Published online Oct 27, 2015. doi: 10.4240/wjgs.v7.i10.226
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
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.
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.