Emerging Trends in Abdominal Wall Reinforcement: Bringing Bio‐Functionality to Meshes

Abstract

Abdominal wall hernia is a recurrent issue world-wide and requires the implantation of over 1 million meshes per year. Because permanent meshes such as polypropylene and polyester are not free of complications after implantation, many mesh modifications and new functionalities have been investigated over the last decade. Indeed, mesh optimization is the focus of intense development and the biomaterials utilized are now envisioned as being bioactive substrates that trigger various physiological processes in order to prevent complications and to promote tissue integration. In this context, it is of paramount interest to review the most relevant bio-functionalities being brought to new meshes and to open new avenues for the innovative development of the next generation of meshes with enhanced properties for functional abdominal wall hernia repair.

Design strategies and applications of biomaterials and devices for Hernia repair

“…Commonly used mesh prosthetic materials, such as polypropylene (PP), polyethylene-terephthalate (PET), and ePTFE, produce varying FBRs due to differing physiochemical properties on the surface of the implant [31]. Alternatively, biologically derived meshes are capable of displaying diminished FBR, particularly in the long term, due to their improved integration with neo-tissue and the presence of bioactive signals and growth factors within the bio-derived materials [33]. Moreover, researchers have deduced relationships between prosthesis design and host response that may act to counter some of the adverse reactions produced from the materials inherent chemical properties.…”

“…Abdominal adhesions are estimated to occur in 90% of all abdominal wall repair procedures and involve irregular fibrous strands that attach between tissues and organs within the abdominal cavity and the prosthesis [39]. The adhesions formed within the abdominal cavity progress to the formation of collagen dense extra-cellular matrix (ECM) which effectively closes the gap between internal viscera and prosthetic [33]. The occurrence of adhesions in hernia repair is predicated around the introduction of foreign bodies to injured peritoneal surfaces within the abdominal cavity [8, 40, 41].…”

“…The occurrence of adhesions in hernia repair is predicated around the introduction of foreign bodies to injured peritoneal surfaces within the abdominal cavity [8, 40, 41]. The formation of adhesion sites within the abdominal cavity can cause chronic abdominal pain, bowel obstructions and perforations, enterocutaneous fistulae, as well as migration of prosthesis, and is responsible for 15-20% of female infertility cases [12, 28, 33, 38, 42-44]. Design and construction parameters of biomaterial prostheses can influence the development of adhesions as well as the production of neoperitoneum, which is formed between the material and visceral peritoneum [28].…”

“…The introduction of a non-native prosthetic material into the human body is quickly followed by a systematic foreign body response activated by the host's immune system. Consequently, the resultant FBR associated with hernia repair can manifest into severe problems such as seroma formation, mesh shrinkage or encapsulation, tissue degradation and chronic pain [33]. At present, the most common treatment options for hernia repair involve the use of prosthetic biomaterials (absorbable, non-absorbable, composite, coated, impregnated), xenografts and allografts [10].…”

“…Since its inception in the early 1960s, polypropylene has remained the most commonly used synthetic biomaterial for hernia repair [51]. Although all of the aforementioned materials are readily available in a clinical setting as a result of their alleged biocompatibility and inertness, some studies suggest these materials may activate certain histopathological processes and immune reactions upon implantation [33]. …”