Biologic Response of Inguinal Hernia Prosthetics: A Comparative Study of Conventional Static Meshes Versus 3D Dynamic Implants

Abstract

Despite improvements in prosthetics and surgical techniques, the rate of complications following inguinal hernia repair remains high. Among these, discomfort and chronic pain have become a source of increasing concern among surgeons. Poor quality of tissue ingrowth, such as thin scar plates or shrinking scars-typical results with conventional static implants and plugs-may contribute to these adverse events. Recently, a new type of 3D dynamically responsive implant was introduced to the market. This device, designed to be placed fixation-free, seems to induce ingrowth of viable and structured tissue instead of regressive fibrotic scarring. To elucidate the differences in biologic response between the conventional static meshes and this 3D dynamically responsive implant, a histological comparison was planned. The aim of this study was to determine the quality of tissue incorporation in both types of implants excised after short, medium, and long periods post-implantation. The results showed large differences in the biologic responses between the two implant types. Histologically, the 3D dynamic implant showed development of tissue elements more similar to natural abdominal wall structures, such as the ingrowth of loose and well-hydrated connective tissue, well-formed vascular structures, elastic fibers, and mature nerves, with negligible or absent inflammatory response. All these characteristics were completely absent in the conventional static implants, where a persistent inflammatory reaction was associated with thin, hardened, and shrunken fibrotic scar formation. Consequently, as herniation is a degenerative process, the 3D dynamic implants, which induce regeneration of the typical groin components, seem to address its pathogenesis.

Neomyogenesis in 3D Dynamic Responsive Prosthesis for Inguinal Hernia Repair

“…The hard, fibrotic plaque sharply contrasts with the highly motile behavior of the inguinal area, sometimes leading to painful impairment of groin movements. In literature, this feature is thought to be related to the static nature of the flat meshes which, incorporated by motionless and rigid tissue elements, impede the regular muscle function of the repaired groin . Furthermore, recent studies concerning the pathogenesis of hernia disease have demonstrated the degenerative source of inguinal protrusions .…”

Foramen epiploicum mesh closure (FEMC) through a ventral midline laparotomy

“…The concept of three-dimensional meshing without additional methods of fixation has gained popularity in human medicine in recent years. Fixation-free three-dimensional meshing induces ingrowth of viable and structured tissue instead of regressive fibrotic scarring causing pain, which is often encountered when fixed static implants are used [15]. Clinical outcome using this meshing concept was considered excellent in human inguinal hernia repair [16].…”

“…The estimated median dimension of the EF was 3 (2-4) fingers corresponding to a median circumference of 12 (8)(9)(10)(11)(12)(13)(14)(15)(16) cm measured on the fingers of a 7.5 gloved surgeon.…”

Combined inguinal hernia in the elderly. Portraying the progression of hernia disease

“…Recently, another hernia repair concept has been developed, concerning the obliteration of the hernia opening by means of 3D dynamic responsive implants [21e29]. The results of this technique seems to be effective in the treatment of combined hernia thanks to the probiotic biologic response that seems to address the degenerative pathogenesis of the inguinal protrusions [30].…”