Essential anatomical landmarks in placement of an adequate size mesh for a successful ventral hernia repair.

Safe and effective hernia repair requires a surgeon to have the appropriate knowledge necessary to learn details of the surgical technique. Long-term results of treatment, even with the use of synthetic implants, have shown that recurrences were still a significant clinical problem concerning up to every fourth patient. Therefore, it was pointed out that the mere presence of synthetic material is not a solitary circumstance sufficient for a successful repair. A key finding in recurrence prevention has been to focus surgeons&apos; attention on the relationship between the size of the hernia orifice and the mesh surface. An optimal ratio of these values has not been established yet, however, it is considered that the mesh surface area should be at least sixteen times larger than the area of the abdominal wall defect. In cases of medium and large hernias, in order to place an extensive mesh sheet in the appropriate anatomical space of the abdominal wall, an extensive dissection needs to be performed, including several different compartments. Therefore, a surgeon undertaking a hernia repair needs to know perfectly the anatomy and function of all the myofascial structures involved. Performing an incorrect dissection of a mistaken structure may lead to catastrophic abdominal deformities. Depriving the patient of the natural support of the abdominal wall provided by the muscles may lead to total or partial destabilization of the trunk and lead to disability. In this paper a detailed description of anatomical structures and its practical use has been presented.

E-TEP repair for midline primary and incisional hernia: technical considerations and initial experience

The Enhanced-View Totally Extra Peritoneal Rives-Stoppa (e-TEP-RS) Technique for the repair of large, complex, ventral abdominal hernias has gained popularity especially in overcoming the disadvantages with Intra Peritoneal Onlay Mesh (IPOM) repairs and to enable siting of a large prosthetic mesh in an anatomical plane distinct from the abdominal cavity and its contents. Evolving variations of the original technique have allowed the definitive repair of such defects in a reproducible manner. We present our initial experience of this approach and detailed steps of our native technical modifications in overcoming the challenges in performing this complex and potentially challenging procedure. This is a retrospective review of the clinical data of midline, large, complex, ventral abdominal hernia patients who underwent e-TEP-RS with and without Transversus Abdominis Release (TAR). Patients, with or without Diastasis of Rectus Abdominis Muscle (DRAM) were included. Key outcomes measured were post-operative pain, operative morbidity, readmission, Quality of Life (QoL), hernia recurrence. A total of 58 midline, ventral abdominal hernia patients who underwent e-TEP-RS with and without Transversus Abdominis Release (TAR), between March 2018 and December 2019 were studied. Mean defect area was 41.0 ± 28cm2 and the mean mesh surface area was 473.5 ± 165cm2. e-TEP-RS was done in 35 cases, e-TEP RS TAR in 15 cases and e-TEP-RS with e-TEP inguinal in 08 cases. There was no intraoperative morbidity. Mean duration of surgery was 156.2 ± 40min and mean blood loss was 40.5 ± 26cc. The CCS QoL scores improved from 34.6 (± 2) pre-operatively to 27.2 (± 4) at the end of 6months. One patient had a supra-umbilical recurrence following bilateral TAR over the superior edge of the mesh. Follow-up ranged from 6 to 22months, with a mean of 14months. Major complications (n = 12; 20.7%) were seroma formation and prolonged ileus. The e-TEP-RS technique for large, complex, midline, ventral abdominal hernias can be used with excellent results and acceptable morbidity. This technique is technically challenging and should be mastered in relatively smaller ventral hernias to achieve good results before attempting it in larger, complex ones.

Optimization of Prosthodontic Computer-Aided Designed Models: A Virtual Evaluation of Mesh Quality Reduction Using Open Source Software.

Mesh optimization reduces the texture quality of 3D models in order to reduce storage file size and computational load on a personal computer. This study aims to explore mesh optimization using open source (free) software in the context of prosthodontic application. An auricular prosthesis, a complete denture, and anterior and posterior crowns were constructed using conventional methods and laser scanned to create computerized 3D meshes. The meshes were optimized independently by four computer-aided design software (Meshmixer, Meshlab, Blender, and SculptGL) to 100%, 90%, 75%, 50%, and 25% levels of original file size. Upon optimization, the following parameters were virtually evaluated and compared; mesh vertices, file size, mesh surface area (SA), mesh volume (V), interpoint discrepancies (geometric similarity based on virtual point overlapping), and spatial similarity (volumetric similarity based on shape overlapping). The influence of software and optimization on surface area and volume of each prosthesis was evaluated independently using multiple linear regression. There were clear observable differences in vertices, file size, surface area, and volume. The choice of software significantly influenced the overall virtual parameters of auricular prosthesis [SA: F(4,15) = 12.93, R2 = 0.67, p < 0.001. V: F(4,15) = 9.33, R2 = 0.64, p < 0.001] and complete denture [SA: F(4,15) = 10.81, R2 = 0.67, p < 0.001. V: F(4,15) = 3.50, R2 = 0.34, p = 0.030] across optimization levels. Interpoint discrepancies were however limited to <0.1mm and volumetric similarity was >97%. Open-source mesh optimization of smaller dental prostheses in this study produced minimal loss of geometric and volumetric details. SculptGL models were most influenced by the amount of optimization performed.

Biomechanical Comparison of Fibrin Sealants for Mesh Fixation

Adhesive use for fixation in hernia repair allows for complete and immediate mesh surface area adherence. Little is known about the fixation strengths of the products and application methods available. The purpose of this study was to compare the immediate and early strength of fixation of Tisseel™ and Evicel™ using hand and spray application techniques. Sixteen Mongrel swine underwent implantation of large-pore, mid-weight polypropylene mesh fixated with either Tisseel™ or Evicel™, applied by hand or with a spray apparatus. Time points studied were zero and four days. All samples underwent lap shear testing to quantify the strength of the mesh-tissue interface as an indicator of mesh fixation strength. Thirty Day 4 and 16 Day 0 samples were tested. Manually applied Tisseel™ mean fixation strength was 2.05 N/cm at Day 0 and 6.02 N/cm at Day 4. Sprayed Tisseel™ had mean fixation strength of 1.22 N/cm at Day 0 and 7.21 N/cm at Day 4. Manually applied Evicel™ showed mean fixation strength of 0.92 N/cm at Day 0 and 6.73 N/cm at Day 4. Mean fixation strength of sprayed Evicel™ was 0.72 N/cm at Day 0 and 6.70 N/cm at Day 4. Analysis of variance showed no difference between groups at Day 0 or Day 4. Immediate strength of mesh fixation could have significant implications for early recurrence and mesh contraction. This study demonstrates that no difference exists in immediate or early fixation strength between these two brands of sealants or their method of application.

Prospective cohort study on mesh shrinkage measured with MRI after laparoscopic ventral hernia repair with an intraperitoneal iron oxide-loaded PVDF mesh

BackgroundCurrent data on shrinkage of intraperitoneal meshes come mainly from animal studies. High-quality human data in prospective studies are scarce.MethodsWe used the ability to visualize intraperitoneal PVDF meshes enhanced with iron particles (DynaMesh IPOM visible) with magnetic resonance imaging (MRI) to determine the amount of shrinkage between 1 and 13 months postoperatively. All measurements of the width, length, and surface area of the mesh were performed with a standardized methodology independently by four radiologists blinded for the timing of the MRI.ResultsOf the 15 patients undergoing laparoscopic ventral hernia repair, 13 patients received an MRI both at 1 and at 13 months. Evaluation of inter-rater reliability between the radiologists showed intra-class correlations of 0.95 (95% CI 0.92–0.98) for the width, 0.96 (95% CI 0.93–0.98) for the length, and 0.99 (90% CI 0.99–1.00) for the surface area of the mesh. The change between measurement at implantation and 1-month MRI was − 0.7 cm (P = 0.023; − 3.6%) for the width and − 1.9 cm (P = 0.001; − 7.2%) for the length. The change between 1 and 13 months was − 0.06 cm (P = 0.74; shrinkage = 0.3%) for the width, − 0.12 cm (P = 0.56; shrinkage = 0.5%) for the length, and − 4.0 cm2 (P = 0.20; shrinkage = 1.0%) for the surface area of the mesh.ConclusionThere is excellent inter-rater reliability between radiologists when measuring width, length, and surface area of visible intraperitoneal PVDF mesh with MRI. There is no significant shrinkage between 1 and 13 months of intraperitoneal PVDF mesh after laparoscopic ventral hernia repair.

First human magnetic resonance visualisation of prosthetics for laparoscopic large hiatal hernia repair.

Mesh repair of large hiatal hernias has increasingly gained popularity to reduce recurrence rates. Integration of iron particles into the polyvinylidene fluoride mesh-based material allows for magnetic resonance visualisation (MR). In a pilot prospective case series eight patients underwent surgical repair of hiatal hernias repair with pre-shaped meshes, which were fixated with fibrin glue. An MR investigation with a qualified protocol was performed on postoperative day four and 3 months postoperatively to evaluate the correct position of the mesh by assessing mesh appearance and demarcation. The total MR-visible mesh surface area of each implant was calculated and compared with the original physical mesh size to evaluate potential reduction of the functional mesh surfaces. We documented no mesh migrations or dislocations but we found a significant decrease of MR-visualised total mesh surface area after release of the pneumoperitoneum compared to the original mesh size (mean 78.9 vs 84 cm(2); mean reduction of mesh area = 5.1 cm(2), p < 0.001). At 3 months postoperatively, a further reduction of the mesh surface area could be observed (mean 78.5 vs 78.9 cm(2); mean reduction of mesh area = 0.4 cm(2), p < 0.037). Detailed mesh depiction and accurate assessment of the surrounding anatomy could be successfully achieved in all cases. Fibrin glue seems to provide effective mesh fixation. In addition to a significant early postoperative decrease in effective mesh surface area a further reduction in size occurred within 3 months after implantation.

Magnetic resonance-visible meshes for laparoscopic ventral hernia repair.

Background and Objectives:We aimed to evaluate the first human use of magnetic resonance–visible implants for intraperitoneal onlay repair of incisional hernias regarding magnetic resonance presentability.Methods:Ten patients were surgically treated with intraperitoneally positioned superparamagnetic flat meshes. A magnetic resonance investigation with a qualified protocol was performed on postoperative day 1 and at 3 months postoperatively to assess mesh appearance and demarcation. The total magnetic resonance–visible mesh surface area of each implant was calculated and compared with the original physical mesh size to evaluate potential reduction of the functional mesh surfaces.Results:We were able to show a precise mesh demarcation, as well as accurate assessment of the surrounding tissue, in all 10 cases. We documented a significant decrease in the magnetic resonance–visualized total mesh surface area after release of the pneumoperitoneum compared with the original mesh size (mean, 190 cm2 vs 225 cm2; mean reduction of mesh area, 35 cm2; P < .001). At 3 months postoperatively, a further reduction of the surface area due to significant mesh shrinkage could be observed (mean, 182 cm2 vs 190 cm2; mean reduction of mesh area, 8 cm2; P < .001).Conclusion:The new method of combining magnetic resonance imaging and meshes that provide enhanced signal capacity through direct integration of iron particles into the polyvinylidene fluoride base material allows for detailed mesh depiction and quantification of structural changes. In addition to a significant early postoperative decrease in effective mesh surface area, a further considerable reduction in size occurred within 3 months after implantation.

Mesh size in Lichtenstein repair: a systematic review and meta-analysis to determine the importance of mesh size

Small mesh size has been recognized as one of the factors responsible for recurrence after Lichtenstein hernia repair due to insufficient coverage or mesh shrinkage. The Lichtenstein Hernia Institute recommends a 7×15cm mesh that can be trimmed up to 2cm from the lateral side. We performed a systematic review to determine surgeons' mesh size preference for the Lichtenstein hernia repair and made a meta-analysis to determine the effect of mesh size, mesh type, and length of follow-up time on recurrence. Two medical databases, PubMed and ISI Web of Science, were systematically searched using the key word "Lichtenstein repair." All full text papers were selected. Publications mentioning mesh size were brought for further analysis. A mesh surface area of 90cm(2) was accepted as the threshold for defining the mesh as small or large. Also, a subgroup analysis for recurrence pooled proportion according to the mesh size, mesh type, and follow-up period was done. In total, 514 papers were obtained. There were no prospective or retrospective clinical studies comparing mesh size and clinical outcome. A total of 141 papers were duplicated in both databases. As a result, 373 papers were obtained. The full text was available in over 95% of papers. Only 41 (11.2%) papers discussed mesh size. In 29 studies, a mesh larger than 90cm(2) was used. The most frequently preferred commercial mesh size was 7.5×15cm. No papers mentioned the size of the mesh after trimming. There was no information about the relationship between mesh size and patient BMI. The pooled proportion in recurrence for small meshes was 0.0019 (95% confidence interval: 0.007-0.0036), favoring large meshes to decrease the chance of recurrence. Recurrence becomes more marked when follow-up period is longer than 1year (p<0.001). Heavy meshes also decreased recurrence (p=0.015). This systematic review demonstrates that the size of the mesh used in Lichtenstein hernia repair is rarely discussed in clinical studies. Papers that discuss mesh size appear to reflect a trend to comply with the latest recommendations to use larger mesh. Standard heavy meshes decrease the recurrence in hernia repair. Even though there is no evidence, it seems that large meshes decrease recurrence rates.

Robust modeling of constant mean curvature surfaces

We present a new method for modeling discrete constant mean curvature (CMC) surfaces, which arise frequently in nature and are highly demanded in architecture and other engineering applications. Our method is based on a novel use of the CVT ( centroidal Voronoi tessellation ) optimization framework. We devise a CVT-CMC energy function defined as a combination of an extended CVT energy and a volume functional. We show that minimizing the CVT-CMC energy is asymptotically equivalent to minimizing mesh surface area with a fixed volume, thus defining a discrete CMC surface. The CVT term in the energy function ensures high mesh quality throughout the evolution of a CMC surface in an interactive design process for form finding. Our method is capable of modeling CMC surfaces with fixed or free boundaries and is robust with respect to input mesh quality and topology changes. Experiments show that the new method generates discrete CMC surfaces of improved mesh quality over existing methods.

Robust modeling of constant mean curvature surfaces

We present a new method for modeling discrete constant mean curvature (CMC) surfaces, which arise frequently in nature and are highly demanded in architecture and other engineering applications. Our method is based on a novel use of the CVT (centroidal Voronoi tessellation) optimization framework. We devise a CVT-CMC energy function defined as a combination of an extended CVT energy and a volume functional. We show that minimizing the CVT-CMC energy is asymptotically equivalent to minimizing mesh surface area with a fixed volume, thus defining a discrete CMC surface. The CVT term in the energy function ensures high mesh quality throughout the evolution of a CMC surface in an interactive design process for form finding. Our method is capable of modeling CMC surfaces with fixed or free boundaries and is robust with respect to input mesh quality and topology changes. Experiments show that the new method generates discrete CMC surfaces of improved mesh quality over existing methods.

Sirolimus drug-eluting, hydrogel-impregnated polypropylene mesh reduces intra-abdominal adhesion formation in a mouse model

Prosthetic mesh is used frequently in abdominal wall hernia reconstruction but is prone to postoperative adhesion formation. Complications resulting from intra-abdominal adhesions represent a considerable clinical and cost burden. We, herein, investigate the antiproliferative and antiadhesiogenic properties of sirolimus and hydrogel-impregnated, drug-eluting mesh to decrease such complications in a mouse model of abdominal wall hernia repair. A 1 × 1cm(2) polypropylene mesh from 1 of 3 groups (group 1, plain control; group 2, hydrogel [2% agarose]; and group 3, hydrogel + 10 mcg sirolimus) was implanted operatively into the peritoneal cavity of BALB/c mice and followed for up to 4 weeks. Adhesions were scored by percent surface area of mesh (range, 0-100%), severity (range, 0-3), and tenacity (range, 0-4). Representative samples were assessed by scanning electron microscopy. Mesh impregnated with the combination of hydrogel and sirolimus led to a significant decrease in adhesion formation. The percent surface area of adhesional attachment to mesh was decreased from 100.0 ± 0% in the plain mesh control group versus 18 ± 8% (P < .001) in the combined impregnated mesh group. Similarly, adhesion severity scores were decreased from a score of 2.9 ± 0.1 (plain mesh) versus 1.4 ± 0.1 (sirolimus/hydrogel-impregnated mesh) (P < .001). Scores for tenacity were also decreased markedly from 3.5 ± 0.2 (plain mesh) versus 1.5 ± 0.1 (sirolimus/hydrogel-impregnated mesh (P < .001). Creation of a sirolimus drug-eluting and hydrogel-impregnated polypropylene mesh resulted in marked decrease of adhesion formation in this mouse model, was well tolerated without side effects, and has potential for clinical application.

Prospective evaluation of adhesion characteristics to intraperitoneal mesh and adhesiolysis-related complications during laparoscopic re-exploration after prior ventral hernia repair

The purpose of this study was to characterize the adhesion characteristics of absorbable- and nonabsorbable-barrier-coated meshes and to report adhesiolysis-related complications during laparoscopic re-exploration after prior ventral hernia repair. Under an IRB-approved protocol, patients undergoing laparoscopic re-exploration after prior intraperitoneal mesh placement were prospectively graded intraoperatively for adhesion tenacity (0-4), adhesion surface area (0 = 0%, 10 = 100%), and ratio of adhesiolysis time to mesh surface area (min/cm(2)). Adhesiolysis-related complications were also recorded. Data are given as mean ± SD. Statistical significance (P < 0.05) was determined using the t test and Fisher's exact test. From March 2006 to March 2009, 69 patients underwent laparoscopic surgery after prior intraperitoneal mesh placement for ventral hernia repair. Previous meshes were absorbable-barrier-coated mesh (n = 18), permanent-barrier composite mesh [Composix® (n = 17)], permanent-barrier noncomposite mesh [DualMesh® (n = 14)], uncoated polypropylene mesh (n = 12), and biologic mesh (n = 8). Indications for laparoscopic re-exploration were recurrent ventral hernia (n = 58), chronic pain (n = 3), cholecystectomy (n = 3), parastomal hernia (n = 2), small bowel obstruction (n = 1), nephrectomy (n = 1), and Nissen fundoplication (n = 1). Adhesions to DualMesh were less tenacious (P < 0.05) compared to all other meshes. Surface area of adhesions to DualMesh were less (P < 0.05) than to Composix and to uncoated polypropylene mesh, but not to absorbable-barrier-coated and biologic meshes. Adhesiolysis time:mesh surface area was less (P < 0.05) for DualMesh compared to Composix, uncoated polypropylene, and biologic mesh, but not to absorbable-barrier-coated mesh. Adhesiolysis-related complications occurred in two (16.7%) (P = ns) patients with uncoated polypropylene mesh, one cystotomy and one enterotomy; both were repaired laparoscopically. There were two (16.7%) (P = ns) conversions to an open procedure: one converted patient had Composix (6.7%) and one had absorbable-barrier-coated mesh (5.9%). There were no adhesiolysis-related complications with these meshes. There were no adhesiolysis-related complications or conversions to open in the DualMesh or biologic mesh groups. Adhesion characteristics of mesh placed intraperitoneally and adhesiolysis-related complications during laparoscopic re-exploration after ventral hernia repair are associated with unique properties of the mesh and/or barrier.

Comparable results with 3-year follow-up for large-pore versus small-pore meshes in open incisional hernia repair

Decreasing the amount of polypropylene by increasing pore size produces a lighter weight mesh that may improve tissue ingrowth and, functional properties of the abdominal wall and diminish mesh-related complications. It was the aim of this prospective observational cohort study to analyze the outcome of incisional hernia repair using small-pore versus large-pore meshes and using a standardized, open, retromuscular surgical technique. Across a 6-year period we analyzed 205 patients treated with a heavyweight mesh (group I) and 235 patients treated with a large-pore mesh (group II) for incisional hernias. Patients with a body mass index greater than 40 kg/m(2) and patients with hernias with a transverse diameter of more than 10 cm were not treated by a retromuscular mesh repair and are not included in this analysis. Recurrent incisional hernias also were not included. Both groups had 3 years of follow-up. Patients were evaluated for pain, discomfort, feeling of foreign material, and recurrences. Pre-operative characteristics were comparable between the groups, including body mass index, diabetes, and smoking. The mean total hernia surface was 56 cm(2) for group I versus 48 cm(2) in group II. The mesh surface area was 448 cm(2) for group I and 425 cm(2) for group II. Considering pain scores, there was only a minor difference between the 2 groups at 1-month follow-up, at which time, the Visual Analogue Scale was 5.8 in group I and 4.9 in group II (P = .16). All other scores were comparable between the groups. In group I, 7 recurrences (3.4%) were recorded after 3 years, of which 6 were already apparent 1 year after initial repair. In group II, 9 recurrences (3.8%) were diagnosed, again 6 within the first year after repair. Large-pore meshes can be used safely for open primary incisional hernia repair with an equal outcome compared with small-pore meshes in nonobese patients with defects smaller than 10 cm in width, in regard to both recurrence rates and chronic discomfort.

Does the additional application of a polylactide film (SurgiWrap) to a lightweight mesh (TiMesh) reduce adhesions after laparoscopic intraperitoneal implantation procedures? Experimental results obtained with the laparoscopic porcine model

Intraperitoneal repair of incisional hernias using a mesh makes particular demands on the material used. In addition to good integration of the mesh on the parietal side, adhesions to the visceral peritoneum must be avoided. Large-pore, light-weight meshes induce fewer adhesions than heavy-weight polypropylene meshes. Although numerous adhesion-barrier substances for use in combination with a polypropylene mesh have been tested already, mostly in open small animal models, unequivocal benefits have been identified to date in only a few of the experiments. Using the laparoscopic intraperitoneal onlay mesh technique, six pigs were implanted with either a lightweight polypropylene mesh (TiMesh light) or TiMesh plus an adhesion-barrier film made of polylactide (SurgiWrap). After 3 months, the animals underwent a postmortem laparoscopy, and specimens were obtained for planimetric and histologic investigations. No adhesions to intestinal structures were found in any of the animals. Adhesions between the greater omentum and the mesh did not differ significantly between the TiMesh (32%) and SurgiWrap (33.5%) groups. The shrinkage of the mesh's surface area was comparable between the two groups (18% vs. 21%). Histology showed pronounced inflammatory reaction and bridging of scar tissue between the filaments with the use of SurgiWrap versus TiMesh light without film. However, immunohistochemical investigations examining the partial volume of the inflammatory cells, the proliferation marker Ki67, and the apoptotic index at the interface of the filaments all failed to show any significant differences. To avoid adhesions, it is essential that the acute and chronic inflammatory reaction to the implanted material be as small as possible. This requirement is met specifically by the lightweight polypropylene mesh TiMesh light. The additional application of a slowly absorbable adhesion-barrier film made of polylactide (SurgiWrap) does not appear to confer any further benefit.