Which mesh should be used to repair abdominal wall defect in peritonitis? An experimental study





Abdominal wall, Polypropylenes, Polytetrafluoroethylene, Rats, Seprafilm


Background: In this study, following the Bogota bag closure of abdominal wall defects created in a rat peritonitis model, the short-term efficacy of polypropylene (PP) mesh (Prolene®, Ethicon), PP Mesh+Seprafilm®, polytetrafluoroethylene (PTFE) mesh [Infinit® Mesh (Gore)] and expanded PTFE (ePTFE) [Dualmesh®plus(Gore)] in the permanent repair of the defects was investigated.

Methods: 64 rats were used. The rats were randomized into four groups, each consisting of 16 subjects: PP mesh (Group 1), PP mesh+Seprafilm (Group 2), PTFE mesh (Group 3), and ePTFE mesh (Group 4). Laparotomy was performed and abdominal wall defects were created. Contamination of the peritoneal cavity was induced, and closure was undertaken using a Bogota bag. After three days, the Bogota bag was removed, and materials were placed. At the end of the follow-up period, the rats were sacrificed. Mortality, grade of adhesion, surgical site infection (SSI), and tensile strength were evaluated.

Results: Mortality was calculated as 6.3%, 50%, 25%, and 0% for Groups 1, 2, 3, and 4, respectively (p=0.002). Adhesion was observed at a rate of 61.1% in Group 1 and 38.9% in Group 2 (p=0.621). There was no adhesion in Groups 3 and 4 (p=0.001). The rate of SSI was 68.8% in Group 1, %75% in Group 2, and 100% in Groups 3 and 4 (p=0.022). Tensile strength was 2196±193.6 g/cm in Group 1 and 1906±142.1 g/cm in Group 2 (p=0.258).

Conclusions: We argue that PP mesh is a suitable prosthesis for the permanent repair of contaminated abdominal wall defects despite the increased adhesion risk.


Buck JR, Fath JJ, Chung SK, Sorensen VJ, Horst HM, Obeid FN. Use of absorbable mesh as an aid in abdominal wall closure in the emergent setting. Am Surg. 1995;61(8):655-7.

Greene MA, Mullins RJ, Malangoni MA, Feliciano PD, Richardson JD, Polk JH. Laparotomy wound closure with absorbable polyglycolic acid mesh. Surg Gynecol Obstetr. 1993;176(3):213-8.

Stone HH, Fabian TC, Turkleson ML, Jurkiewicz MJ. Management of acute full-thickness losses of the abdominal wall. Ann Surg. 1981;193(5):612.

Fabian TC, Croce MA, Pritchard FE, Minard G, Hickerson WL, Howell RL, et al. Planned ventral hernia. Staged management for acute abdominal wall defects. Ann Surg. 1994;219(6):643.

Fernandez L, Norwood S, Roettger R, Wilkins HE. Temporary intravenous bag silo closure in severe abdominal trauma. J Trauma Acute Care Surg. 1996;40(2):258-60.

Cohn SM, Burns GA, Sawyer MD, Tolomeo C, Milner KA, Spector S. Esmarch closure of laparotomy incisions in unstable trauma patients. J Trauma Acute Care Surg. 1995;39(5):978-9.

Yeh KA, Saltz R, Howdieshell TR. Abdominal wall reconstruction after temporary abdominal wall closure in trauma patients. South Medi J. 1996;89(5):497-502.

Mastboom WJ, Kuypers HH, Schoots FJ, Wobbes T. Small-bowel perforation complicating the open treatment of generalized peritonitis. Arch Surg. 1989;124(6):689-92.

Lamb JP, Vitale T, Kaminski DL. Comparative evaluation of synthetic meshes used for abdominal wall replacement. Surgery. 1983;93(5):643-8.

Voyles CR, Richardson JD, Bland KI, Tobin GR, Flint LM, Polk Jr HC. Emergency abdominal wall reconstruction with polypropylene mesh: short-term benefits versus long-term complications. Ann Surg. 1981;194(2):219.

Law NW, Ellis H. Adhesion formation and peritoneal healing on prosthetic materials. Clini Material. 1988;3(2):95-101.

Nagy KK, Fildes JJ, Mahr C, Roberts RR, Krosner SM, Joseph KT, Barrett J. Experience with three prosthetic materials in temporary abdominal wall closure. Am Surg. 1996;62(5):331-5.

Bauer JJ, Salky BA, Gelernt IM, Kreel I. Repair of large abdominal wall defects with expanded polytetrafluoroethylene (PTFE). Ann Surg. 1987;206(6):765.

Köckerling F, Alam NN, Antoniou SA, Daniels IR, Famiglietti F, Fortelny RH, et al. What is the evidence for the use of biologic or biosynthetic meshes in abdominal wall reconstruction? Hernia. 2018;22(2):249-69.

Ibrahim AM, Vargas CR, Colakoglu S, Nguyen JT, Lin SJ, Lee BT. Properties of meshes used in hernia repair: a comprehensive review of synthetic and biologic meshes. J Reconstr Microsurg. 2015;31(02):083-94.

Cobb WS. A current review of synthetic meshes in abdominal wall reconstruction. Plastic Reconstru Surg. 2018;142(3S):64S-71S.

Van der Lei B, Bleichrodt RP, Simmermacher RK, Van Schilfgaarde R. Expanded polytetra-fluoroethylene patch for the repair of large abdominal wall defects. Br J Surg. 1989;76(8):803-5.

Boyd WC. Use of Marlex mesh in acute loss of the abdominal wall due to infection. Surg Gynecol Obstetr. 1977;144(2):251-2.

Brown GL, Richardson JD, Malangoni MA, Tobin GR, Ackerman D, Polk Jr H. Comparison of prosthetic materials for abdominal wall reconstruction in the presence of contamination and infection. Ann Surg. 1985;201:705

Alimoglu O, Akcakaya A, Sahin M, Unlu Y, Ozkan OV, Sanli E, et al. Prevention of adhesion formations following repair of abdominal wall defects with prosthetic materials (an experimental study). Hepato-gastroenterol. 2003;50(51):725-8.

Beck DE. The role of Seprafilm bioresorbable membrane in adhesion prevention. Eur J Sur. 1997(577):49-55.

Nohuz E, Alaboud M, Darcha C, Alloui A, Aublet-Cuvelier B, Jacquetin B. Effectiveness of hyalobarrier and seprafilm to prevent polypropylene mesh shrinkage: A macroscopic and histological experimental study. Int Urogynecol J. 2014;25:1081-1087

Dinsmore RC, Calton Jr WC. Prevention of adhesions to polypropylene mesh in a rabbit model. Am Surg. 1999;65(4):383.

Vrijland WW, Tseng LN, Eijkman HJ, Hop WC, Jakimowicz JJ, Leguit P, et al. Fewer intraperitoneal adhesions with use of hyaluronic acid-carboxymethylcellulose membrane: a randomized clinical trial. Ann surg. 2002;235(2):193.

Bleichrodt RP, Simmermacher RK, Schakenraad JM. Expanded polytetrafluoroethylene patch versus polypropylene mesh for the repair of contaminated defects of the abdominal wall. Surg gynecol Obstetr. 1993;176(1):18-24.

Müller-Stich BP, Senft JD, Lasitschka F, Shevchenko M, Billeter AT, Bruckner T, et al. Polypropylene, polyester or polytetrafluoroethylene-is there an ideal material for mesh augmentation at the esophageal hiatus? Results from an experimental study in a porcine model. Hernia. 2014;18(6):873-81.

Akcakaya A, Aydogdu I, Citgez B. Investigation into the optimal prosthetic material for wound healing of abdominal wall defects. Exp Ther Medi. 2018;15(2):1622-5.

Kayaoglu HA, Ozkan N, Hazinedaroglu SM, Ersoy OF, Erkek AB, Koseoglu RD. Comparison of adhesive properties of five different prosthetic materials used in hernioplasty. J Investig Surg. 2005;18(2):89-95.

Cevasco M, Itani KM. Ventral hernia repair with synthetic, composite, and biologic mesh: characteristics, indications, and infection profile. Surgic Infect. 2012;13(4):209-15.






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