Functional impairment and complaints following incisional hernia repair with different polypropylene meshes

Abstract

The influence of mesh material on the clinical outcome of hernia repair has often been neglected, although recent studies have clearly demonstrated the importance of mesh properties for integration in the abdominal wall. Of particular significance are the amount of mesh material and the pore size. In the following study, patients received different mesh types with distinct amounts of polypropylene and of various pore sizes for incisional hernia repair. We investigated whether the type of material influenced the clinical and functional outcomes. Between 1991 and 1999, 235 patients received polypropylene meshes in a sublay position for incisional hernia repair: 115 patients were implanted with a Marlex heavy-weight mesh (Mhw mesh), 37 patients with an Atrium heavy-weight mesh (Ahw mesh) and 83 with a Vypro low-weight mesh (Vlw mesh). The study protocol included ultrasound examination and 3D-stereography in all patients, with a total follow-up of 24 +/- 13 months (Mhw-mesh), 11 +/- 8 months (Ahw-mesh) and 8 +/- 7 months (Vlw-mesh). Our findings demonstrate that the side effects of mesh implantation, comprising paraesthesia and restriction of abdominal wall mobility, were significantly affected by the type of material implanted. Three-dimensional stereographic examinations were well in accordance with our clinical findings. Our data support the hypothesis that the use of low-weight large-pore meshes is advantageous for abdominal wall function.

Lower recurrence rate with heavyweight mesh compared to lightweight mesh in laparoscopic totally extra-peritoneal (TEP) repair of groin hernia: a nationwide population-based register study

“…The IEHS’s recommendation is that meshes with large pores are more beneficial to use than meshes with more foreign body material [14]. The theory is that HWM is oversized with regards to the mechanical properties that can lead to more postoperative pain and stiffness [16, 17]. The findings are summarized from controlled-randomized studies, with short-to-medium-term results having different postoperative aspects as primary outcome [8, 18, 19].…”

Foreign Body Reaction Associated with PET and PET/Chitosan Electrospun Nanofibrous Abdominal Meshes

“…Among them, the formation of adhesions between the mesh and the bowel results in several complications, such as chronic pain, bowel obstruction or enterocutaneous fistula. Also, nonresorbable meshes have been associated with a high occurrence of chronic foreign body response and increased risk of infection [25], [26]. Improvements have been achieved by using polymer meshes that gradually degrade in vivo , promoting improved tissue integration and rapid resorption [19].…”

Effects of macroporous monofilament mesh on infection in a contaminated field

“…For macrophages, the micropores act as a filter that prevents effective phagocytosis [32]. The conclusion of Falgas’ study led to the introduction of a monofilament lightweight mesh containing less polypropylene into broad surgical practice [33]. Recently published papers by Sanders [34] and Deerenberg [35] are showing that low prosthetic load materials, i.e., lightweight meshes with large pores, may be beneficial.…”