Intraabdominal mesh prosthesis in a canine model.

Laparoscopic inguinal hernia repair is still at an investigational stage, and varying methods have been described in the literature. These include the transabdominal preperitoneal approach, the intraperitoneal onlay mesh procedure, and the extraperitoneal approach. This study evaluates the differences in macroscopic adhesion formation between transabdominal preperitoneal mesh placement, intraperitoneal onlay mesh procedures, and extraperitoneal mesh placement in a canine model. The determination of microscopic tissue ingrowth and mesh incorporation was not a goal of this study. Operative sites utilizing mesh in a reperitonealized fashion resulted in less adhesion formation than did those sites where mesh was placed in an intraperitoneal manner using the onlay technique. Mesh placed in the extraperitoneal space without entering the peritoneal cavity did not exhibit any adhesion formation. Results favor the reperitonealization of intraabdominal mesh or mesh placement by an extraperitoneal approach.