Recent Development in Prosthetic Mesh Materials

Wai Keong WONG Associate Professor and Head Department of General Surgery Singapore General Hospital Visiting Consultant National Cancer Centre Singapore

Hernia repair

Prosthetic Mesh Repair

Mesh is used increasingly in hernia repair Rationale of using prosthetic mesh - provides tension free repair - provides a matrix for host fibroblast ingrowth which will add further strength to the repair Shown to improve recurrence rate by 30 to 50%

Hernia repair

Prosthetic Mesh Repair

Properties of ideal Mesh 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. Not physically modified by body tissue fluids Chemically inert Not causing hypersensitivity Does not excite inflammatory foreign tissue reaction High tensile strength Capable of being fabricated in the form required Can be sterilized Non-carcinogenic Resistant to infection Barrier to adhesion Cost-effective

Hernia repair

Prosthetic Mesh

Three types of prosthetic mesh 1. 2. 3. Polyester(Dacron) mesh Polypropylene mesh expanded polytetrafluoroethylene mesh(ePTFE)

Hernia repair

Prosthetic Mesh

Polyester(Dacron) mesh Braided, multifilament, macroporous fibers The mesh is knitted Satisfy most mesh criteria

Hernia repair

Prosthetic Mesh
Polypropylene (PPM) mesh More pliable and readily fit into any defect size More tolerant of bending Minimal discomfort to patient Minimal infection rate Less predispose to sinus tract formation High tensile strength

Premilene, Optilene, Marlex, Prolene, Surgipro,

Premilene Mesh

Hernia repair

Prosthetic Mesh

Disadvantages of Polypropylene (PPM) mesh Wound sepsis Bowel fistulaption Adhesion in the abdominal cavity Induces fairly intense inflammatory response and foreign body response Results in dense incorporation of mesh into surrounding tissue Forming a firm and contracted/shortening of mesh

Premilene Mesh

Premilene Mesh

The fine traditional distinction

Aesculap Division

Hernia repair

Prosthetic Mesh
expanded Polytetrafluoroethylene mesh(ePTFE) Rapidly incorporated into the host tissue Minimal inflammatory reaction Minimal infection rate No erosion into bowel

Disadvantage Cost Difficult to handle Not macroporous Gore-Tex

Gore Dual Mesh

2 sided PTFE mesh Textured surface on one side, smooth on the other Good when adhesions are not wanted For incisional and ventral hernias Plus version has chlorhexidine and silver for infection resistance

Aesculap Division

Hernia repair

Prosthetic Mesh
Hybrid prosthesis Composix mesh Composite mesh

Hernia repair

Prosthetic Mesh
Hybrid prosthesis Composix mesh combination of polypropylene mesh that has a thin coat of ePTFE on one side to overcome crumpling effect of ePTFE mesh

BARD

Composix Mesh

-Low porosity ePTFE layer minimizes the risk of adhesion in case of viscera exposure to the mesh -Submicronic porosity ePTFE minimizes the chance of bacterial harbouring

Aesculap Division

Hernia repair

Prosthetic Mesh
Hybrid prosthesis Composite mesh Polypropylene and polyglactin mesh macroporous More pliable while maintaining its tensile strength

Cost Example : Vipro

Hernia repair

Prosthetic Mesh
Bioresorbable Mesh coating of a thin bioresorbable fabric layer on polypropylene mesh Separates the mesh from abdominal viscera reduces the incidence of adhesion for incisional hernia

Cost Examples : Sepracoat, Proceed

Ethicon

Proceed Mesh

Aesculap Division

Heavyweight small porous vs Lightweight large porous mesh Heavy small porous mesh-currently used mesh

closely knitted with small pores < 1 mm size high tensile strength to provide support intense foreign body reaction giving additional support but give rise to scarring and discomfort

Heavyweight small porous vs Lightweight large porous mesh Lightweight mesh

Minimal foreign body reaction because of reduced amount of material and decreased surface area in contact with recipient reduced tensile strength required lighter, more pliable and more comfortable causes less contraction or shrinkage of the mesh allows for better tissue incorporation with the host

Heavyweight small porous vs Lightweight large porous mesh

Optilene Mesh LP Lightweight Polypropylene Mesh

The champion of the lightweights

Aesculap Division

Optilene Mesh LP
Product features

Material

Monofilament Polypropylene

Construction Knitted Weight Pore Size Thickness

Aesculap Division

36 g/m2 1.0 mm 0,39mm

Lightweight large porous mesh

Optilene Mesh LP Lightweight Polypropylene Mesh

Premilene Mesh

Material Construction Weight Thickness Pore size

Monofilament Polypropylene Knitted 82 g/m 0.48 mm 0.8 mm Premilene Mesh should not be implanted in infected areas as well as in children during the

Contraindications contaminated and growth phase Sterilization

Ethylene oxide

Aesculap Division

Hernia repair

Prosthetic Mesh
Special designed mesh Prolene Hernia System Precut mesh for inguinal hernia

Cost

Hernia repair

Precut Premilene Mesh

Mesh Plug Designs

B Braun Plug System Bard PerFix Plug Ethicon Prolene Hernia System - 1997 Tyco USSC HerniaMate - 1999

Aesculap Division

Premilene Mesh Self-Forming Plug

Aesculap Division

BARD Marlex Mesh Perfix Plug

Aesculap Division

Ethicon Meshes

PROLENE Hernia System Pre-formed mesh plug for direct and indirect hernias

Aesculap Division

Summary

1. 2. 3. 4.

Mesh is used increasingly in hernia repair both in inguinal and ventral hernia Many types of mesh available in the market Many changes have taken place in the development of mesh We must know the various types of mesh available, knowing their properties well so that we can decide which is best suited for the individual