Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Oct 27, 2015; 7(10): 226-236
Published online Oct 27, 2015. doi: 10.4240/wjgs.v7.i10.226
Mesh implants: An overview of crucial mesh parameters
Lei-Ming Zhu, Philipp Schuster, Uwe Klinge
Lei-Ming Zhu, Department of Surgery, Tongren Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200336, China
Philipp Schuster, FEG Textiltechnik mbH, 52074 Aachen, Germany
Uwe Klinge, Department for General, Visceral and Transplant Surgery, the University Hospital of the RWTH Aachen, 52074 Aachen, Germany
Author contributions: Zhu LM and Schuster P conceived the study and wrote the manuscript; Klinge U reviewed the manuscript and made valuable contributions to the intellectual content and structure of the paper.
Conflict-of-interest statement: Lei-Ming Zhu declares no conflict of interest. Philipp Schuster is an employee of FEG Textiltechnik mbH, Aachen, Germany. Uwe Klinge received fees for serving as a speaker, a consultant for FEG Textiltechnik mbH, and an expert in litigation. Uwe Klinge received research funding from the German government and commercial manufacturers.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Uwe Klinge, Professor, Med, Department for General, Visceral and Transplant Surgery, the University Hospital of the RWTH Aachen, Pauwelsstraβe 30, 52074 Aachen, Germany. uklinge@ukaachen.de
Telephone: +49-241-8089352 Fax: +49-241-8082442
Received: April 10, 2015
Peer-review started: April 11, 2015
First decision: June 24, 2015
Revised: August 24, 2015
Accepted: September 25, 2015
Article in press: September 28, 2015
Published online: October 27, 2015
Processing time: 206 Days and 8.4 Hours
Abstract

Hernia repair is one of the most frequently performed surgical interventions that use mesh implants. This article evaluates crucial mesh parameters to facilitate selection of the most appropriate mesh implant, considering raw materials, mesh composition, structure parameters and mechanical parameters. A literature review was performed using the PubMed database. The most important mesh parameters in the selection of a mesh implant are the raw material, structural parameters and mechanical parameters, which should match the physiological conditions. The structural parameters, especially the porosity, are the most important predictors of the biocompatibility performance of synthetic meshes. Meshes with large pores exhibit less inflammatory infiltrate, connective tissue and scar bridging, which allows increased soft tissue ingrowth. The raw material and combination of raw materials of the used mesh, including potential coatings and textile design, strongly impact the inflammatory reaction to the mesh. Synthetic meshes made from innovative polymers combined with surface coating have been demonstrated to exhibit advantageous behavior in specialized fields. Monofilament, large-pore synthetic meshes exhibit advantages. The value of mesh classification based on mesh weight seems to be overestimated. Mechanical properties of meshes, such as anisotropy/isotropy, elasticity and tensile strength, are crucial parameters for predicting mesh performance after implantation.

Keywords: Hernia repair; Hernia mesh; Incontinence mesh implant; Synthetic mesh; Mesh properties; Textile structure; Structure parameters; Mechanical parameters; Mesh weight; Synthetic raw materials

Core tip: Hernia repair is one of the most frequently performed surgical interventions that use mesh implants. This article evaluates crucial mesh parameters to facilitate selection of the most appropriate mesh implant based on raw material, mesh composition, and structural and mechanical parameters. The structural parameters of the mesh, especially the porosity, are the most important predictors of the biocompatibility performance of synthetic meshes. Monofilament large-pore meshes exhibit less inflammatory infiltrate, connective tissue and scar bridging, which allows increased soft tissue ingrowth. The value of mesh classification based on the mesh weight seems to be overestimated. Other properties, such as the isotropy, elasticity and tensile strength, are crucial parameters for predicting the performance of meshes after implantation.