Effects of macroporous monofilament mesh on infection in a contaminated field

Abstract

BackgroundThe aim of this study was to evaluate whether the type of the mesh and proper surgical technique can influence the outcome of a tension-free hernia repair in a contaminated filed.Materials and methodsThis study was based on the model of bacterial peritonitis in rats induced with a mixture composed of Escherichia coli and Bacteroides fragilis. Two animals were used as a control group without induced peritonitis and 10 animals with mesh implanted inside of the peritoneal cavity. For the 20 animals in the studied group, bacterial fluid was applied into the abdominal cavity together with the mesh implantation. In 10 cases, the mesh was fixed flatly upon the surface of the peritoneum; in the other 10, the mesh was rolled and then fixed within the peritoneal cavity. After 5 weeks, the animals were operated on again, and the meshes, the peritoneal fluid and, if present, any granulomas were taken for bacterial cultivation.ResultsThe results of the bacterial cultivation of the material from the control group (without mesh) and from the rats with flatly fixed mesh were almost completely negative (0/10 and 1/10, respectively). In 9 out of 10 rats that were exposed to the rolled mesh for 5 weeks, the colonisation of meshes with both B. fragilis and E. coli was found (p < 0.0198).ConclusionsWhen properly fixed, flat mesh, even in a contaminated field, may allow for a proper mesh healing and does not influence the ability to cure bacterial peritonitis in an animal model. A bad surgical technique, such as inadequately positioned or rolled mesh, may cause persistent peritoneal bacteraemia.

Laparoscopic Inguinal Hernia Repair and Mesh Infection: Does the Type of Mesh Used Matter?

“…Some factors have been proposed as an underlying or possible potentiator for the increase likelihood of mesh implant infection. These include the increase inflammatory reactions noted with poly-filament type meshes, and free unrestricted migration of bacterial organisms associated with micro porous mesh (size <10 µm) [10,12]. It is also pivotal to mention that surgical technique, with thoughtful tissue handling, does play a critical role in surgical outcome [13].…”

“…This has led to the creation of several composite, light-weight mesh. Despite this, the ideal mesh is still yet to be discovered [12,16].…”

To the question about a possibility of use ultra-light titanium- containing mesh in abdominal wall repair in contaminated fields (experimental study)

“…Исследователи подчеркивают необходимость соблюдения правил размещения имплантата, что особенно важно при контаминации операционного поля. Неадекватная хирургическая техника, неправильное расположение эндопротеза способствуют персистенции инфекционного процесса [19]. В ряде ситуаций это приводит к необходимости удаления сетки [18].…”

“…В ряде ситуаций это приводит к необходимости удаления сетки [18]. Свернутая сетка колонизируется достоверно интенсивнее, чем имплантированная по плоскости, lege artis [19]. Авторы объясняют этот эффект адекватной пенетрацией иммунокомпетентных клеток и гуморальных факторов во втором случае [19].…”

“…Известно о возможности успешной экспериментальной и клинической имплантации эндопротезов из полипропилена в условиях инфицирования [19,25]. Однако в ряде случаев у пациентов наблюдается нагноение, образуются парапротезные гнойные свищи.…”