Does lining polypropylene with polyglactin mesh reduce intraperitoneal adhesions ? Discussion

A method that appears to reduce the rate of adhesion formation between intraperitoneal viscera and prosthetic mesh is the placement of absorbable mesh between nonabsorbable mesh and intraperitoneal viscera. In this study, polyglactin mesh was compared with nonabsorbable polypropylene mesh (Marlex). Forty-seven Sprague-Dawley rats were divided into four groups: 1) control, 2) polyglactin (Vicryl), 3) polypropylene mesh, and 4) polyglactin-lined polypropylene mesh. All rats that underwent mesh placement had midline laporotomy with anastamosis of mesh to fascial borders. Controls underwent midline laporotomy and closure only. Groups were then studied at 1, 2, and 3 months, respectively, to determine the degree of adhesion formation. Gross inspection was performed by a blinded researcher with numerical rank given based on the number of adhesions observed: 0, none; 1, mild; 2, moderate; and 3, severe. The data showed that rats in group 3 (polypropylene only) had significant adhesions at 3 months, with average numerical score of 2.75. Polyglactin and polyglactin/ polypropylene groups had similar scores of 1.5 each. Control groups predictably showed little adhesion formation, with average score of 0.25. Based on these data, it is observed that lining polypropylene mesh with absorbable polyglactin mesh can reduce adhesion formation to nonabsorbable mesh. The difference in degree of adhesions is most notable at 3 months. This technique may be an important adjunt to reduce the clinical sequelae of intraperitoneal adhesions.