Mesh implants for hernia repair: an update

Klinge, U.; Klosterhalfen, B.

doi:10.1080/17434440.2018.1529565

Cited by 18 publications

(12 citation statements)

References 76 publications

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“…In 2012, Klinge and Klosterhalfen made a critical distinction between simple mesh porosity-the percentage area of mesh which is not covered by filaments, in contrast to the effective mesh porosity-representing only the area of "good" pores where bridging of scar tissue is avoided by sufficient inter-filamentary distance [25]. Furthering this concept, in 2019 Jacombs et al determined that if the effective porosity is reduced due to mesh construct, surgical technique or axial loading such that it results in decreased mesh tissue integration, then contamination with biofilm formation may become significant and problematic [1].…”

Section: Discussionmentioning

confidence: 99%

Are late hernia mesh complications linked to Staphylococci biofilms?

Patiniott

Jacombs

Kaul

et al. 2022

Hernia

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Purpose The purpose of this study was to investigate the link between bacterial biofilms and negative outcomes of hernia repair surgery. As biofilms are known to play a role in mesh-related infections, we investigated the presence of biofilms on hernia meshes, which had to be explanted due to mesh failure without showing signs of bacterial infection. Methods In this retrospective observational study, 20 paraffin-embedded tissue sections from explanted groin hernia meshes were analysed. Meshes have been removed due to chronic pain, hernia recurrence or mesh shrinkage. The presence and bacterial composition of biofilms were determined. First, specimens were stained with fluorescence in situ hybridisation (FISH) probes, specific for Staphylococcus aureus and coagulase-negative staphylococci, and visualised by confocal laser scanning microscopy. Second, DNA was extracted from tissue and identified by S. aureus and S. epidermidis specific PCR. Results Confocal microscopy showed evidence of bacterial biofilms on meshes in 15/20 (75.0%) samples, of which 3 were positive for S. aureus, 3 for coagulase-negative staphylococci and 9 for both species. PCR analysis identified biofilms in 17/20 (85.0%) samples, of which 4 were positive for S. aureus, 4 for S. epidermidis and 9 for both species. Combined results from FISH/microscopy and PCR identified staphylococci biofilms in 19/20 (95.0%) mesh samples. Only 1 (5.0%) mesh sample was negative for bacterial biofilm by both techniques. Conclusion Results suggest that staphylococci biofilms may be associated with hernia repair failure. A silent, undetected biofilm infection could contribute to mesh complications, chronic pain and exacerbation of disease.

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Section: Discussionmentioning

confidence: 99%

Are late hernia mesh complications linked to Staphylococci biofilms?

Patiniott

Jacombs

Kaul

et al. 2022

Hernia

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“…In the case of hernia and PFDs, an excessive production of fibrotic tissue may cause native tissue erosion with the subsequent extrusion (or migration) of the mesh [3,5]. Moreover, the formation of the fibrotic capsule is often linked to a reduction of the available mesh area, also known as mesh contraction [5,62]. Similarly, for breast reconstructive meshes the intense immune reaction may promote capsular contracture, which in turn could result in pain and breast deformation [63].…”

Section: Mesh-related Complicationsmentioning

confidence: 99%

“…However, meshes based on absorbable polymeric materials have showed several issues, especially with regards to hernia and PFDs. In fact, due to polymer degradation, it is very likely that the use of these implants is accompanied by loss of tensile strength and subsequent mechanical failure [5]; additionally, rapid absorption rates could potentially lead to the formation of a very poor scar tissue [62].…”

Section: Absorbable Synthetic Materialsmentioning

confidence: 99%

Next-generation surgical meshes for drug delivery and tissue engineering applications: materials, design and emerging manufacturing technologies

2021

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Surgical meshes have been employed in the management of a variety of pathological conditions including hernia, pelvic floor dysfunctions, periodontal guided bone regeneration, wound healing and more recently for breast plastic surgery after mastectomy. These common pathologies affect a wide portion of the worldwide population; therefore, an effective and enhanced treatment is crucial to ameliorate patients’ living conditions both from medical and aesthetic points of view. At present, non-absorbable synthetic polymers are the most widely used class of biomaterials for the manufacturing of mesh implants for hernia, pelvic floor dysfunctions and guided bone regeneration, with polypropylene and poly tetrafluoroethylene being the most common. Biological prostheses, such as surgical grafts, have been employed mainly for breast plastic surgery and wound healing applications. Despite the advantages of mesh implants to the treatment of these conditions, there are still many drawbacks, mainly related to the arising of a huge number of post-operative complications, among which infections are the most common. Developing a mesh that could appropriately integrate with the native tissue, promote its healing and constructive remodelling, is the key aim of ongoing research in the area of surgical mesh implants. To this end, the adoption of new biomaterials including absorbable and natural polymers, the use of drugs and advanced manufacturing technologies, such as 3D printing and electrospinning, are under investigation to address the previously mentioned challenges and improve the outcomes of future clinical practice. The aim of this work is to review the key advantages and disadvantages related to the use of surgical meshes, the main issues characterizing each clinical procedure and the future directions in terms of both novel manufacturing technologies and latest regulatory considerations. Graphic abstract

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“…[ 8,19 ] These biomechanical and inflammatory complications derived from commercial mesh implants might also depend on the magnitude of the hernia injury, previous medical history as well as health habits of the patient. [ 20 ] Therefore, the manufacturing of customized mesh implants adapted to specific hernia injury and patient necessities could avoid biomechanical and infection complications and enabling better recovery.…”

Section: Introductionmentioning

confidence: 99%

Tailor‐Made 3D Printed Meshes of Alginate‐Waterborne Polyurethane as Suitable Implants for Hernia Repair

Olmos-Juste

Olza

Gabilondo

et al. 2022

Macromolecular Bioscience

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Hernia injuries are the main condition where mesh implants are needed to provide a suitable reinforcement of the damaged tissue. Mesh implants made of polypropylene (PP) are widely used for this application, however complications related to lack of flexibility, elasticity, and mesh infection have been reported. The development of mesh implants from safer materials adaptable to patient necessities can suppose an alternative for conventional PP meshes. In this work, personalized mesh implants made of alginate and waterborne-polyurethane (A-WBPU) are developed using 3D printing technology. For that purpose, five waterborne polyurethane ink formulations with different amounts of alginate are developed and rheologically characterized. All ink formulations are 3D printed showing good printability, manufacturing surgical mesh implants with suitable morphological characteristics customizable to patient injury through computer-aided design (CAD) mesh model adaptation. A calcium chloride (CaCl 2 ) coating is applied after 3D printing as mesh reinforcement. Mechanical analysis revealed that CaCl 2 coated meshes containing 6 wt % of alginate in their formulation are the most suitable to be used as implants for small and groin hernias under physiological tensile strength value of 16 N cm −1 , and presenting proper elasticity to cover physiological corporal movements (42.57 %). Moreover, an antibiotic-loaded A-WBPU formulation suitable for 3D printing of meshes are developed as strategy to avoid possible mesh infection.

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Mesh implants for hernia repair: an update

Cited by 18 publications

References 76 publications

Are late hernia mesh complications linked to Staphylococci biofilms?

Are late hernia mesh complications linked to Staphylococci biofilms?

Next-generation surgical meshes for drug delivery and tissue engineering applications: materials, design and emerging manufacturing technologies

Tailor‐Made 3D Printed Meshes of Alginate‐Waterborne Polyurethane as Suitable Implants for Hernia Repair

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