Background There is an increasing number of patients following hernia surgery with implanted mesh reporting symptoms that could indicate autoimmune or allergic reactions to mesh. ‘Allergy’ to metals, various drugs, and chemicals is well recognised. However, hypersensitivity, allergy or autoimmunity caused by surgical mesh has not been proven by a scientific method to date. The aim of this study was twofold: to describe the pathophysiology of autoimmunity and foreign body reaction and to undertake a systematic review of surgical mesh implanted at the time of hernia repair and the subsequent development of autoimmune disease. Methods A systematic review using the PRISMA guidelines was undertaken. Pubmed (Medline), Google Scholar and Cochrane databases were searched for all English-written peer-reviewed articles published between 2000 and 2021. The search was performed using the keywords “hernia”, “mesh”, “autoimmunity”, “ASIA”, “immune response”, “autoimmune response”. Results Seven papers were included in the final analysis—three systematic reviews, three cohort studies and one case report. Much of the current data regarding the association of hernia mesh and autoimmunity relies on retrospective cohort studies and/or case reports with limited availability of cofounding factor data linked to autoimmune disease such as smoking status or indeed a detailed medical history of patients. Three systematic reviews have discussed this topic, each with a slightly different approach and none of them has identified causality between the use of mesh and the subsequent development of autoimmune disease. Conclusion There is little evidence that the use of polypropylene mesh can lead to autoimmunity. A large number of potential triggers of autoimmunity along with the genetic predisposition to autoimmune disease and the commonality of hernia, make a cause and effect difficult to unravel at present. Biomaterials cause foreign body reactions, but a chronic foreign body reaction does not indicate autoimmunity, a common misunderstanding in the literature.

Aim The SARS- CoV-2 pandemic has greatly affected health care systems worldwide, including the Czech Republic. However, the degree to which Covid-19 has impacted on hernia surgery is unknown. The aim of this study was to review the hernia surgery workload in a large university teaching hospital department. Material and Methods A computer based medical record system was used to identify all patients undergoing elective and emergency hernia repair of all types from March 1 to November 30, 2020 and for a similar time period in 2019 at the Motol University Hospital, Prague. Results 194 elective hernia operations were undertaken over the study period in 2020, a reduction from the 285 over a similar period in 2019. The number of emergency hernia operations in 2020 was 13 compared to 25 in 2019. Conclusions The SARS –CoV- 2 pandemic has reduced both the number of elective and emergency hernia operations in 2020 compared to 2019. Time will tell if the reduced elective workload will subsequently increase the emergency hernia workload during the recovery from the pandemic.

Background There is an increasing number of patients following hernia surgery with implanted mesh reporting symptoms that could indicate autoimmune or allergic reactions. ‘Allergy’ to metals, drugs, and chemicals is well recognised. However, allergy or autoimmunity caused by mesh has not been proven by a scientific method to date. The aim of this study was twofold: to describe the pathophysiology of autoimmunity and foreign body reaction and to undertake a systematic review of mesh implanted at the time of hernia repair and the subsequent development of autoimmune disease. Methods A systematic review using the PRISMA guidelines was undertaken. Pubmed, Google Scholar, and Cochrane databases were searched for English-written articles published between 2000 and 2021. The search was performed using keywords “hernia”, “mesh”, “autoimmunity”, “ASIA”, “immune response”, “autoimmune response” Results Seven papers, were included in the final analysis – three systematic reviews, three cohort studies and one case report. Much of the current data regarding the association of hernia mesh and autoimmunity relies on retrospective cohort studies and/or case reports with limited availability of cofounding factor data linked to autoimmune disease. Three systematic reviews have discussed this topic, each with different approach and none of them has identified causality between the use of mesh and development of autoimmune disease. Conclusion There is evidence that certain biomaterials can lead to immune dysregulation and induce autoimmunity. However, this has never been proven with synthetic hernia mesh. The bias in trials are high. And scientific studies have not been undertaken mesh-related autoimmunity.

Aim Our aim was to analyze patient’s reported EuraHS QoL (quality of life) scores before and after hernia surgery. And find whether the result is surgeon dependent or not, because hernia repair often serves as a training surgery for young surgeons or is performed by surgeons with no hernia interest. However, even a simple groin hernia repair can lead to life-long pain or reduced QoL and the risk of complications following incisional hernia repair is much higher. Material and Methods We have utilized the EuraHS database and its QoL questionnaire and prospectively entered all patients undergoing any hernia repair at our department since Jan. 2019. Results 519 patients have been included. Many patients in the incisional hernia cohort have reported no or very little symptoms before the operation. Only 251 have completed their 1 month follow-up with the QoL questionnaire. 63 patients have been contacted and questioned 1 year post-surgery to this date. In 6 cases the QoL scores are lower than pre-repair. 45 patients had a record of major complication or reoccurrence requiring surgery so far. Unfortunately 31 of those did not fill up the QoL questionnaire. 37 were operated on by resident with a supervision of a surgeon without a hernia interest. Conclusions Results of hernia repair are surgeon dependent and an internal audit of current practices is needed at many general surgery departments.

Aim Background: Surgical mesh is widely used not only to treat but also to prevent incisional hernia formation. Despite much effort by material engineers, the ‘ideal' mesh mechanically, biologically and surgically easy to use remains elusive. Advances in tissue engineering and nanomedicine have allowed new concepts to be tested with promising results in both small and large animals. Abandoning the concept of a pre-formed mesh completely for a ‘pour in liquid mesh’ has never been tested before. Material and Methods Thirty rabbits underwent midline laparotomy with closure using an absorbable suture and small stitch small bites technique. In addition, their abdominal wall closure was reinforced by a liquid nanofibrous scaffold composed of a fibrin sealant and nanofibers of poly-ε-caprolactone with or without hyaluronic acid or the sealant alone, placed as an ‘onlay’ over the closed abdominal wall. The animals were sacrificed at 6 weeks and their abdominal wall was subjected to histological and biomechanical evaluations. Results All the animals survived the study period with no major complication. Histological evaluation showed an eosinophilic infiltration in all groups and foreign body reaction more pronounced in the groups with nanofibers. Biomechanical testing demonstrated that groups treated with nanofibers developed a scar with higher tensile ultimate and yield strength. Conclusions The use of nanofibers in a liquid form applied to the closed abdominal wall is easy to use and improves the biomechanical properties of healing fascia at 6 weeks after midline laparotomy in a rabbit model.