Induction of leukocyte activation by meshes surgically implanted in the peritoneal cavity

The search for surgical prosthetics that do not act to promote infection has been frustrating. However, recent experience with the implantation of polyglycolic acid mesh (PGA) used as an intestinal sling has been associated with a lack of pelvic infections. To examine the basis for these observations, 1 × 1cm pieces of biomaterials were sewn onto the peritoneal cavity of rats. The biomaterials examined included PGA mesh, a composite mesh composed of a permanent nonabsorbable Novafil inner layer coated with a PGA outer layer, polyvinyl alcohol sponge, and silicon elastomer. Biomaterials were removed at postoperative days 1, 2, 8, and 14, and examined for bacteriostatic and bactericidal activity by standard techniques. Mesh adherent leukocytes were evaluated for their ability to oxidize dichlorofluorescein diacetate (DCFH-DA), which is fluorescent in the presence of intracellular hydrogen peroxide produced by both polymorphonuclear cells and monocytes. PGA and the composite mesh had no intrinsic bacteriostatic or bactericidal activity. However, adherent leukocytes were induced to oxidize DCFH at levels 10-fold and 5-fold, respectively, by postoperative day 14, compared with earlier time points and other biomaterials. The ability of these PGA meshes to stimulate respiratory bursts by peritoneal cells may partly be responsible for the lack of infections associated with their use.