Peritoneal Adhesions to Prosthetic Materials: An Experimental Comparative Study of Treated and Untreated Polypropylene Meshes Placed in the Abdominal Cavity

Background: Frequently, hernia repair requires polypropylene (PP) meshes, which carry a well-known adhesiogenic risk when placed in contact to the intestine. The aim of this experimental study in a rat model was to assess the role of some materials, when combined with PP, in preventing the adhesions' formation. Materials and Methods: Sixty male Sprague-Dawley rats were assigned to five groups for intraperitoneal mesh placement: untreated PP, PP+polyurethane (PP+PU), PP+Surgisis (PP+SIS), PP+expanded polytetrafluoroethylene (PP+ePTFE), and a control group without mesh. Twenty-one days and 3 and 6 months after the operation, an assessment of adhesion formation was performed, scoring adhesions in terms of extent and type and the adhesion index (AI; product of adhesions' extent and type). Results: No significant difference was seen between PP+SIS, PP+PU, and control groups in adhesions extent/quality and in AI. The PP+SIS group had significantly lower adhesions' quality value and AI than PP+ePTFE. PP+PU had significantly lower adhesions' extent/quality value and AI than PP+ePTFE. The control group had adhesions with significantly lower extent/quality and AI than PP+ePTFE. The PP group had significantly more and denser adhesions, compared to PP+ePTFE, as well as a significantly higher AI. Conclusions: Adhesions' incidence is reduced by using treated PP meshes. PP+PU and PP+SIS were superior to PP+ePTFE in adhesion prevention.