H E R N I A
R E P A I R
COATED MESHES
Fewer Adhesions, Less Infection?
There are various types of composite meshes with coatings for intra-peritoneal use. First among them: ePTFE mesh, which comes impregnated with antiseptic to minimize infection. I sometimes use this mesh for diaphragmatic hernias.
One composite, partially absorbable, polyester mesh comes covered on 1 side with a bovine-collagen coating and anti-adhesion films of polyethylene glycol and glycerol. However, the anti-adhesion property is thought to be of shortterm benefit. I occasionally use this mesh for incisional or abdominal wall hernias. My preference is always to fix these defects with primary repair — including component release — as necessary to achieve a tension-free hernia repair.
When the abdominal wall is too thin, denervated, devascularized or attenuated, however, I'd use the same material with an underlay mesh technique to reinforce the repair. The anti-adhesion film is then placed on the bowel side. For hernias that cannot be repaired primarily with bilateral flaps and component release, I'd use this mesh to bring the fascial edges together with running
sutures and in a tension-free manner. Other coated meshes, such as polypropylene and sodium-based coated options, or polypropylene/ omega-3 composite mesh, seem to have only short-term benefits. For example, the former's coating turns into gel in 48 hours; the gel remains on the mesh for 1 week to allow reepithelialization.
— Sharona B. Ross, MD
