Ventral Hernia Repair with Synthetic, Composite, and Biologic Mesh: Characteristics, Indications, and Infection Profile

Abstract

Synthetic PP mesh is an appropriate, durable material for extra-peritoneal placement in uncomplicated, clean VHR. Expanded polytetrafluoroethylene and composite meshes are suitable for intraperitoneal placement during laparoscopic VHR. Biologic meshes may be appropriate for contaminated fields or other special situations, but there is no consensus on when or how to use them.

Comparison between polypropylene and polypropylene with poliglecaprone meshes on intraperitoneal adhesion formation

“…The intraperitoneal use of surgical meshes in the repair of incisional hernias can induce the formation of adhesions, intestinal obstruction and fistulae 5,6 .…”

“…Thus, by being in contact with abdominal structures, they have brought complications such as adhesions, fistulae and intestinal obstructions 5,6 .…”

Innovative Modifications for Preventing Mesh Infections

“…Physicochemical properties of the mesh determine the extent of bacterial adhesion and biofilm production. Chemical composition, electrical charge, hydrophobicity, surface roughness and porosity of the biomaterial surface also condition its bio-receptivity [53][54][55][56].…”

Surgical mesh for ventral incisional hernia repairs:Understanding mesh design

“…Many composite meshes are 'biface implants' -meshes with a porous external surface to encourage tissue integration and a smooth microporous internal surface to prevent adhesions when placed in contact with viscera. The external surface generally consists of a nondegradable synthetic material, while the visceral surface can be any combination of degradable or nondegradable, synthetic or biological materials, such as polyglactin, collagen, polyglecaprone, cellulose, titanium, omega-3, monocryl, polyvinylidene fluoride and hyaluronate (47,48). Another group of composite meshes are not biface, but rather consist of a nondegradable synthetic mesh with a temporary barrier coating (48).…”

“…The external surface generally consists of a nondegradable synthetic material, while the visceral surface can be any combination of degradable or nondegradable, synthetic or biological materials, such as polyglactin, collagen, polyglecaprone, cellulose, titanium, omega-3, monocryl, polyvinylidene fluoride and hyaluronate (47,48). Another group of composite meshes are not biface, but rather consist of a nondegradable synthetic mesh with a temporary barrier coating (48). Temporary barrier coated meshes have a barrier coating that is degradable and consists of a material that discourages adhesion formation, usually hydrophilic coatings such as collagen.…”