Promotion of Hernia Repair with High-Strength, Flexible, and Bioresorbable Silk Fibroin Mesh in a Large Abdominal Hernia Model.

The use of synthetic surgical meshes for abdominal hernia repair presents numerous challenges due to insufficient mechanical strength, nonabsorbability, and implant rigidity that leads to complications including chronic inflammatory reactions and adhesions. In this study, a naturally derived, high-strength, flexible, and bioresorbable silk fibroin mesh was developed by knitted textile engineering and biochemical manipulation. The mechanical properties of the mesh were optimized with the trial of different surface coating methods (thermal or chemical treatment) and 12 different knit patterns. Our silk fibroin mesh showed sufficient tensile strength (67.83 N longitudinally and 62.44 N vertically) which afforded the high mechanical strength required for abdominal hernia repair (16 N). Compared to the commonly used commercial nonabsorbable and absorbable synthetic meshes (Prolene mesh and Ultrapro mesh, respectively), the developed silk fibroin mesh showed advantages over other meshes, including lower elongation rate (47.14% longitudinally and 67.15% vertically, < 0.001), lower stiffness (10-1000 fold lower, < 0.001), and lower anisotropic behavior (λ = 0.32, < 0.001). In a rat model of large abdominal hernia repair, our mesh facilitated effective hernia repair with minimal chronic inflammation which gradually decreased from 15 to 60 days postoperation, as well as lower adhesion formation rate and scores compared to control meshes. There was more abundant and organized collagen deposition, together with more pronounced neovascularization in the repaired tissue treated with silk fibroin mesh as compared to that treated with synthetic meshes. Besides, the silk fibroin mesh gradually transferred load-bearing responsibilities to the repaired host tissue as it was bioresorbed after implantation. Its isotropic architecture favored an ease of use during operations. In summary, our findings indicate that the use of knitted silk fibroin mesh provides a safe and effective alternative solution for large abdominal hernia repairs as it overcomes the prevailing limitations associated with synthetic meshes.