Background: Despite numerous experimental studies, conducted most often with the open small-animal model, the ideal structure for a mesh with maximum biocompatibility in the intraabdominal region has yet to be found. To date, few experimental models have been concerned with the laparoscopic intraabdominal implantation of meshes. Numerous experimental and clinical studies appear to have identified expanded polytetrafluoroethylene (ePTFE), in the form of DualMesh, as the gold standard. Since publications have reported fistula formation and marked adhesions to be associated with the use of polypropylene meshes, only few studies have investigated meshes made of this material. It is known, however, that a reduction in the amount of material and an increase in pore size results in better mesh biocompatibility.
Methods: Six pigs each underwent laparoscopic intraabdominal placement of either a TiMesh or a DualMesh, both of which were prepared for implantation in standardized fashion. After 87 +/- 2 days, the pigs were killed, and postmortem laparoscopy was performed, followed by the removal of the tissue embedding the mesh for assessment of adhesions and shrinkage, and for histologic workup. The specimens were processed both histologically and immunohistochemically.
Results: In all but one case, the greater omentum adhered, usually over discrete areas, to the mesh. In every case the omentum was separable from the mesh surface only by sharp dissection. With the titanium-coated polypropylene meshes, the average total adhesion area was only 0.085, as compared with 0.25 for the GoreTex meshes (p = 0.055). The GoreTex meshes showed an average shrinkage to almost half of the original surface area (median, 0.435). The average shrinkage of the TiMesh, was to 0.18 of the original area (p = 0.006), which thus was significantly smaller. Determination of the partial volume of the inflammatory cells showed significantly lower median figures for the TiMesh (p = 0.009). Measurements of the proliferation marker Ki67 showed significantly higher values for ePTFE than for TiMesh (p = 0.011). The apoptosis index was significantly higher for the ePTFE membranes (p = 0.002).
Conclusions: Titanium-coated polypropylene mesh (TiMesh) is clearly superior to the DualMesh in terms of biocompatibility, and is thus suitable for the laparoscopic intraperitoneal repair of abdominal wall and incisional hernias.