Biological Scaffolds for Abdominal Wall Repair: Future in Clinical Application?

Abstract

Millions of abdominal wall repair procedures are performed each year for primary and incisional hernias both in the European Union and in the United States with extremely high costs. Synthetic meshes approved for augmenting abdominal wall repair provide adequate mechanical support but have significant drawbacks (seroma formation, adhesion to viscera, stiffness of abdominal wall, and infection). Biologic scaffolds (i.e., derived from naturally occurring materials) represent an alternative to synthetic surgical meshes and are less sensitive to infection. Among biologic scaffolds, extracellular matrix scaffolds promote stem/progenitor cell recruitment in models of tissue remodeling and, in the specific application of abdominal wall repair, have enough mechanical strength to support the repair. However, many concerns remain about the use of these scaffolds in the clinic due to their higher cost of production compared with synthetic meshes, despite having the same recurrence rate. The present review aims to highlight the pros and cons of using biologic scaffolds as surgical devices for abdominal wall repair and present possible improvements to widen their use in clinical practice.

Bridging repair of the abdominal wall in a rat experimental model. Comparison between uncoated and polyethylene oxide-coated equine pericardium meshes

“…This study underlines how the behavior of a biomaterial can be dramatically modeled by the processing with a polymeric coating. Recent reviews [46][47][48] , claim that an ideal material for abdominal wall reinforcement should be able to be integrated and slowly degraded while providing a matrix to native tissue growth. The ideal mesh should also show low encapsulation phenomena, low adhesiogenic potential, resistance to infections and capacity of remesothelialization.…”

Regulatory science for hernia mesh: Current status and future perspectives

“… Type of material Chemical name of material Ref. 1 Non-absorbable synthetic materials ePTFE [ 65 ] 2 PVDF [ 30 ] 3 Cross-linked acrylic polymer with polyamide [ 27 ] 4 Polyurethane [ 31 ] 5 silicone [ 66 ] 6 Absorbable synthetic materials P (LA-CL) [ 32 , 67 ] 7 P (GA-CL) [ 31 ] 8 P (GA-TMC) [ 40 ] 9 P (GA-CL-TMC-LA) [ 68 ] 10 Oxidized regenerated cellulose (ORC) [ 56 , 69 ] 11 Natural materials Bioabsorbable Oil Fatty Acid (O3FA): fatty acids, lipids and glycerides [ 31 ] 12 Cross-linked resorbable collagen film of porcine origin [ 53 ] 13 Composite materials Porcine collagen, polyethylene glycol (PEG)and glycerol …”

The Promise of viral phage therapy in hernia mesh infection, is this the biological ‘silver bullet’ of the future?

“…5,6 This is reasonable as operative care is not compromised through entrusting a registrar with either certain steps of a procedure or even the whole operation under supervision of the consultant. [7][8][9] Training in private practice appears very achievable in modern day surgical practice, given that patients understand they receive care from a team of individuals led by their specialist. The key to ongoing involvement of registrars in these operations is a preoperative discussion between the surgeon and patient about how their care will not be adversely affected from the trainee's involvement in the procedure.…”

“…Some advocate biologics in high-risk situations; however, break down after implantation with the potential for hernia recurrence has plagued this mesh type. 9 Minimally invasive surgery such as laparoscopic or robotic reduces risk of infection. 10 Antibiotics used prophylactically 11 do not cover all possible organisms.…”