Implantation Of Polypropylene Mesh Research Articles

Surgical treatment of intercostal hernia with implantation of polypropylene mesh

The intercostal hernia of the lung is a very rare extraordinary disease that requires operation because of the complaints and potential complications. The authors review cases of their operations and analyze the subsequence and treatment. Three patients have been treated for intercostal lung hernia in our treatment. The causes of this disease were a previous thoracotomy in one case and fits of coughing in the other two cases. The diagnosis was set up on the grounds of the specific clinical symptoms, thoracic X-ray and CT scan. The hernia was dissolved with percostal stitches and with the suture of the thoracic musculature in two cases. Plastic operation of the thoracic wall by implanting a polypropylene surgical mesh (Prolen, Ethicon, Johnson & Johnson) was performed in the case of the third patient and later in the first two patients due to recrudescence. In one case the authors were constrained to resect the dystelectasial lung in the hernial sac. The three patients had been operated five times. Relapse of hernia was detected in two patients, in whom the intercostal space had been reconstructed with percostal stitches. We did not detect any relapsing in those two patients at 33 and 66 months after the second operation with mesh implantation. The third patient who got mesh implant immediately did not relapse 12 months after the operation. Intercostal lung hernia is an indication of operation. A plastic operation of the thoracic wall combined with the implantation of a surgical mesh is recommended to close the hernial orifice, which is suitable for treating both primary and relapsed hernias. Recurrence is rare in those patients treated with this method.

Modifications in the production of cytokines and growth factors in drainage fluids following mesh implantation after incisional hernia repair

Background The aim of this study was to evaluate changes in the production of some cytokines (interleukins [ILs]-6, -10, -1, and -1ra), vascular endothelial growth factor, and beta-fibroblast growth factor after polypropylene mesh implantation. Methods Twenty female patients were divided into 2 groups. In 1 group, hernia repair was performed with conventional sutures (CR), whereas in the other group polypropylene mesh (MR) was used. Growth factors and cytokines production was analyzed in wound drain fluids based on the amount produced during 24 hours. Results IL-1 increased substantially in MR patients on postoperative days 1 and 2. IL1-ra and IL-10 production was always significantly higher in CR patients. IL-6 production did not show any considerable difference between the 2 groups. Vascular endothelial growth factor production was significantly higher in the MR than the CR group at all time points, whereas beta-fibroblast growth factor production was higher in the MR than the CR group only on postoperative day 1. Comments Our data suggest that different surgical procedures induce various levels of inflammation and that implantation of prostheses significantly stimulates the inflammatory response.

Is there a risk of infertility after inguinal mesh repair? Experimental studies in the pig and the rabbit

The implantation of a non-absorbable polypropylene mesh during hernia repair causes chronic foreign body reaction involving the surrounding tissue. In case of inguinal hernia repair using mesh techniques, the spermatic cord is potentially affected by this chronic inflammatory tissue remodeling. This effect has been investigated using standardized animal models (pig and rabbit). Fifteen adult male pigs underwent transinguinal preperitoneal implantation of a polypropylene mesh. The contralateral side with a Shouldice repair served as control. After 7, 14, 21, 28, and 35 days, three animals were sacrificed. The spermatic cords were resected and analyzed histologically. In a second experiment Lichtenstein repair using the same polypropylene mesh and Shouldice repair on the contralateral side was done in eight chinchilla rabbits. Three animals served as controls. Three months after operation, the analysis included testicular size, testicular temperature, and testicular and spermatic cord perfusion. We added histological evaluation of the foreign body reaction and the spermatogenesis using the Johnsen score. In the pig, we observed a certain foreign body reaction with diffuse infiltrating inflammatory cells after mesh implantation. Venous thrombosis of the spermatic veins occurred in five of 15 cases. One animal presented focal fibrinoid necrosis of the deferent duct wall. The side of Shouldice repair showed only minor postoperative changes. In the rabbit, we also observed a typical foreign body reaction at the interface between mesh and surrounding tissue, which was not detectable after Shouldice repair. The mesh repair led to a decrease of arterial perfusion, testicular temperature, and the rate of seminiferus tubules with regular spermatogenesis classified as Johnsen 10 (Lichtenstein: 48.1%, Shouldice: 63.8%, controls: 65.8%). Testicular volume increased about 10% after each operation. The implantation of a polypropylene mesh in the inguinal region induces major response of the structures of the spermatic cord. This may have an influence also on spermatogenesis. Due to this a strict indication for implantation of a prosthetic mesh during inguinal hernia repair is recommended.

Extended indications for polypropylene mesh closure of the abdominal wall.

Over a two-year period (1982-1984) polypropylene (Marlex) mesh was used without closing the abdominal wound in 21 patients judged clinically likely to require further abdominal exploration. A total of 43 meshes were implanted. All 21 patients had more than one major laparotomy, median 3 laparotomies (range 2-7) for drainage of pus (76 per cent) and/or intestinal leakage (67 per cent). Definitive abdominal wound closure after removal of polypropylene mesh was either by delayed primary suturing (33 per cent) or consisted of split skin grafting on the granulating wound (24 per cent). Three wounds were left to granulate without skin grafting (14 per cent). Mortality in this group of patients was 29 per cent and no complications resulted directly from implantation of polypropylene mesh. Polypropylene mesh closure of the abdominal wall not only provides simple and rapid access to the abdomen but also allows free drainage and daily inspection for the development of fistulae or the seepage of pus which are indications for further exploration. In that the clinical outcome is relatively favourable in this group of critically ill surgical patients who required multiple laparotomies within a short interval, it is suggested that mesh closure of the abdominal wound is indicated whenever abdominal re-entry is judged probable or rational.

Evaluation of implant/host tissue interactions following intraperitoneal implantation of porcine dermal collagen prosthesis in the rat

An ideal prosthesis for ventral hernia repair should minimize development of postoperative adhesions. This study evaluates adhesion formation following intraperitoneal implantation of acellular porcine dermal collagen (PDC) and polypropylene (PP) mesh in 16 rats. Implant placement alternated left/right. Sacrifice (4 or 12 weeks) was randomized. Methods included adhesion grading (extent, severity, required dissection method) and histological evaluation. At 4 weeks, 7 of 8 PDC specimens and 0 of 8 PP implants were adhesion-free; results were identical at 12 weeks. Four-week adhesions were less developed than 12-week adhesions. Histology showed mononuclear cell foreign body reaction and disorganized collagen deposition for PPs compared to infiltration with neovascular channels and qualitatively less intense foreign body reaction for PDCs. PDC exhibits fewer adhesions and more favorable cellular response than PP in the rat.

Acute inflammatory response after inguinal and incisional hernia repair with implantation of polypropylene mesh of different size

The purpose of this study was to assess the modifications of interleukin (IL)-6, C-reactive protein (CRP), leukocytes and fibrinogen after implantation of polypropylene mesh. Thirty-six patients were included in this study and divided into two groups. To the first group were allocated patients affected by inguinal hernia and undergoing conventional repair (subgroup Ia) or hernioplasty with 40-cm(2) polypropylene mesh (subgroup Ib). To the second group were allocated patients affected by incisional hernia and undergoing conventional repair (subgroup IIa) or incisional hernia repair with 400-cm(2) polypropylene mesh (subgroup IIb). Peripheral venous blood samples were collected 24 h before surgery and then 6, 24, 48 and 168 h postoperatively. We present evidence that serum levels of IL-6, CRP, leukocytes and fibrinogen were significantly increased postoperatively in all subgroups compared with their baseline values. In particular, the production of inflammatory mediators was higher in subgroups Ib vs Ia and IIb vs IIa. Comparing the entities of the inflammatory responses among various groups we found that it was clear that they were similar in subgroups Ib and IIa, and that the highest were in subgroup IIb and the lowest in subgroup Ia. The data show that conventional inguinal and incisional hernia repair induces an inflammatory response, which is smaller than that observed if both operations are carried out with polypropylene meshes. Furthermore, the results suggest that a larger mesh is associated with a higher production of inflammation mediators.

Histological studies of monofilament and multifilament polypropylene mesh implants demonstrate equivalent penetration of macrophages between fibrils

The tissue reaction to implanted monofilamentous and multifilamentous polypropylene mesh was compared in samples removed at operation from the perivaginal area of a 58 year old patient. The fibrils of both were surrounded by collagenous connective tissue, collagen types I and III, and proteoglycans. Smaller, less compacted bundles were seen in the vicinity of the monofilamentous mesh than around the multifilamentous mesh, and in addition, a greater number of inflammatory cells and larger multinucleate giant cells were seen apposed to the monofilamentous mesh. Following this, eight rats were implanted with multifilamentous synthetic polypropylene tape and examined at two, four, six and eight weeks after surgery. Macrophages and multinucleated giant cells were seen in the immediate vicinity of the fibrils, while fibrovascular connective tissue surrounded the implantation site. These observations do not support the prevailing hypotheses that macrophages cannot penetrate between the fibrils of multifilament tape. They do suggest that differences in tensile strength may be present in the artificial neoligaments created by the two tapes.

Textile analysis of heavyweight, midweight, and lightweight polypropylene mesh in a porcine ventral hernia model

Purpose. The purpose of this study was to assess the burst strength and stiffness of lightweight (LW), midweight (MW), and heavyweight (HW) polypropylene mesh preimplantation and 5 months postimplantation in a porcine ventral hernia model. Methods. HW (95 g/cm 2), MW (45 g/cm 2), and LW (28 g/cm 2) polypropylene (PP) were tested as dry samples ( n = 8/mesh) before implantation using a stamp strain machine. The HW and MW PP mesh are constructed exclusively of polypropylene, and the LW PP mesh is woven with absorbable poliglecaprone monofilament. One month after creating four hernia defects in each mini-pig ( n = 6), the PP meshes (8 × 10 cm; n = 8/mesh type) were implanted in the preperitoneal space with 2 cm overlap circumferentially. At 5 months, the mesh was harvested en bloc with the abdominal wall, and testing was repeated. Specimens of the LW mesh were chemically degraded to remove the poliglecaprone and tested for comparison. Significance ( P < 0.05) was determined with a two-way ANOVA, Tukey’s test, or Student’s t-test. TABLE—ABSTRACT 107 Results: HW(a) MW(b) LW(c) LW absorbed P-value Burst strength (N) Pre-implant 1165.1 (b,c) 557.9 (a,c) 812.0 (a,b) 452.2 <0.0001 Post-implant 1111.5 (b,c) 590.88 (a) 575.0 (a) — <0.0001 Stiffness (N/mm) Pre-implant 57.22 (b,c) 52.90 (a,c) 68.57 (a,b) 39.47 <0.0001 Post-implant 62.77 (b,c) 50.16 (a,c) 41.52 (a,b) — 0.0002 Conclusion. A reduction in mean burst strength and stiffness occurs after 5 months implantation of LW PP mesh with an absorbable monofilament. The LW PP mesh has initial increased burst strength during the critical time period of tissue-mesh incorporation. Following tissue incorporation, the LW PP mesh maintains mean burst strength comparable to MW PP mesh, while becoming less stiff than HW and MW PP meshes. This may contribute to more physiologic abdominal wall compliance after lightweight PP mesh implantation long term.

The long-term effect of mesh bioprosthesis in inguinal hernia repair on testicular nitric oxide metabolism and apoptosis in rat testis.

Polypropylene mesh is the most widely used material in inguinal hernia repair. Although polypropylene mesh is known as an inert material, it is experimentally proven that mesh generates a chronic inflammatory tissue reaction. The aim of the present study was to investigate the long-term effects of polypropylene mesh material used in inguinal hernia operations on testicular function, testicular nitric oxide (NO) metabolism and germ cell-specific apoptosis in rats. The study comprised 40 male rats that were randomly allocated into two groups. In group 1, the left spermatic cord was elevated and a 0.5 x 1 cm polypropylene mesh was placed behind the left inguinal spermatic cord and group 2 consisted of the sham-operated controls. Blood samples were taken at 6 months preoperatively and postoperatively after to assess luteinizing hormone (LH) and follicle stimulating hormone (FSH) levels for hormonal evaluation. Testicular NO was evaluated by the Griess method, apoptosis by a TUNEL method and inducible nitric oxide synthase (iNOS) and endothelial NOS (eNOS) expressions by immunohistochemical staining. Mild (+) eNOS expression was observed in all specimens. Mild (+) iNOS expression was only detected in ipsilateral testis of the mesh-implanted study group. Apoptotic cells were not detected in any samples. We are of the opinion that long-term polypropylene mesh implantation has no effect on testicular hormonal function and only a limited effect on nitric oxide levels and this effect is not sufficient to cause apoptosis in testis that could lead to infertility. It seems that mesh implantation is a reliable method in inguinal hernia repair; however, further work is required by more sensitive methods to fully elucidate the potential testicular damage.

Comparison of Adhesion Formation to Intra-Abdominal Mesh after Laparoscopic Adhesiolysis in the New Zealand White Rabbit

The purpose of this study was to investigate the effects of early adhesiolysis on long-term adhesion formation after the intraperitoneal implantation of polypropylene (PP) mesh and expanded polytetrafluoroethylene (ePTFE) mesh in a rabbit model. Through a small midline laparotomy a 2 x 2-cm piece of mesh (n = 80) was sewn to an intact peritoneum on each side of a midline incision in 40 New Zealand White rabbits. Two types of ePTFE mesh [Dual Mesh (Dual) and modified Dual Mesh (C-Type), W.L. Gore and Associates, Flagstaff, AZ] and PP mesh (Marlex, C.R. Bard, Murray Hill, NJ) were compared. In 10 rabbits (n = 20) a laparoscopic adhesiolysis (LapA) was performed at one week. Mesh adhesions were scored using a modified Diamond scale (0, 0%; 1, 1-25%; 2, 26-50%; and 3, > 50%) at 1, 3, 9, and 16 weeks by serial microlaparoscopic (2 mm) examinations. After recording the final adhesion score at 16 weeks the prosthetic biomaterials were excised en bloc with the anterior abdominal wall for histologic evaluation of mesothelial layer growth (%) on the visceral surface of the mesh. Statistical differences (P value < 0.05) were measured by chi-square and Wilcoxon signed rank tests. There were no statistical differences in mean adhesion scores at adhesiolysis at 7 days. The mean adhesion scores in the groups undergoing laparoscopic adhesiolysis was statistically less (P < 0.05) for PP and both ePTFE meshes at 3-, 9-, and 16-week intervals compared with those not undergoing adhesiolysis. The percentage of mesothelialization on the visceral surface of the mesh was not statistically different between the adhesiolysis and control groups for any of the prosthetic biomaterials. Laparoscopic adhesiolysis at one week minimizes subsequent adhesion formation to PP and ePTFE mesh over a 4-month follow-up. Adhesion formation within the first 7 days after mesh implantation appears to determine the long-term adhesion score. Eliminating adhesions to mesh by mechanical or other means during this critical time may control adhesions to the mesh and subsequent mesh-related complications.

In vivo study of meshes implanted over the inguinal ring and external iliac vessels in uncastrated pigs.

The effects of placing a prosthesis directly on the internal inguinal ring and external iliac vessels in inguinal hernia repair are unknown. We compared tissue responses to five prostheses implanted in this position in uncastrated male pigs. Three types of polypropylene and two types of expanded polytetrafluoroethylene (ePTFE) mesh were implanted in 20 pigs (n = 8 for each prosthesis type). Specimens of the implants and surrounding tissue were obtained 30 and 90 days after implantation and assessed histologically. The polypropylene implants had more adhesions, more surface area covered by adhesions, and more tenacious adhesions than did the ePTFE implants. Perivascular cuffing was observed in eight polypropylene and one ePTFE specimen; ossification, necrosis, and testicular venous congestion were seen in polypropylene specimens. Abnormal healing processes after implantation of polypropylene mesh may increase complications of the transabdominal preperitoneal and total extraperitoneal approaches in laparoscopic inguinal hernia repair, whereas the minimal response to ePTFE meshes may make them safer for use in the preperitoneal space.

A modified technique for implantation of polypropylene mesh for the repair of external abdominal hernias in horses: A review of 21 cases

Summary During a 3-year period 21 horses were surgically treated because of large abdominal wall defects. In each case the defect was bridged with a polypropylene mesh, which was placed on the outside of the hernial ring. This was in contrast with the technique for mesh herniorrhaphy generally described in human and veterinary literature, in which the mesh is always implanted on the inside of the hernial ring. One horse was destroyed on the first postoperative day because of postanaesthetic myelomalacia. Surgical repair as described was successful in 18 patients. Recurrence of herniation occurred in two horses. On re-herniorrhaphy a second and larger mesh was successfully implanted.

Herniorrhaphy wound infec'i'ions associated with polypropylene mesh implants

Herniorrhaphy wound infec'i'ions associated with polypropylene mesh implants