Comparison of adhesion prevention efficacy of coated Parietex® and Proceed® meshes versus uncoated polypropylene mesh combined with anti-adhesion device 4DryField® PH in a new IPOM rat model with impaired intestinal peritoneum

Introduction: Intestinal adhesions to IPOM meshes are a problem following hernia surgery. In areas where the hernia sac content has been dissolved from the hernia wall, an intact peritoneal coverage is missing and is a location at risk for intestine to IPOM adhesions. Using a new IPOM rat model the role of missing intact peritoneal coverage in the development of intestine to mesh adhesions was investigated. The adhesion prevention capability of the two coated meshes Proceed® (PC) and Parietex® (PT) was compared to uncoated Ultrapro® combined with the adhesion prevention barrier 4DryField® PH (4DF). Furthermore, the quality of integration of meshes into the abdominal wall was evaluated.

Material and methods: 58 rats were divided into 6 groups. Cecal abrasion (CA) was conducted in all rats but for the 'CT no CA' group (control without CA). On the opposite side of CA a mesh was implanted in the abdominal wall. In rats of the PC and PT groups either a Proceed® (PC) or a Parietex® (PT) mesh was used. In control animals (CT), in the ‚CT no CA‘-group, in 4DF premixed gel- and 4DF in-situ gel-animals an Ultrapro® mesh was implanted. 4DF treated animals received a treatment of the abraded cecum and the mesh surface. After 1 week quality of mesh ingrowth into the abdominal wall was ranked and the amount of intestine to mesh adhesions was evaluated.

Results: De-peritonealisation of the cecum caused a significant increase of adhesion scores compared to controls without abrasion (p = 0.0002). The use of PC or PT meshes had no significant influence on the development of intestine to mesh adhesions (PC: p = 0.078, PT: p = 0.069). Treatment with 4DF reduced the development of intestine to mesh adhesions significantly (p =< 0.0001). None of the treatment groups showed an impaired quality of mesh ingrowth into the abdominal wall.

Conclusion: Impairment of visceral peritoneum is a critical factor in the development of adhesions to IPOM meshes. PT and PC meshes did not significantly reduce intestine to mesh adhesions. In contrast, the use of the anti-adhesion barrier 4DF reduced intestine to mesh adhesions significantly. Thus treatment with the adhesion prevention barrier 4DF might be considered an effective strategy for the reduction of intestine to mesh adhesions.