The lightweight and large porous mesh concept for hernia repair

Abstract

In modern hernia surgery, there are two competing mesh concepts which often lead to controversial discussions, on the one hand the heavyweight small porous model and on the other, the lightweight large porous hypothesis. The present review illustrates the rationale of both mesh concepts and compares experimental data with the first clinical data available. In summary, the lightweight large porous mesh philosophy takes into consideration all of the recent data regarding physiology and mechanics of the abdominal wall and inguinal region. Furthermore, the new mesh concept reveals an optimized foreign body reaction based on reduced amounts of mesh material and, in particular, a significantly decreased surface area in contact with the recipient host tissues by the large porous model. Finally, recent data demonstrate that alterations in the extracellular matrix of hernia patients play a crucial role in the development of hernia recurrence. In particular, long-term recurrences months or years after surgery and implantation of mesh can be explained by the extracellular matrix hypothesis. However, if the altered extracellular matrix proves to be the weak area, the decisive question is whether the amount of material as well as mechanical and tensile strength of the surgical mesh are really of significant importance for the development of recurrent hernia. All experimental evidence and first clinical data indicate the superiority of the lightweight large porous mesh concept with regard to a reduced number of long-term complications and particularly, increased comfort and quality of life after hernia repair.

Elongation of textile pelvic floor implants under load is related to complete loss of effective porosity, thereby favoring incorporation in scar plates

“…Porosity has been identified to be decisive for proper tissue integration. 9,10 In small pores, the foreign body reaction bridges from one filament to the other and leads to pores completely filled with scar, whereas in structures with sufficiently large pores local physiologically regenerated tissue, for example, fat can be seen. Large pores with a diameter of more than 1000 mm for polypropylene or 600 mm for polyvinyl fluoride have been found to prevent the undesirable bridging of scar tissue throughout the pore.…”

Colonization by human fibroblasts of polypropylene prosthesis in a composite form for hernia repair

“…Heavyweight 4 meshes have greater tensile strength than lightweight meshes, but cause a more intense foreign-body reaction, produce greater shrinkage than lightweight meshes, and are stiffer [9]. Lightweight meshes are designed to mimic the physiology of the abdominal wall, and their tensile strength is adapted to that of tissue [10]. When placed in contact with abdominal viscera, however, macroporous meshes are associated with the formation of bowel adhesions and obstructions, and enterocutaneous fistulae [11].…”

Prospective study on the effects of a polypropylene prosthesis on testicular volume and arterial flow in patients undergoing surgical correction for inguinal hernia

“…Every year, more than one million polypropylene prostheses are implanted for treating hernias around the world 1,2 . Over the evolution of treatments for inguinal hernia, it has been discovered that the use of prostheses is fundamental for obtaining low recurrence rates and high satisfaction rates 3,4,5 .…”