Folding, Shrinkage and Infection Relation at Polypropylene Mesh Placed on the Rat Abdominal Wall

Background: Although mesh implementation provides better results in terms of recurrence during abdominal wall hernia repair, mesh infection is an important issue that can cause prolonged hospitalization, recurrence, and increased costs. Sometimes is not possible to treat the infection without mesh extraction. Among the various commercially available meshes, polypropylene-based non-absorbable mesh most commonly used. Mesh composition, surface properties, and textile are the mesh-related factors that contribute to infection. Bacterial properties can also contribute to infection. Additionally, inappropriate surgical technique during mesh application can be another factor facilitating infection. The aim of this study is to investigate the relationship between folding, shrinkage, and infection in polypropylene mesh that is implemented on the rat abdominal wall. Materials and Methods: Forty rats were divided into four groups of ten rats. Non-infected and infected 20 x 20-mm meshes were applied in groups 1 and 3, respectively, and after folding the non-infected and infected 40 x 20-mm meshes, were placed onto the abdominal wall in groups 2 and 4, respectively. After 16 days, all rats were sacrificed and bacterial colonization levels and mesh shrinkage rates were measured. Results: Statistically significant mesh shrinkage was detected in both the infected groups. A strong causal relationship between surface area and bacterial colonization was detected. Conclusion: Folding the mesh during hernia repair increased bacterial colonization. Infection leads to mesh shrinkage, which is a reason for recurrence. Unfolded mesh resulted in less bacterial colonization in this study.