In vivo evaluation of a novel mesh suture design for abdominal wall closure

Jason M Souza, Zari P Dumanian, Anandev N Gurjala, Gregory A Dumanian, Jason M Souza, Zari P Dumanian, Anandev N Gurjala, Gregory A Dumanian

Abstract

Background: The authors present a novel mesh suture design aimed at minimizing the early laparotomy dehiscence that drives ventral hernia formation. The authors hypothesized that modulation of the suture-tissue interface through use of a macroporous structure and increased aspect ratio (width-to-height ratio) would decrease the suture pull-through that leads to laparotomy dehiscence.

Methods: Incisional hernias were produced in 30 rats according to an established hernia model. The rat hernias were randomized to repair with either two 5-0 polypropylene sutures or two midweight polypropylene mesh sutures. Standardized photographs were taken before repair and 1 month after repair. Edge-detection software was used to define the border of the hernia defect and calculate the defect area. Histologic analysis was performed on all mesh suture specimens.

Results: Seventeen hernias were repaired with mesh sutures and 13 were repaired with conventional sutures. The mean area of the recurrent defects following repair with mesh suture was 177.8 ± 27.1 mm2, compared with 267.3 ± 34.1 mm2 following conventional suture repair. This correlated to a 57.4 percent reduction in defect area after mesh suture repair, compared with a 10.1 percent increase in defect area following conventional suture repair (p < 0.0007). None (zero of 34) of the mesh sutures pulled through the surrounding tissue, whereas 65 percent (17 of 26) of the conventional sutures demonstrated complete pull-through. Excellent fibrocollagenous ingrowth was observed in 13 of 17 mesh suture specimens.

Conclusions: Mesh sutures better resisted suture pull-through than conventional polypropylene sutures. The design elements of mesh sutures may prevent early laparotomy dehiscence by more evenly distributing distracting forces at the suture-tissue interface and permitting tissue incorporation of the suture itself.

Conflict of interest statement

The authors have no financial interest to declare in relation to the content of this article.

Figures

Fig. 1.
Fig. 1.
Original hernia defect, defect closure, and postrepair hernia defect following mesh suture (above) and conventional suture (below) repair. Defect area measurement by means of edge-detection technique is demonstrated.
Fig. 2.
Fig. 2.
(Left) Comparison of prerepair and postrepair hernia defect area. (Right) Percentage change in hernia defect area following repair.
Fig. 3.
Fig. 3.
Sample hematoxylin and eosin photomicrograph of the mesh suture 1 month after implantation at 100× magnification. Vacuolated regions represent mesh fibers.
Video.
Video.
Supplemental Digital Content 1 shows a rat acute abdominal burst model demonstrating mesh suture’s increased resistance to pull-through over conventional 5-0 polypropylene suture. Balloon insufflation of a rat abdomen closed with two conventional sutures fails at the suture-tissue interface, whereas identical balloon insufflation of an abdomen closed with mesh suture fails by means of rupture of the abdominal wall itself, http://links.lww.com/PRS/B194.

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