Strength Properties of Abdominal Wall in Intraperitoneal and Retromuscular Repair Using Lightweight and Ultra-Lightweight Synthetic and Titanium-Containing Endoprostheses (Experimental Study)

The application of ultra-lightweight materials for abdominal wall hernia repair has not been controlled so far, and the capabilities of synthetic and titanium-containing endoprostheses, as well as the peculiarities and possible differences in connective tissue development in an implantation area are not adequately investigated.

The aim of the investigation was to study in experiment strength properties of connective tissue formation in the area of synthetic and titanium-containing endoprostheses implanted during abdominal wall prosthetic repair.

Materials and Methods. Abdominal wall prosthetic repair was simulated in rabbits. The first series animals underwent retromuscular (sublay retromuscular, SRM) implantation, the second series — intraperitoneal (intraperitoneal onlay mesh, IPOM). We used the model including implantation of two meshes situated in close proximity to each other. Group 1 animals were implanted synthetic lightweight polypropylene meshes (90 µm fiber), group 2 — ultra-lightweight titanium-containing meshes (made of lightweight polypropylene titanium-coated, 65 µm fiber), group 3 were implanted titanium (65 µm fiber) endoprostheses. 30 and 60 days later the animals were sacrificed, their abdominal wall strength being studied in the contact area of meshes. Intact abdominal wall areas were control.

Results. Connective tissue strength in group 2 was higher (13.12 H/cm) compared to group 1 (9.2 H/cm) in both series, p=0.001. In group 3 the parameter under study was maximal (15.89 H/cm), which differed significantly from that in group 1 (p=0.0000) and 2 (p=0.002). The comparison showed connective tissue strength after SRM to be higher (13.32 H/cm) than after IPOM (12.88 H/cm); p=0.976. The parameter was significantly higher on day 60 of the experiment (13.9 H/cm) compared to that on day 30 (12.4 H/cm); p=0.008. On day 30 the abdominal wall strength along the implantation perimeter was significantly lower (12.4 H/cm) compared to inrtact areas (14.84 H/cm); p=0.0004. No significant differences in strength between the areas under study and intact areas (13.9 H/cm) were found by the 60^th postoperative day; p=0.08.

Conclusion. The application of lightweight and ultra-lightweight synthetic and titanium-containing endoprostheses for abdominal wall repair is accompanied by the formation of connective tissue of adequate strength. The abdominal wall along the implantation perimeter has satisfactory parameters of tensile strength comparable with intact abdominal wall strength, and by day 60 after surgery the parameters are no different from an intact wall. Lightweight and ultra-lightweight meshes are safe to use in clinical settings in case of adequate abdominal wall reconstruction. Strength characteristic in experiment was determined for surgically operated (newly formed) abdominal wall, not only for mesh or connective tissue capsule. It is of great importance for hernia prognosis and recurrence prevention.

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Parshikov V.V., Kazantsev A.A., Mironov A.A., Zavaruev V.А., Chernikov А.N., Belayev О.F., Alyokhin A.I. Strength Properties of Abdominal Wall in Intraperitoneal and Retromuscular Repair Using Lightweight and Ultra-Lightweight Synthetic and Titanium-Containing Endoprostheses (Experimental Study). Sovremennye tehnologii v medicine 2016; 8(3): 27, https://doi.org/10.17691/stm2016.8.3.03