Absorbable versus permanent mesh in abdominal operations

Abstract

Because previous studies evaluating prosthetic mesh have yielded conflicting results, we compared two permanent (polypropylene and polytetrafluoroethylene) and two absorbable (polyglactin and polyglycolic acid) meshes with respect to histologic appearance, development of adhesions, tensile strength and occurrence of hernias in rabbits in which defects of the abdominal wall measuring 2 by 3 centimeters were repaired with one of the meshes. Twenty experiments were performed with each material, and observations were made at two, five, seven and ten weeks. The inflammatory response was minimal with all products. Adhesions were more marked with polypropylene (Marlex) than with polytetrafluoroethylene (Gore-tex); there was no difference between the absorbable meshes. In vitro tensile strength measurements at ten weeks indicated that Marlex was superior to the other materials, and between the absorbable products, polyglactin (Vicryl) was superior to polyglycolic acid (Dexon). No hernias were observed with the nonabsorbable meshes, but all of the rabbits repaired with absorbable meshes had ventral hernias by the tenth week. Thus, absorbable meshes are not indicated when prolonged tensile strength is required, but they may be useful for other purposes, including the temporary repair of fascial defects, since evisceration was not observed.