Squid Ring Teeth–coated Mesh Improves Abdominal Wall Repair

Background: Hernia repair is a common surgical procedure with mesh often used. Current mesh materials have a high incidence of repair failures, due to poor tissue integration, and complications such as seroma and pain. Polypropylene (PP) mesh is the standard material in hernia repair secondary to its material durability; however, failures still approach 15%. In this first time animal study, we hypothesized that squid ring teeth (SRT), a biologically-derived high strength protein, coated polypropylene (SRT-PP) mesh, would offer enhanced tissue integration and strength compared to standard PP mesh, while proving biocompatibility for in vivo use. Materials and methods: Polypropylene mesh was coated with SRT. Mechanical properties and cell proliferation studies of the composite mesh were performed in vitro. Rats underwent inlay mesh implantation in an anterior abdominal wall defect model. Repair was assessed clinically and radiographically, with integration evaluated by histology and mechanical testing. Results: Cell proliferation was enhanced on SRT-PP composite mesh. This was corroborated by abdominal wall histology, dramatically diminished cranio-caudal mesh contraction, improved strength testing, and higher tissue failure strain following in vivo implantation. There was no increase in complications with SRT, with regard to seroma or visceral adhesion. No foreign body reactions were noted on liver histology. Conclusion: SRT-PP mesh showed better tissue integration than PP mesh. SRT is a high strength protein that is applied as a coating to augment mesh-tissue integration leading to improvements in abdominal wall stability with potential to reduce re-intervention for failures.