Though widely considered the “industry standard,” using mesh for hernia repair is still a relatively new practice. The idea itself is simple and straightforward: a material is used to reinforce the abdominal wall, engaging the body’s natural creation of scar tissue—essentially, creating a “scaffold” for the patient’s body to produce new (scar) tissue, incorporating the “scaffolding” at the repair site. From this simple idea, many complex types of surgical products have been created to meet medical demand.
Physicians and biomedical engineers agree that at present, there is no “ideal” product, prompting the invention of composites. Composites are made from polypropylene, polyester, or ePTFE—often in combination with titanium, omega 3, monocryl, PVDF, and hyaluronate. All these materials have proven to have disadvantages, including infection, adhesions, hernia recurrence, and chronic pain.
Absorbable, with low infection risk, primarily used in situations where infection is already present. Not suited for extraperitoneal spaces, because they tend to produce adhesions; often subject to long-term degradation.
Readily colonized by the host, and can also be used to repair contaminated wounds. At first, the product is strong, but weakens through remodeling and repair.
Best-suited for intraperitoneal use, composites are ultra-lightweight with large pores and are infused with other materials to minimize risk of infection, adhesion, or rejection. Additives include: antiseptics, collagen, anti-adhesives, cellulose, PVDF, re-epithelization materials, titanium, and omega-3 acids.
Primary suture repair is the worldwide standard for reparative surgery, classified as tension or tension-free, using sutures (absorbable or nonabsorbable.)
Other alternatives include laparoscopic (TAPP), endoscopic (TEP), and laparoscopic fundoplication repairs. The TAPP approach is a straightforward laparoscopic procedure, though there is a risk for bowel/vascular injury. TEP repairs implement a surgical balloon, creating a laparoscopic “workspace” and minimize risk of bowel injury. Laparoscopic fundoplication involves a portion of the stomach wrapped around the affected part of the esophagus and sutured into place, and can also be used to buttress hiatal hernias closed with primary sutures. Benefits include smaller incisions, lowered risk of infection, recurrence prevention, less pain, and quicker returns to work.
