Visceral Adhesions after Tension-Free Abdominal Wall Repair with Ultra-Lightweight Synthetic and Titanium-Containing Meshes
Sovremennye tehnologii v medicine
Criteria of reliability and safety of abdominal wall prosthetic repair with the help of ultra-lightweight synthetic and titanium-containing materials are not clearly defined, and the results of their application are insufficiently studied. The aim of the investigation was to study in the experiment the intensity of the abdominal adhesive process after tension-free repair with ultra-lightweight synthetic and titanium-containing meshes. Materials and Methods. Ultra-lightweight synthetic and
... synthetic and titanium-containing meshes were implanted to laboratory animals (n=128). Synthetic meshes (PP Light) were used in group 1, in group 2 titanium-containing meshes (TiMesh) were employed, and in group 3 meshes were from titanium filaments (Titan, Titanium silk). In the first series of the investigation, intraperitoneal onlay mesh (IPOM) technique was used, in the second series sublay retromuscular (SRM) repair was performed. 30 and 60 days later, the zone of implantation was examined with photofixation of the results, viscera-parietal adhesions were evaluated using a modified Vanderbilt assessment scale. Differences were considered statistically significant at p<0.05. Results. The intensity of the adhesive process was significantly higher in the IPOM series (4.0 points) in comparison with the SRM series (0.44 points), p=0.000. The intensity of this phenomenon in the PP Light, TiMesh, and Titan groups amounted on average to 2.73, 3.78, and 5.33 points, respectively. Differences of the results in the TiMesh group from the PP Light group were not statistically significant, p=0.07, however, they were significant with the Titan group, p=0.03. The intensity depended also on the postoperative period duration. In the PP Light group its value on day 30 and 60 was 3.16 and 2.20 points, respectively, p=0.22; in the TiMesh group it was 3.64 and 4.0 points, respectively, p=0.81; in the Titan group it was 6.60 and 4.42, p=0.004. Minimal formation of viscera-parietal adhesions was noted in the SRM series: in the groups PP Light, TiMesh, and Titan it was equal to 0.36, 0.44, and 0.50 points, respectively. In some cases the zone of repair was completely free of adhesions. Adhesive process in the IPOM series should be considered unacceptably intensive in all periods for all tested meshes. In the SRM series, opposite (the best) results have been obtained, which were comparable for all types of meshes used in the work. Safety of retromuscular repair using ultra-lightweight synthetic and titanium-containing meshes has been convincingly proved by the data of the experiment. Conclusion. Retromuscular repair with ultra-lightweight synthetic and titanium-containing meshes should be used for the reconstruction of the abdominal wall. But application of titanium-containing meshes seem to be more preferable, as it is associated with formation of significantly more strong connective tissue in the implantation zone, and an inflammatory reaction induced by such a mesh is substantially less than by a synthetic one.