H E R N I A
R E P A I R
PATCH WORK Mesh fixation — with tacks or sutures — depends on the type of defect that needs repairing.
1. Mesh choice
There are 3 synthetic materials used to make meshes, and each comes with its own benefits and drawbacks.
• Polypropylene meshes are nonabsorbable, heavyweight options with small to medium pores. The heavy weight provides high tensile strength. The large mass of material activates profound tissue reaction and dense scarring which, in turn, can limit elasticity and can restrict abdominal distention. The smaller pores of heavyweight meshes lead to more shrinkage in the body due to the formation of scar plate. These meshes also produce dense adhesions, but have low infection risks.
• Polyester meshes are also non-absorbable, but with medium weight and large pores, features that allow increased soft tissue in-growth. These meshes are more elastic because they tend to avoid the granuloma bridging (a reaction to a foreign body) that leads to stiff scar plate and reduced flexibility. These meshes have a low infection risk and lower inflammatory responses than polypropylene meshes. However, polyester meshes degrade over the long term, perhaps the result of hydrolysis, which results in brittleness and loss of mechanical strength. Polyester meshes are less likely to cause seroma because of their large pores.
