Evolution and advances in laparoscopic ventral and incisional hernia repair

Table 2 Advantages and disadvantages of commonly used composite meshes

Mesh	Abdominal wall side/visceral side	Advantages	Disadvantages
Composite meshes[24]	Permanent mesh/anti-adhesion barrier	Permanent mesh for inflammation, fibrosis, and abdominal wall ingrowth and strength	No level I evidence of the superiority of one mesh over another. Some differences have been noted in animal models, although adhesion prevention is similar for most[28]. A multi-center, human study is underway to better determine the characteristics of these composite meshes (NCT01355939)[29]
		Visceral side designed to prevent adhesion related complications
Dualmesh[25]	Micropore ePTFE/Macropore ePTFE	Minimal inflammatory reaction[22]	PTFE has higher rates of bacterial adherence and less resistant to colonization[31,32]
		Adhesions less tenacious than all other meshes[24,30]	Higher risk of explantation in open cases (14.2%), but not laparoscopic cases (4.6%)[32]
		Less adhesiolysis time/mesh surface area compared to composix[24]	Limited fibrous tissue ingrowth and incorporation[22]
Composix™[25]	PP/ePTFE	PP thought to promote better ingrowth and inflammation	Adhesions predominately found due to mesh eversion at periphery[24]
			Possible increased infection risk (8% in one series)[33]
Parietex[30]	PET/type I collagen, polyethylene glycol, and glycerol	United States evaluation showed adhesions in 18% of patients, vs 77% when uncoated PE was used	Collagen film absorbed quickly (20 d)[34]
Proceed[30]	PP encapsulated by PDS/oxidized regenerated cellulose	Lightweight, macro-porous mesh[34]	Incomplete peritoneal mesothelialization over graft
			Induced dense adhesions in rabbit models[35]
C-QUR[30]	PP/omega 3 fatty acid gel	Less contracture in rabbit model[30]	Poor incorporation strength in rat model[28]
Sepramesh[25]	PP/sodium haluronate and carboxy - methylcellulose	Low adhesion coverage and good incorporation[28]	Inflammation induces breakdown of the coating, resulting in delayed adhesion formation[28]

ePTFE: Expanded polytetrafluoroethylene; PDS: Polydioxanone; PE: Polyester; PET: Polyethylene terephthalate; PP: Polypropylene.