The role of suture fixation on mesh contraction after abdominal hernia repair.

ABSTRACT

Mesh contraction is a threat for hernia repair. Our aim is to analyze the effects of fixation techniques on mesh contraction. Forty-eight rats with abdominal wall defects were equally divided into four groups (G) G1 (control) with no repair, G2 defects were repaired with free polypropylene mesh, and G3 and G4 defects were reinforced with prolene mesh fixed by running and interrupted sutures, respectively. The corners of the defect and prolene mesh were marked with silver clips. The contraction rate was calculated by radiological measurement of distances between corner clips and by measuring the mesh areas after harvesting abdominal wall containing the patch. Host reaction was histhopathologically and biochemically examined by inflammation score, fibroblast count, thickness of the granulation tissue, and tissue hydroxyproline level. Distances between corner clips and mesh area have decreased by 31.5% and 26.4% respectively in G2, while in G3 the decrease was 24.4% (p = .008) and 22% (p = .01), respectively. Granulation tissue thickness was highest in the group with mesh fixed by running suture. The tissue hydroxyproline levels were similar in mesh repair groups. Our study suggests that mesh contraction, which reduces mesh surface, occurs during the wound healing process. In order to decrease the contraction rate, it is important to keep the mesh in place until its incorporation into the surrounding tissue. Our results suggest that mesh contraction is minimized by suture fixation, and running fixation suture, which provides more balanced tension around the mesh, seems more beneficial for decreasing contraction rate.