Acute inflammatory response in the subcutaneous versus periprosthethic space after incisional hernia repair: an original article

BACKGROUND: The acute inflammatory response following mesh implantation has been often evaluated in vitro and in animal models. The aim of this study was to evaluate the acute inflammatory response near the prosthesis in human by analysing some inflammatory indicators. METHODS: We used a cohort of twelve male patients affected by midline incisional hernia, who were admitted for surgical mesh repair. A suction drain was placed between the mesh and rectal muscles whereas, the other one was placed between the subcutaneous tissue and the oblique external sheath. The acute inflammatory response was analyzed by measuring the production of interleukin [IL]-1, IL-10, IL-1ra, C-Reactive Protein (CRP), total proteins, albumin and pH in the drain fluids. RESULTS: The dynamics of CRP and ILs production resulted similar in both drainages. Comparing drain over mesh and subcutaneous drain at all times, IL-1 and CRP values always resulted significantly higher in the first one, whereas IL-1ra and IL-10 values were significantly higher in the last one. Total protein and albumin were similar in both drains at all time; only in the drain over mesh fluid, pH values resulted significantly reduced in the fourth post-operative day. CONCLUSIONS: Our data showed that an acute inflammatory reaction is present in both sites examined. However, it was significantly higher in the space after mesh implantation.