Hernia Mesh
There is a lot of press surrounding mesh. What is it? Why do we use it? Is it safe?
We know more about mesh, the different types and their indications than most hernia surgeons. This is because we are very uniquely in tune with the needs of our patient. We only want the best. Also, we are at the forefront of technology–companies come to us to seek our input on their mesh product. So, we always have the most advanced technology available to our patients.Let’s define what mesh is: It is a physical barrier that we use to bridge or cover or support a hernia. Some form of mesh product has been used since early 1900’s. It has evolved a lot since then, and it continues to evolve. That is what is so exciting about the hernia field!Mesh products may be synthetic, biologic (non-synthetic), or a combination (hybrid). They may be permanent or absorbable. They may be microporous or macroporous. They may come in sheets or braided. They have different densities and weights.Each mesh product has its own profile and each patient may benefit from a different aspect of a product. We don’t believe in one mesh fits all. In fact, we promote non-mesh repairs when appropriate.
This is the most common mesh type. It is mass-produced and easy to access. Most are made of polypropylene. Other materials include ePTFE, polyester, PVDF, or a combination thereof. Almost all are permanent, though new products are now available that are synthetic absorbables.
In general, permanent synthetic mesh is considered the standard product for hernia repair. They come in a variety of shapes, sizes, braids, sheets, porosities, densities, and weights.
Almost all synthetic mesh causes some sort of inflammation reaction. This triggers the body to start growing into it. The more inflammation, the stronger the mesh:tissue bond. The tendency in newer products is to move away from causing too much inflammation, as this may cause more pain after surgery. Newer products are lower in their inflammatory potential. That said, they may also therefore stick less to the surrounding tissue and possibly also cause to have a higher recurrence rate. Studies are not yet conclusive.
This is usually non-synthetic, usually harvested from cadavers (human or animal). Unlike most synthetic mesh, biologic mesh absorbs. They are not permanent. Thus, they result in a higher recurrence rate when compared to synthetic mesh.
Biologic mesh promote tissue growth onto their scaffold. They are typically indicated for placement when synthetic mesh is contraindicated, such as in infected or contaminated areas. We have a lot of experience treating patients with infected mesh complications. We implant biologic mesh as part of our algorithm for treating this complex set of patients.
Most high quality biologic mesh do not inflict much inflammatory potential. Thus, there is less pain associated with its implantation. We sometimes rely on biologic mesh for this purpose and have used it in those with chronic pain risks.
These are new to the market. They are a combination of synthetic and biologic mesh. We are very excited about the potential of these products. They give us an opportunity to implant a low inflammatory product (due to the biologic) but theoretically with lower risk for recurrence (due to the small amount of synthetic that is left behind).
Dr. Towfigh debates use of Biologic Mesh for hernia repair
What is Mesh Implant Illness?
Just as not all mesh are created equal, not all patients react the same to mesh products. Mesh Implant Illness (MII) is a subtype of ASIA (Autoimmune/Autoinflammatory Syndrome Induced by Adjuvants) which describes the systemic (total body, not local) reaction a patient may have to mesh as a foreign body. Dr. Towfigh is at the forefront of studying MII, including who may be at risk, which meshes and sutures are least reactive, and thus tailoring hernia repair to your needs with the goal of reducing MII. You can read more about MII here. If you feel you may have MII or any other type of reaction to a foreign body, we encourage you to participate in our anonymous study so that we can help others:
Dr. Towfigh discusses Mesh Implant Illness.
