Intra Peritoneal Polypropylene Mesh and Newer Meshes in Ventral Hernia Repair: What EBM Says?

Abstract

Incisional hernias and other ventral hernias are common surgical problems. It is estimated that incisional hernia complicates about 2 % to 10 % of laparotomies. Ventral and incisional hernia repairs are among the common surgeries done by a general surgeon. It is proven beyond any doubt that suture repair of these hernias should not be done as recurrence rates are unacceptably high, some series reporting as high as 54 % on long-term follow-up. A prosthetic mesh should always be used in ventral hernia repair (VHR). Now, the polypropylene mesh (PPM) has become the prosthetic mesh of choice in the repair of hernias, including inguinal hernia. However, with the advent of laparoscopic repair where the mesh is placed intraperitoneally, concerns regarding safety of PPM are raised. Newer meshes are introduced, claiming lesser complication rate. Many types of newer meshes are available now. Newer meshes are invariably costlier than PPM by 15-20 times. Is this extra cost worth? We looked in to available literature for an answer.

Lightweight, Highly Permeable, Biocompatible, and Antiadhesive Composite Meshes for Intraperitoneal Repairs

“…However, such layer films eliminated the big pore of lightweight PP mesh and made it become nonpermeable. Moreover, the films might be more complicated and 5–20 times costlier than lightweight PP mesh . The cost of PP/PDA is estimated to be US dollar (USD) 3 cm −2 , which proves economically competitive with the advanced meshes used for ventral hernia repair today, including PCO (USD 20 cm −2 ) and biological meshes (more than USD 60 cm −2 ).…”

Single‐port laparoscopic incisional hernia repair in a horse

“…; Whitfield‐Cargile et al . ; Ramakrishna and Lakshman ). Small hernias may need surgical repair to prevent intestinal strangulation in the hernial ring (Elce et al .…”

“…In human patients, laparoscopic mesh hernioplasty is currently the preferred technique (Alexander and Scott ; Ramakrishna and Lakshman ) and, compared with the open technique, seems to be advantageous in terms of shorter rehabilitation periods, less post operative pain and minor risk of wound infection (Alexander and Scott ; Basile et al . ).…”

“…Ventral and incisional hernias are common surgical problems in large animals (Elce et al 2005;Caron and Mehler 2009;Vilar et al 2009;Whitfield-Cargile et al 2011). In horses, incisional hernias occur in 8-16% of cases after median laparotomy (Caron and Mehler 2009;Vilar et al 2009;Whitfield-Cargile et al 2011;Ramakrishna and Lakshman 2013). Small hernias may need surgical repair to prevent intestinal strangulation in the hernial ring (Elce et al 2005), while large hernias may require closure because they interfere with athletic activities or normal parturition, may worsen from repeated trauma, or are cosmetically unsightly.…”

“…Open-surgery mesh hernioplasty is not free from complications, both in man and large animals (Rijkenhuizen 2005;Kelmer and Schumacher 2008;Caron and Mehler 2009;Vilar et al 2009;Whitfield-Cargile et al 2011;Ramakrishna and Lakshman 2013).…”