Visceral adhesions to hernia prostheses

Purpose To report our experience with abdominal adhesion formation to various synthetic and biologic prosthetic materials in a rat ventral hernia model. Methods A total of 14 prostheses, nine synthetic, four biologic, and one bioresorbable, were evaluated in the rat. Two synthetic prostheses had bioresorbable coatings and one consisted of synthetic and bioresorbable materials woven together. The model involved the removal from the midline of a 2.5 × 2.5-cm segment of full-thickness ventral abdominal wall with the test prosthetic material sewed into the defect, thus, exposing the viscera directly to one surface of the prosthesis. There were four or more rats in each group. Adhesions were assessed at autopsy 7 days after operation or later. The results were expressed as the percentage area of prosthesis surface involved. Results All 14 of the tested prosthetic materials induced adhesions. Vicryl Mesh® and the four biologic varieties had lesser overall adhesion coverage than the bare synthetic prostheses. Sepramesh® developed the least adhesion coverage (15%). The two synthetic materials with bioresorbable coatings had smaller areas involved compared to bare synthetic prostheses. Conclusions All of the tested prostheses attracted adhesions. Biologic prostheses had smaller areas of coverage compared to synthetic prostheses. Barrier surfaces on synthetic meshes were associated with a much lesser extent of adhesion involvement.