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The aims of this study were dual. First, to evaluate the feasibility of a sheep model as an animal model for vaginal surgery with meshes. Second, to compare host response to two low-weight polypropylene (PP) meshes, a noncoated (Soft Prolene, Gynecare, Ethicon) and a coated mesh with an absorbable hydrophilic film (Ugytex, Sofradim). Thirty-six 20 x 20 mm polypropylene meshes (18 coated and 18 noncoated) were surgically implanted by the vaginal route in 12 adult ewes. Meshes were implanted in the anterior (n=12) and the posterior vaginal compartments (n=24). Animals were killed 1 (n=6) and 12 (n=6) weeks after surgery. Postimplantation evaluation included macroscopical examination, histological and immunohistochemical analysis and histomorphometrical measures of the distance between the meshes and the vaginal epithelium. The experimental procedure was feasible in all cases. Vaginal erosions were observed twice as frequently with the noncoated-PP meshes (6/18, 33.3%) as with the coated-PP meshes (3/18, 16.7%), even if that difference was not significant (p=0.4). However, no differences were observed between the two meshes in terms of shrinkage, tissue ingrowth, inflammatory response, and position of the mesh in the vaginal wall. The mechanism involved in the reduction of vaginal erosion could be due to the lesser adhesion of the coated mesh on the vaginal wound during the early postoperative period.

Summary: The repair of inguinal or incisional hernias may occasionally require the placement of an intraabdominal mesh to reinforce parietal wall defects or weaknesses. An original composite mesh, consisting of a conventional polyester mesh combined with a coated hydrophilic and absorbable membrane designed to prevent intraperitoneal adhesions was evaluated. The efficacy of the product was tested through three experiments. The first carefully examined the absorption properties of the hydrophilic film as well as the biocompatibility of the patch after subcutaneous implantation. The second experiment was designed to evaluate adhesion formation in an animal model, comparing the mesh to two other commercially available membranes and to a control. In the third experiment, the product was tested in a porcine model. This was done in order to better evaluate the performance of the mesh in a model closer to human dimensions. These three experimental procedures demonstrated the biocompatibility of the membrane, the dramatically superior performance of the patch compared to other commercially available ones and to controls, and the validity of the concept in large animals. The composite mesh made of polyester and coated hydrogel fulfils the conditions for human evaluation.