Triple-layered composite mesh for managing anterior abdomen wall defects in ventral hernia

Introduction: In managing ventral hernia, using mesh for the anterior abdominal wall defect closure has become a standard. Different types of materials have been used as a mesh, each with its own benefits and drawbacks. This study aimed to investigate the potential of a triple-layered composite mesh made from amniotic membrane-coated polypropylene mesh (AMPM) with an adhesion barrier as an alternative for anterior abdominal wall defect closure. Methods: An experimental study was conducted using Sprague-Dawley mice, imposed with a mechanical ventral hernia and divided into four groups with different treatments: sham surgery, mesh polypropylene, AMPM composite, and AMPM with adhesion barrier (triple-layered composite mesh). After 7 and 30 days of the procedure, the mice were evaluated for the recurrence of anterior abdominal wall defects, the histological profile of polymorphonuclear (PMN) cells, foreign body giant cells (FBGC), fibroblast cells, neovascularization, and adhesion of mesh to surrounding tissue in each group. Results: No anterior abdominal wall defect recurrence was observed in all groups at 7-and 30-days post-procedure. We found no significant difference in histological profiles of PMN, FBGC, and fibroblast cells from each group. There was a statistically significant difference in the neovascularization (p=0.025) and adhesion (p=0.034) between the polypropylene mesh group and the triple-layered composite mesh group. Conclusion: Triple-layered composite mesh has the potential to be an alternative to cover anterior abdominal wall defects, with triple-layered composite mesh and AMPM mesh groups showing a significantly higher rate of neovascularization and a lower rate of adhesion than the polypropylene mesh group.