Abdominal adhesions to prosthetic mesh evaluated by laparoscopy and electron microscopy

Background: Most adhesion experiments involve observations at a single time point. We developed a method to evaluate abdominal adhesions to surgical m esh by,sequential laparoscopy. Study Design: An abdominal wall defect was created in rats and repaired wit h polypropylene mesh. Sequential laparoscopic evaluation of adhesion format ion was performed in each animal. The percentage of mesh area involved was scored (0% to 100%). At various time intervals animals were sacrificed and samples were obtained for light and scanning electron microscopy. Results: Adhesions were already present on day 1, increased by day 7, and d id not progress thereafter. Mesh surfaces free of adhesions were covered wi th a confluent mesothelial cell layer, first seen by scanning electron micr oscopy on day 5 and complete by day 7. Conclusions: Intraabdominal adhesions are best studied by sequential laparo scopy. Adhesions develop within 1 day of prosthesis placement. Adhesion-fre e surfaces are carpeted with mesothelial cells by day 7 and remain free the reafter, for duration of study. (J Am Coll Surg 2000;190:271-280. (C) 2000 by the American College of Surgeons).