ADHESION FORMATION AFTER INTRAPERITONEAL AND EXTRAPERITONEAL IMPLANTATION OF POLYPROPYLENE MESH

Polypropylene mesh is commonly used in open and laparoscopic hernia re pairs. We tested the hypothesis that intra-abdominal adhesion formatio n secondary to polypropylene mesh is greater when mesh is placed in an intraperitoneal versus an extraperitoneal position. Fifty adult male rats underwent midline laparotomy with or without implantation of a no nabsorbable mesh. There were ten rats in each of the following five gr oups: EP-M, creation of an extraperitoneal pocket without mesh placeme nt; EP+M, mesh placement in an extraperitoneal pocket; IP+M, intraperi toneal mesh; IT-M, creation of an abdominal wall ischemic defect witho ut mesh placement; IT+M, ischemic defect plus mesh. Adhesion formation was graded on a scale of 0 to 5, 2 weeks after operation. All groups formed adhesions. Tissue injury or the placement of a mesh in an intra peritoneal position resulted in significantly more adhesions. An entir ely extraperitoneal approach to mesh placement is needed to minimize a dhesions after laparoscopic hernia repair.