Pm. Cristoforoni et al., ADHESION FORMATION AFTER INCISIONAL HERNIA REPAIR - A RANDOMIZED PORCINE TRIAL, The American surgeon, 62(11), 1996, pp. 935-938
Adhesion formation involving intraperitoneal contents is a significant
complication of incisional hernia repair. We evaluated the rate of pe
ritoneal adhesion formation following closure of experimentally induce
d large ventral fascial defects using selected synthetic prosthetic ma
terials in a well standardized porcine model. Sixty 25 kg hogs had a 4
x 6 cm ventral fascial defect induced and were randomized to repair w
ith either interrupted O-Prolene(R) suture, Marlex(R) surgical mesh (M
x), GoreTex Dual Mesh(R) (Gore-DM), or an experimental version of the
latter having multiple 0.4 mm fenestrations (Gore-DMH). Mr mesh induce
d significantly more adhesions than did Gore-DM when the two materials
were placed in a comparable manner (P < 0.001). Those animals whose d
efects were closed primarily with Prolene(R) suture alone developed si
gnificantly fewer adhesions than either Mr or Gore-DM (with or without
holes) when these materials were sutured in an overlaying (i.e., extr
aperitoneal) manner (Mx, P < 0.0001; Gore-DM, P < 0.05; Gore-DMH, P <
0.01). The intraperitoneal placement of the Gore-DM materials (i.e., u
nderlay manner) resulted in a rate of adhesion formation that was not
statistically different from that induced by closure with Prolene(R) a
lone (P = 0.08 for Gore-DM and P = 0.07 for Gore-DMH). Our findings su
pport the use of Gore-DM biomaterial as the preferred material in the
repair of large abdominal fascial defects when the use of a synthetic
prosthetic material is necessitated by the defect size.