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01-02-2010 | Original Article

Impact of mesh positioning on foreign body reaction and collagenous ingrowth in a rabbit model of open incisional hernia repair

Authors: M. Binnebösel, C. D. Klink, J. Otto, J. Conze, P. L. Jansen, M. Anurov, V. Schumpelick, K. Junge

Published in: Hernia | Issue 1/2010

Abstract

Background

Incisional hernia remains as one of the most common surgical complications. Different mesh techniques are used in 75–80% of hernia repair. The aim of this study was to evaluate the dependence of mesh positioning and the type of mesh implanted on foreign body reaction and collagenous ingrowth.

Materials and methods

In 24 male Chinchilla rabbits, an incisional hernia repair was performed with mesh reinforcement either by sublay (n = 12) or by onlay technique (n = 12). In each group, two different types of mesh prosthesis were investigated: polypropylene (PP, Prolene^®) and polypropylene-polyglecaprone 25 composite (PP-PG, UltraPro^®). On postoperative day 60, the inflammatory and connective tissue formation was characterised by measuring the diameter of inner cellular infiltrate and outer fibrous capsule of the foreign body granuloma, and by verifying the collagen type I/III ratio. Furthermore, the expression of matrix metalloproteinase-2 (MMP-2) was analysed.

Results

Microscopic investigation of the mesh/host-tissue interface showed typical formation of foreign body granuloma. The diameters of the inner part of the foreign body granuloma representing the amount of inflammatory cell infiltrate were significantly increased in the PP mesh compared to the PP-PG mesh, both in the sublay group (PP 13.1 ± 1.21 μm vs. PP-PG 11.7 ± 0.34 μm; P = 0.026) and in the onlay group (PP 13.1 ± 1.24 μm vs. PP-PG 11.2 ± 0.55 μm; P = 0.009). The diameter of the fibrous capsule as the outer ring of the granuloma was significantly increased when investigating the PP mesh in sublay position (29.5 ± 1.12 μm) compared to the PP mesh in onlay position (27.9 ± 0.73 μm) (P = 0.026). Investigating the quality of perifilamentary collagen deposition expressed as collagen type I/III ratio, the sublay group showed significantly elevated values compared to the onlay group (PP sublay 3.1 ± 0.18 vs. PP onlay 2.4 ± 0.41; P = 0.004) (PP-PG sublay 3.5 ± 0.34 vs. PP-PG onlay 2.6 ± 0.13; P = 0.002). The analysis of MMP-2 expression revealed no significant differences.

Conclusion

The beneficial results of mesh reinforcement in the sublay technique might be due to a superior quality of postoperative connective tissue formation. Mesh incorporation, irrespective of positioning, is favourable in low-weight, large, porous mesh material represented by a reduced inflammatory part of the foreign body granuloma.

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Title: Impact of mesh positioning on foreign body reaction and collagenous ingrowth in a rabbit model of open incisional hernia repair
Authors: M. Binnebösel
C. D. Klink
J. Otto
J. Conze
P. L. Jansen
M. Anurov
V. Schumpelick
K. Junge
Publication date: 01-02-2010
Publisher: Springer-Verlag
Published in: Hernia / Issue 1/2010
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI: https://doi.org/10.1007/s10029-009-0580-4

At a glance: The STEP trials

Springer Medicine

Impact of mesh positioning on foreign body reaction and collagenous ingrowth in a rabbit model of open incisional hernia repair

Abstract

Background

Materials and methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Materials and methods

Results

Conclusion

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