Inflammatory Reaction as Determinant of Foreign Body Reaction Is an Early and Susceptible Event after Mesh Implantation

Abstract

Purpose. To investigate and relate the ultrashort-term and long-term courses of determinants for foreign body reaction as biocompatibility predictors for meshes in an animal model. Materials and Methods. Three different meshes (TVT, UltraPro, and PVDF) were implanted in sheep. Native and plasma coated meshes were placed bilaterally: (a) interaperitoneally, (b) as fascia onlay, and (c) as muscle onlay (fascia sublay). At 5 min, 20 min, 60 min, and 120 min meshes were explanted and histochemically investigated for inflammatory infiltrate, macrophage infiltration, vessel formation, myofibroblast invasion, and connective tissue accumulation. The results were related to long-term values over 24 months. Results. Macrophage invasion reached highest extents with up to 60% in short-term and decreased within 24 months to about 30%. Inflammatory infiltrate increased within the first 2 hours, the reached levels and the different extents and ranking among the investigated meshes remained stable during long-term follow up. For myofibroblasts, connective tissue, and CD31+ cells, no activity was detected during the first 120 min. Conclusion. The local inflammatory reaction is an early and susceptible event after mesh implantation. It cannot be influenced by prior plasma coating and does not depend on the localisation of implantation.

Protocol for a Randomized Phase II Trial for Mesh Optimization by Autologous Plasma Coating in Prolapse Repair: IDEAL Stage 3

“…Those findings were shown to be consistent under both in vivo and in vitro conditions [15][16][17][18].…”

Comparative study of polyvinylidene fluoride and polypropylene suburethral slings in the treatment of female stress urinary incontinence

“…However, the use of polyvinylidene fluoride (PVDF) in suburethral tapes was also approved in Europe. PVDF is a nonabsorbable fluoropolymer, introduced in 2002 for surgical mesh, with an excellent biocompatibility . Its biomechanical properties include lower elongation and deformation capacities compared to PP .…”

Transvaginal PVDF-mesh for cystocele repair: A cohort study

“…The recurrence rates could be reduced significantly but for the price of an increased inflammatory and fibrotic tissue reaction to the implant. Current examinations show the importance of acute inflammatory and immune responses for the integration of mesh into the surrounding tissue [10,18]. The studies aim to engineer a material which holds shape over time and reduces the inflammatory host reaction.…”

“…The in vivo performance of these meshes in a sheep model was predictable with a previously developed in vitro test system. The early inflammatory reaction determined the outcome and mesh biocompatibility [10].…”