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