In vivo evaluation of a new composite mesh (10% polypropylene/90% poly-L-lactic acid) for hernia repair

Abstract

The increasing use of mesh insertion for groin hernia repair is dashed by a worrying prevalence of chronic pain frequently related as a reaction to the biomaterial implantation. Thus, new biocompatible prosthesis, designed as a composite material associating polypropylene (PP) and long-term absorbable material, are now under development. In the present study, the typical commercially available Prolene mesh has been compared to two new meshes designed with 3-fold less PP, either alone (light PP) or associated with poly-L-lactic acid (PP-PLA) accounting for 90% of the mesh weight. These PP-mesh variants were implanted in an extraperitoneal position within the abdominal wall of 90 rats. Mesh adhesion and size were determined at autopsy 2, 4 and 8 weeks after implantation (10 animals per group) and morphometric parameters of the host tissues by light microscopy. Prolene and light PP-meshes presented intra-corporeal shrinkage and tissue adhesion, both more pronounced with light-PP, whilst PP-PLA meshes were not affected in spite of a strongest fibrosis. In contrast to Prolene and even more with light PP meshes, inflammation and cell-mediated immune responses were reduced without occurrence of angiogenesis or oedema. All these findings advocate together for a better tolerance of this new composite biomaterial, more likely due to a low macrophage response that appeared statistically correlated to the absence of mesh shrinkage and to a decreased adhesion to the tissue. On the basis of these experimental observations, it could be expected that the better tolerance of this composite biomaterial may avoid both long-term pain and recurrence when used as plug in groin hernia repair.