Bacterial biofilm as a risk factor for infectious complications in the use of polypropylene endoprostheses in surgery of anterior wall hernias

Objective. To analyze data on synthetic prostheses used in herniology, features of the body’s reaction to their implantation, possible infectious complications, and to search for ways to solve identified problems.

Materials and methods. An analysis of publications in the PubMed, Web of Science, Elibrary and CyberLeninka systems was carried out, describing the use of synthetic prostheses for hernioplasty and the nature of complications in the postoperative period. The following search terms were used: “synthetic prostheses”, “tension-free hernioplasty”, “bacterial biofilm”, “infectious complications of hernioplasty”. A total of 38 original publications were selected.

Results. The materials used for tension-free hernioplasty and their physical and mechanical properties were studied. The concept of bacterial biofilm was studied as one of the reasons for maintaining infectious complications on mesh endoprosthesis.

Conclusion. Currently, the use of synthetic prostheses in operations on hernias of the anterior abdominal wall is the “gold standard”. The material of choice for the manufacture of endoprostheses is polypropylene. The elasticity of the polypropylene mesh is close to the physiological elasticity of the anterior abdominal wall. The polypropylene mesh consists of monofilament threads that do not have capillarity and wicking. In response to implantation, the polypropylene mesh causes a weak inflammatory reaction of soft tissues. At the same time, the use of polypropylene meshes in hernioplasty in comorbid patients, patients with strangulated hernias can lead to postoperative infectious complications, which is associated with the formation of a biofilm on the surface of the endoprosthesis. The development of a polymer coating for a mesh polypropylene prosthesis with prolonged release of antibiotics to delay bacterial colonization and the formation of a bacterial biofilm in conditions of bacterial contamination of the surgical field is relevant.

1. Ivanov YV, Panchenkov DN, Afonina NS, Chugunov MS, Zinovsky M.V. The medical economic approaches to the choice of method of surgical treatment of inguinal hernias in modern conditions of insurance medicine. Vestnik experimental’noy i klinicheskoy khirurgii. 2016;9(1):10-18. (in Russ.). DOI: https://doi.org/10.18499/2070-478X-2016-9-1-10-18

2. Alekseev AK, Jurasov AV, Timoshina AD, Shestakov AL. Complications of various explantation methods in the treatment of postoperative ventral hernias. Gerniologiya. 2006;3(11):8. [date of access 2025 January 18]. Available from: https://www.elibrary.ru/item.asp?id=32826190 (in Russ.).

3. Langer C, Liersch T, Kley C, Flosman M, Süss M, Siemer A, et al. Twenty-five years of experience in incisional hernia surgery. A comparative retrospective study of 432 incisional hernia repairs. Chirurg. 2003;74(7):638-645. DOI: https://doi.org/10.1007/s00104-002-0594-2.

4. Zhu LM, Schuster P, Klinge U. Mesh implants: An overview of crucial mesh parameters. Gastrointest Surg. 2015;7(10):226-236. DOI: https://doi.org/10.4240/wjgs.v7.i10.226

5. Amid PK. Polypropylene prostheses. Abdominal wall hernias: principles and management. In: Bendavid R, Abrahamson J, Arregui ME, Flament JB, Phillips EH, eds. Abdominal Wall Hernias. New York: Springer; 2001. pp. 272-278. DOI: https://doi.org/10.1007/978-1-4419-8574-3

6. Zogbi L, Pignatello R. The Use of Biomaterials to Treat Abdominal Hernias. In: Biomaterials Applications for Nanomedicine. 2008;18:359-382. DOI: https://doi.org/10.5772/24313

7. Zhuov BN, Bystrov SA, Shestakov EV. Optimization of surgical treatment of patients with strangulated abdominal wall hernia. Pirogov Russian Journal of Surgery. 2014;(8):67-70. [date of access 2025 January 18]. Available from: https://elibrary.ru/item.asp?id=22381338 (in Russ.).

8. Yurasov AV, Abonyan LA, Kurashvili EV, Lysenko M, Dubrov VJe. Long-term results of surgical treatment of patients with umbilical hernias and diastasis of the rectus abdominis muscles. Vestnik of Experimental and Clinical Surgery. 2014;(4):309-314. [date of access 2025 January 18]. Available from: https://www.elibrary.ru/item.asp?id=23435570 (in Russ.).

9. Amid PK. Classification of biomaterials and their related complications in abdominal wall hernia surgery. Hernia. 1997;1:15-21. DOI: https://doi.org/10.1007/BF02427664

10. Klosterhalfen B, Klinge U. Retrieval study at 623 human mesh тexplants made of polypropylene - impact of mesh class and indication for mesh removal on tissue reaction. Journal of biomedical materials research. 2013;101:1393-1399. DOI: https://doi.org/10.1002/jbmb.32958.

11. Bilsel Y, Abci I. The search for ideal hernia repair; mesh materials and types. International journal of surgery. 2012;10:317-321. DOI: https://doi.org/10.1016/j.ijsu.2012.05.002

12. Zhu LM, Schuster P, Klinge U. Mesh implants: An overview of crucial mesh parameters. World Journal of Gastrointestinal Surgery. 2015;7(10):226-236. DOI: https://doi.org/10.4240/wjgs.v7.i10.226

13. Pott PP, Schwarz ML, Gundling R, Nowak K, Hohenberger P, Roessner ED. Mechanical properties of mesh materials used for hernia repair and soft tissue augmentation. PLoS One. 2012;7:e46978. DOI: https://doi.org/10.1371/journal.pone.0046978

14. Bennett RG. Selection of Wound Closure Materials. Journal of the American Academy of Dermatology. 1988;18(4):619-637. DOI: https://doi.org/110.1016/s0190-9622(88)70083-3

15. Klink C, Binnebösel M, Kaemmer D, Schachtrupp A, Fiebeler A, Anurov M, et al. Comet-tail-like inflammatory infiltrate to polymer filaments develops in tensionfree conditions. European surgical research. 2011;46:73-81. DOI: https://doi.org/10.1016/s0190-9622(88)70083-3

16. Baktir A, Dogru O., Girgin M, Aygen E, Kanat BH, Dabak DO, Kuloglu T. The effects of different prosthetic materials on the formation of collagen types in incisional hernia. Hernia. 2013;17:249-253. DOI: https://doi.org/10.1007/s10029-012-0979-1

17. Cobb WS, Carbonell AM, Kalbaugh CL. Infection risk of open placement of intraperitoneal composite mesh. The American surgeon. 2009;75(9):762-767.

18. Mazaki T, Mado K, Masuda H, Shiono M, Tochikura N, Kabur MA. A randomized trial of antibiotic prophylaxis for the prevention of surgical site infection after open mesh-plug hernia repair. American journal of surgery. 2014;207(4):476-484. DOI: https://doi.org/10.1016/j.amjsurg.2013.01.047

19. Lyzikov AA. Infectious complications in the transplantation of vascukar prostheses. Health and Ecology Issues. 2011;(4):75-79. (In Russ.). DOI: https://doi.org/10.51523/2708-6011.2011-8-4-13

20. Sarkisyan AS. Complications after reconstructive operations in the pulmonary basin of the aorta and arteries of the lungs of the extremities (literature review). Vestnik Hirurgii Armenii. 2011;(1):23-29. (In Russ.).

21. Napolitano L, Di Bartolomeo N, Aceto L, Waku M, Innocenti P. Utilizzo dei materiali protesici nei laparoceli: la nostra esperienza clinica [Use of prosthetic materials in incisional hernias: our clinical experience]. G Chir. 2004 Apr;25(4):141-145. (Italian.).

22. Yang H, Xiong Y, Chen J, Shen Y. Study of mesh infection management following inguinal hernioplasty with an analysis of risk factors: a 10-year experience. Hernia. 2020 Apr;24(2):301-305. DOI: https://doi.org/10.1007/s10029-019-01986-w

23. Pande T, Naidu CS. Mesh infection in cases of polypropylene mesh hernioplasty. Hernia. 2020;24(4):849-856. DOI: https://doi.org/10.1007/s10029-020-02142-5

24. Tubre D, Schroeder A, Estes J, Eisenga J, Fitzgibbons RJ. Surgical site infection: the “Achilles Heel” of all types of abdominal wall hernia reconstruction. Hernia. 2018;22(6):1003-1013. DOI: https://doi.org/10.1007/s11605-022-05248-6

25. Parshikov VV, Chebotar IV, Khodak VA, Samsonov AA. In vitro studies of biofilms on the surface of synthetic macroporous endoprostheses for abdominal wall plasty. Modern technologies in medicine. 2012;(1):15-20. [date of access 2025 January 18]. Available from: http://www.stm-journal.ru/ru/numbers/2012/1/846 (in Russ.).

26. Glushanova NA, Bkinov AI, Alekseev NB. Bacterial biofilms in human infectious pathology. Medicine in Kuzbass. 2015;(2):30-35. [date of access 2025 January 18]. Available from: https://cyberleninka.ru/article/n/bakterialnye-bioplenki-v-infektsionnoy-patologii-cheloveka (in Russ.).

27. Kathju S. Nistico L, Lasko L, Stoodley S. Bacterial biofilm on monofilament suture and porcine xenograft after inguinal herniorrhaphy. FEMS immunology and medical microbiology. 2010;59:405-409. DOI: https://doi.org/10.1111/j.1574-695X.2010.00691.x

28. Mardanova AM, Kabanova DA, Rudakova NL, Sharipova MP. Biofilms: basic principles of organization and research methods. Kazan; 2016. [date of access 2025 January 18]. Available from: https://kpfu.ru/portal/docs/F1250326711/posobie._.Bioplenki._.Mardanova.AM.Kabanov.D.A..Sharipova.M.R.pdf (in Russ.).

29. Okulich VK, Kabanova AA, Senkovich SA, Plotnikov FV. Antibiotic resistance of staphylococcus aureus hospital isolates forming biofilm. Zdravoohranenie. 2015;(7):11-16. [date of access 2025 January 18]. Available from: https://rnpcmt.by/files/00106/obj/110/73703/doc/Zdrav7.pdf (in Russ.).

30. Romanov YuM, Gincburg AL. Bacterial biofilms as a natural form of existence of bacteria in the environment and in the host body. Journal of microbiology, epidemiology and immunobiology. 2011;(3):99-109. [date of access 2025 January 18]. Available from: https://microbiol.crie.ru/jour/article/view/13542 (in Russ.).

31. Mavros MN, Athanasiou S, Alexiou VG, Mitsikostas PK, Peppas G, Falagas ME. Risk factors for mesh-related infections after hernia repair surgery: a meta-analysis of cohort studies. World Journal of Surgery. 2011;35(11):2389-2398. DOI: https://doi.org/10.1007/s00268-011-1266-5

32. Juvany M, Hoyuela C, Carvajal F, Trias M, Martrat A, Ardid J. Long-term follow-up (at 5 years) of midline incisional hernia repairs using a primary closure and prosthetic onlay technique: recurrence and quality of life. Hernia. 2018;22(2):319-324. DOI: https://doi.org/10.1007/s10029-018-1730-3

33. Olsen MA, Nickel KB, Wallace AE, Mines D, Fraser VJ, Warren DK. Stratification of surgical site infection by operative factors and comparison of infection rates after hernia repair. Infection Control and Hospital Epidemiology. 2015;36(3):329-335. DOI: https://doi.org/10.1017/ice.2014.44

34. Lyzikov AA, Artyushkov EL, Doroshko YaY, Kaplan ML. Clinical characteristics and assessment of the frequency of complications after surgical treatment of patients with free and strangulated hernias using synthetic implants. Health and Ecology Issues. 2023;20(4):63-69. (In Russ.). DOI: https://doi.org/10.51523/2708-6011.2023-20-4-08

35. Warren JA, Love M, Cobb WS. Beffa LR, Couto FJ, Hancock BH, Morrow D, Ewing JA, Carbonell AM. Factors affecting salvage rate of infected prosthetic mesh. American Journal of Surgery. 2020;220(3):751-756. DOI: https://doi.org/10.1016/j.amjsurg.2020.01.028

36. Wolcott RD, Rhoads DD. A study of biofilm-based wound management in subjects with critical limb ischaemia. Journal of Wound Care. 2008;17(4):145-155. DOI: https://doi.org/10.12968/jowc.2008.17.4.28835

37. Podoluzhny VI, Shabalina OV, Miheev AG, Egorova ON, Shternis TA. Experimental evaluation of Esfil argentiferous endoprosthesis use. Siberian Medical Review. 2019;(4):47-53. (In Russ.). DOI: https://doi.org/10.20333/2500136-2019-4-47-53

38. Lyzikov AA, Tapalski DV, Doroshko YY, Tsvetkova EA, Ziatskov AA, Kaplan ML. Antibacterial resistance of modified woven vascular prostheses in experimental infected wound modeling. Health and Ecology Issues. 2022;19(1):83-92. (In Russ.). DOI: https://doi.org/10.51523/2708-6011.2022-19-1-11