Introduction: Since the introduction of mesh in Inguinal Hernia Repair (IHR) the recurrence rate was lowered. Instead, postoperative pain which may be related to mesh side effects e.g. fibrosis, foreign body reaction, erosion and migration, and infection, has been recognized as the relevant outcome factor. The long-term effects of mesh and composite mesh need to be analyzed.Methods: Pubmed, google scholar search using the search terms: polypropylene mesh, titanized mesh, TiMesh ® ; about polypropylene mesh the following terms: adhesion, erosion, infection, shrinkage, migration, seroma, degradation, pain; biocompatibility, foreign body reaction. Also, a bibliography of relevant articles and product-related information was searched.Results: Mesh properties are determined by tensile strength, pore size, weight, reactivity and biocompatibility, elasticity, constitution, and shrinkage. PolyPropylene Mesh (PP) is associated with actual and long-term complications more than expected. These complications are associated with mesh structure-lightweight meshes showed fewer risks for complication as infection, pain, mesh migration, foreign body response, erosion, adhesion, shrinkage, pain, seroma, and recurrence. TiMesh ® showed an advantage in in-vitro and animal studies which were supported by clinical studies. There is a shorter convalescence, and lesser foreign material sensitivity with comparable results in complications (Chronic pain, infection, recurrence).
Conclusion:Polypropylene mesh has been successful in inguinal hernia repair for decades. However, in recent years complications of PP became evident in scientific reports and the public. Complications seem to be related to the material and structure of the mesh but also to the surgeon's expertise and patient's characteristics. It became evident that more complications appear long-term. The true rate of complications could be higher. There are a few clinical reports on titanium-coated mesh (TiMesh) in TAPP and TEP inguinal hernia repair. Experience with TiMesh in laparoscopic procedures long-term and open IHR are missing. Especially about the long-term effects of coating PP with titanium we need to have a better understanding of the interaction of soft tissue and mesh. There are promising results of pure titanium mesh for inguinal hernia repair which need to be confirmed in further controlled clinical studies.