The structure of a biomaterial rather than its chemical composition modulates the repair process at the peritoneal level

Background: This study was designed to establish whether the spatial structure of a prosthesis conditions its behavior at the peritoneal level. Methods: Abdominal defects comprising all the wall (except skin) were created in rabbits and repaired with a laminar (DM) or reticular (CV-4) ePTFE-prosthesis. Fourteen days postimplant, specimens were obtained for scanning electron and light microscopy. Peritoneal adhesions, resistance to traction, and neoperitoneum thickness were quantified. Results: Adhesions to CV-4 were firm and integrated within surrounding tissue; only scarce adhesion formation was observed for DM. Adhesion area was significantly greater (P <0.01) in the CV-4 than in DM (7.00 ± 2.6; 0.15 ± 0.08 cm2). The neoperitoneum was organized for DM and disorganized for CV-4. This layer was significantly thicker (P <0.05) in DM than CV-4 (455 ± 3.4; 70 ± 3.1 μm). The CV-4 showed a greater resistance to traction than the DM (26.75 ± 3.71; 14.11 ± 3.71 N; P <0.05). Conclusions: The structure of a biomaterial, rather than its chemical composition, modulates behavior at the peritoneal interface.