The placement of synthetic meshes into the body of a patient has become routine in the field of surgical practice. The most common use for mesh implants is the placement into the abdominal cavity for the repair of ventral and incisional hernias. The meshes are either placed extraperitoneally in onlay or sublay technique or intraperitoneally in intraperitoneal onlay mesh technique (IPOM). Inlay technique also played a role in the past. IPOM technique is indicated in multiple defect hernias (also known as Swiss cheese hernias) as well as for the treatment of large abdominal wall defects with loss of domain in obese patients. The implants are usually fixed by sutures, tacks or anchors. Complications found with IPOM technique are seroma formation, impaired functionality of the abdominal wall, chronic pain and adhesion formation. Chronic pain (continuous or intermittent pain persisting for more than 3 months postoperatively is mainly caused by perforating fixation devices with a reported incidence of 5-15% in open and laparoscopic hernia repair operations.
Clinical and experimental studies have shown that synthetic meshes as well as fixation devices can evoke a foreign body reaction. Unspecific tissue inflammation provokes tissue adhesions often elicited by protruding tacks, sutures or sharp mesh margins. These adhesions are potentially resulting in major complications like bowel adhesion, bowel obstruction or perforation.
Different mesh concepts for adhesion prevention have been developed including coated meshes, developed for separation of peritoneal defects and used for the individual coating of meshes. Large pores and high flexibility increase mesh integration into the abdominal wall and provide good biomechanical function. Examples for coated meshes are Parietex Composite®, Sepramesh® and Proceed®. The idea of integrating mesh and antiadhesive layer in the implant is to separate implant and viscera until the mesh is covered by neomesothelium (after approximately 10 days) and in the following to reduce the foreign body reaction and adhesion formation triggered by the implant.
However, using coated meshes may still trigger adverse reaction due to the use of mechanical fixation means such as sutures, tacks and anchors, which may extend from the implant. It is therefore a goal of the present invention to provide improved means to prevent or minimize all causes of unwanted tissue adhesion to the implant or its fixtures.