Intraabdominal adhesion formation of polypropylene mesh. Influence of coverage of omentum and polyglactin

Surg Endosc. 2005 Jun;19(6):798-803. doi: 10.1007/s00464-004-2192-5. Epub 2005 May 3.


Background: Adhesions after intraabdominal surgical procedures are related to high morbidity and mortality. Biomaterials, particularly those made of polypropylene, in the intraabdominal position have to be considered as pathophysiological cofactor in a multifactorial process of adhesion formation. To investigate the adhesive potential induced by the biomaterial, an animal model was performed. In addition, the influence of coverage by omentum or a polyglactin barrier was investigated.

Methods: In, 18 Chinchilla rabbits the biomaterial was placed laparoscopically using the intraperitoneal onlay mesh technique. Using this model, a polypropylene-polyglactin mesh compound (PPMC) was used with three different implantation techniques: group 1, PPMC implantation without coverage (PPMC): group 2, PPMC implantation with additional omentum coverage (PPMC-O): and group 3, PPMC implantation with coverage of an absorbable polyglactin mesh (PPMC-V). The degree of adhesion formation was measured 90 days after implantation by computer-assisted planimetry. Morphometric examination followed the explantation analyzing the amount of foreign body response.

Results: We found a significant reduction of adhesion formation for the PPMC and PPMC-O groups compared to the PPMC-V group, in which dense adhesions were found. Morphometric investigations of the perifilamental granulomas of the pure (PPMC) group revealed a typical foreign body reaction with a mild to moderate fibrosis around all mesh fibers. However, tissue specimens of the PPMC-O and PPMC-V groups indicated a similar inflammatory reaction but significantly increased connective tissue formation around the polymer fibers compared to the pure PPMC group.

Conclusion: The intraabdominal placement of a pure PPMC shows a neoperitonealization and perifilamental collagenous ingrowth with almost no adhesions. Coverage with omentum (PPMC-O) or polyglactin mesh (PPMC-V) resulted in a significant increase in inflammation and perifilamentary connective tissue formation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Female
  • Omentum
  • Polyglactin 910 / adverse effects
  • Polypropylenes / adverse effects*
  • Postoperative Complications / etiology*
  • Rabbits
  • Surgical Mesh / adverse effects*
  • Surgical Procedures, Operative / methods
  • Tissue Adhesions / etiology*


  • Polypropylenes
  • Polyglactin 910