Recent Development in Prosthetic Mesh Materials

Wai Keong WONGAssociate Professor and Head

Department of General SurgerySingapore General Hospital

Visiting ConsultantNational 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. Not physically modified by body tissue fluids2. Chemically inert3. Not causing hypersensitivity4. Does not excite inflammatory foreign tissue reaction5. High tensile strength6. Capable of being fabricated in the form required7. Can be sterilized8. Non-carcinogenic9. Resistant to infection10. Barrier to adhesion11. Cost-effective

Hernia repair

Prosthetic Mesh

Three types of prosthetic mesh

1. Polyester(Dacron) mesh2. Polypropylene mesh3. 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 ® Mesh

Premilene, Optilene, Marlex, Prolene, Surgipro,

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

Aesculap Division

Premilene ® Mesh

The fine traditional distinction…

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

Aesculap Division

• 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

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

Aesculap Division

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

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

Aesculap Division

Ethicon

Proceed Mesh

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

Aesculap Division

Optilene® Mesh LPLightweight Polypropylene Mesh

The champion of the lightweights…

Optilene® Mesh LP

Aesculap Division

• Material Monofilament Polypropylene

• Construction Knitted

• Weight 36 g/m2

• Pore Size 1.0 mm

• Thickness 0,39mm

Product features

Lightweight large porous mesh

Optilene® Mesh LPLightweight Polypropylene Mesh

Aesculap Division

Premilene® MeshMesh

Material Monofilament Polypropylene

Construction Knitted

Weight 82 g/m²

Thickness 0.48 mm

Pore size 0.8 mm

Contraindications Premilene® Mesh should not be implanted in contaminated and infected areas as well as in children during the growth phase

Sterilization Ethylene oxide

Hernia repair

Prosthetic Mesh

Special designed mesh

• Prolene Hernia System • Precut mesh for inguinal hernia

Cost

Hernia repair

Precut Premilene Mesh

Aesculap Division

Mesh Plug DesignsMesh Plug Designs

• Bard PerFix Plug• Ethicon Prolene Hernia System - 1997• Tyco – USSC –HerniaMate - 1999

•B Braun Plug System

Aesculap Division

Premilene® Mesh Self-Forming Plug

BARD

Aesculap Division

Marlex Mesh Perfix Plug

Aesculap Division

Ethicon Meshes

PROLENE Hernia System

• Pre-formed mesh plug for direct and indirect hernias

Summary

1. Mesh is used increasingly in hernia repair both in inguinal and ventral hernia

2. Many types of mesh available in the market3. Many changes have taken place in the development of

mesh4. 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