One discussion this week included abdominal wall mesh.
Reference: Cevasco M, Itani KMF. Ventral hernia repair with synthetic, composite, and biologic mesh: characteristics, indications, and infection profile. Surgical Infections. 2012 Aug;13(4):209-215. doi:10.1089/sur.2012.123.
Summary: Cevasco and Itani (2012) provide a succinct overview of available mesh materials, as well as their characteristics and special situations.
- polypropylene (PP) – The most popular choice for ventral hernia repair (VHR), it is available in both lightweight and heavy weight options. It allows fibrous scar tissue to surround its fibers, incorporating the mesh into the abdominal wall. However it can also induce scarring of intra-abdominal structures, and so it is not suitable for cases where the mesh may be exposed to the bowel (p.210).
- polyester – engineered for greater pliability and reduced adhesiogenic properties, it’s a non-absorbable carbon-based polymer that’s less susceptible to oxidative stress and less likely to contract after implantation. Risk of infection is less with polyester mesh than with PP mesh (p.210).
- expanded polytetrafluoroethylene (ePTFE) – inert, fluorocarbon-based polymer with a macroporous ventral side characterized by ridges and depressions, promoting tissue ingrowth and high tensile strength (p.211). It can be placed in direct contact with intestines. However, it has higher infection rates, possibly due to the common seroma formation. Also, increased hernia recurrences were associated with the use of ePTFE because of the decreased inflammatory response by ePTFE than with PP or polyester.
Composite meshes (also known as “second-generation” or “barrier” mesh)
- coated mesh with a temporary barrier coating – exhibit more adhesion formation over time
- dual-sided mesh with a permanent barrier layer
- cross-linked – prevents collagenase access to the collagen, prevents degradation of the collagen-based backbone
- non-cross-linked – composed of natural, unprocessed collagen, may be incorporated and resorbed within 3 months
The ideal biologic mesh would not trigger immune response; it stimulates new collagen growth, resist or survive infection, and maintain durability over time (p.212).
- Use of prosthetic mesh in contaminated abdominal wounds
- Use of prosthetic mesh in complex abdominal wall reconstructions