Tissue ingrowth and bowel adhesion formation in an animal comparative study: polypropylene versus Proceed versus Parietex Composite

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Abstract
The optimal prosthesis for laparoscopic ventral hernia repair would combine excellent parietal surface tissue ingrowth with minimal visceral surface adhesiveness. Currently, few data are available from randomized trials comparing the commercially available prostheses. In a pig model designed to incite adhesions, three 10 × 15-cm pieces of mesh (Proceed, Parietex Composite [PCO], and polypropylene [PPM]) were randomly positioned intraperitoneally in each of 10 animals using sutures and tack fixation. After a 28-day survival, the amount of shrinkage, the area and peel strength of visceral adhesions, the peak peel strength, the work required to separate mesh from the abdominal wall, and a coefficient representing the adhesiveness of tissue ingrowth were averaged for each type of mesh and then compared with the averages for the other prostheses. The histologic appearance of each prosthesis was documented. Proceed had more shrinkage (99.6 cm2) than PCO (105.8 cm2) or PPM (112 cm2), although the difference was not statistically significant. The mean area of adhesions to PCO (11%) was significantly less than for Proceed (48%; p < 0.008) or PPM (46%; p < 0.008). Adhesion peel strength was significantly less for PCO (5.9 N) than for Proceed (12.1 N; p < 0.02) or PPM (12.9 N; p < 0.02). According to a filmy-to-dense scale of 1 to 5, adhesions were more filmy with PCO (1.7) than with PPM (2.9) or Proceed (3.7) (p < 0.007). Peak peel strength from the abdominal wall was significantly higher for PCO (17.2 N) than for Proceed (10.7 N) or PPM (10 N; p < 0.002). The histology of each prosthesis showed a neoperitoneum only with PCO. With less shrinkage, fewer and less dense adhesions to the viscera, and significantly stronger abdominal wall adherence and tissue ingrowth at 28 days in this animal study, PCO was superior to both Proceed and PPM in all categories. Furthermore, PCO demonstrated all the favorable qualities needed in an optimal prosthesis for laparoscopic ventral hernia repair, including the rapid development of a neoperitoneum.

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