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The Role of Bioadhesive Mesh in the Prevention of Incisional Hernia Formation
Paul N. Afrooz, MD
Latha Satish, PhD
Sandeep Kathju, MD, PhD
University of Pittsburgh
2014-03-01
Presenter: Paul N. Afrooz, MD
Affidavit:
This represents 100% of the resident's work.
Director Name: Joseph E. Losee, MD
Author Category: Resident Plastic Surgery
Presentation Category: Basic Science Research
Abstract Category: General Reconstruction
Studies demonstrate that 10-11% of abdominal wall closures lead to incisional hernia formation. The goal of this study is to develop an adhesive-coated, load-sharing mesh to reinforce suture closure of laparotomies to prevent hernia formation.
23 Sprague Dawley rats underwent ventral laparotomy. A 5cm full thickness laparotomy incision was made. Fascia was closed with 2 interrupted 5-0 fast-absorbing catgut sutures.
Group 1 (n=7): fascial closure only.
Group 2 (n=6): following fascial closure, a 6 x 2cm vicryl mesh was centered over the laparotomy incision. The corners of the mesh were sewed to the anterior rectus fascia on one side only.
Group 3 (n=10): following fascial closure, a 6 x 3cm adhesive-coated mesh was centered over the incision.
At day 28 abdominal walls were harvested en bloc, and samples were evaluated for hernia. Cross sections of the incisional hernia underwent routine H&E staining.
Defect sizes at postoperative day 28:
Length (cm) Width (cm) Surface Area (cm2)
Group 1 1.83 + .21 1.36 + .11 2.49 + .40
Group 2 1.85 + .19 1.15 + .08 2.14 + .32
Group 3 0.97 + .88 0.34 + .30 0.53 + 0.58
Group 3 demonstrated a 79% reduction in hernia surface area in comparison to Group 1, and a 75% reduction in comparison to Group 2.
Incisional hernia is common following laparotomy, and several load-sharing adjuncts have been utilized in attempts to reduce the incidence. In this model an adhesive-coated onlay mesh served as a technically simple, load-sharing adjunct to reduce hernia defect size considerably in comparison to control groups. These positive results offer encouraging therapeutic potential to reduce the incidence of incisional hernia formation with technical ease.
