Degradation of mesh coatings and intraperitoneal adhesion formation in an experimental model

Background: In laparoscopic ventral hernia repair a mesh is placed in direct contact with the viscera, often leading to substantial adhesions. In this experimental study the ability of different coated and uncoated meshes to attenuate adhesion formation was examined. Methods: Six commercially available meshes were placed intraperitoneally against a closed peritoneum in rats: Prolene (R) (polypropylene), Timesh (R) and Ultrapro (R) (polypropylene composites with titanium and polyglecaprone respectively), Proceed (R) and Parietex Composite (R) (polypropylene and polyester meshes coated with a layer of cellulose and collagen respectively) and C-Qur (R) (polypropylene mesh coated with a layer of omega-3 fatty acids). Adhesions and incorporation were evaluated macroscopically and microscopically after 7 and 30 days. Results: Parietex Composite (R) and C-Qur (R) significantly reduced adhesion formation at 7 days' follow-up compared with all other meshes. By 30 days, this effect had diminished as a significant increase in adhesions together with phagocytosis of the coating was seen for all meshes with layered coatings (Proceed (R), Parietex Composite (R) and C-Qur (R)). Incorporation was insufficient for all meshes. Conclusion: The absorbable layers of Parietex Composite (R) and C-Qur (R) reduce adhesion formation to intraperitoneal mesh in the short term, but the effect diminishes and phagocytosis of absorbable coatings may contribute to adhesion formation.