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A B D O M I N A L
S U R G E R Y
lower risk of inflammation, but older versions of the material have
been known to degrade with time.
• ePTFE. Extended polytetrafluoroethylene (commonly known by the
brand name "Gore-Tex") is a heavyweight mesh with small pores and
a non-stick surface, which resists adhesions. It doesn't admit tissue
ingrowth, however, so the implant is encapsulated, not incorporated,
potentially resulting in more scarring and a higher infection risk than
the other 2 options, since the body's antibacterial response cannot
reach any contamination in the mesh.
Lightening the load
As mentioned above, the density of polypropylene mesh — the composition most commonly used by U.S. surgeons — can easily mar
patient outcomes with scarring, adhesions, stiffness and pain. The
development of a lightweight version aims to lessen the incidence of
such complications.
By swapping out some of the polypropylene content for resorbable
materials, manufacturers have created a less dense, more porous,
lighter-weight mesh. It's not only more flexible and more amenable to
tissue integration, but some of the material also disappears over time.
As they constitute less foreign material, lightweight meshes are
believed by a consensus of surgeons to decrease the incidence of chronic
post-op pain. While this is backed up by a number of clinical studies,
other studies exist that see no long-term difference, and it has been pointed out that lighter-weight mesh can be harder to handle and position.
Still, we've seen a trend toward the use of less dense material,
except among larger and heavier patients, in whom lightweight mesh
may tear more easily and density may be a more durable choice.
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O U T PAT I E N T S U R G E R Y M A G A Z I N E O N L I N E | S E P T E M B E R 2013
