Hernia repair: the search for ideal meshes

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Abstract

Background

Effective repair of hernia is a difficult task. There have been many advances in hernia repair techniques over the past 50 years, but new strategies must be considered to enhance the success of herniorrhaphy.

Discussion

At the 30th International Congress of the European Hernia Society, nine experts in hernia repair and experimental mesh evaluation participated in a roundtable discussion about today’s unmet needs in hernia repair, including what constitutes an “ideal” hernia repair and the portfolio of “ideal” mesh prostheses. Defining characteristics of lightweight mesh, mesh alternatives, the surgeon’s role in hernia repair, adverse events, the unmet requirements for today’s hernia repair, and optimized animal models were among the topics discussed.

Conclusion

The ideal mesh’s construction is still in progress, but greater understanding of its critical characteristics was explored. It is hoped that these suggestions will lead to the development of improved hernia treatments and a maximally effective portfolio of hernia mesh prostheses.

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Most cited references 22

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Classification of biomaterials and their related complications in abdominal wall hernia surgery

P Amid (1997)

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Comparison of generic versus specific quality-of-life scales for mesh hernia repairs.

Amy Lincourt, W. W. Hope, Yuri W Novitsky … (2008)

With the use of mesh shown to considerably reduce recurrence rates for hernia repair and the subsequent improvement in clinical outcomes, focus has now been placed on quality-of-life outcomes in patients undergoing these repairs, specifically, as they relate to the mesh prosthesis. Traditionally, quality of life after hernia surgery, like many other medical conditions, has been tested using the generic SF-36 survey. The SF-36 quality-of-life survey, although well studied and validated, may not be ideal for patients undergoing hernia repairs. We propose a new quality-of-life survey, the Carolinas Comfort Scale (CCS), pertaining specifically to patients undergoing hernia repair with mesh; our goal was to test the validity and reliability of this survey. The CCS questionnaire was mailed to 1,048 patients to assess its acceptability, responsiveness, and psychometric properties. The survey sample included patients who were at least 6 months out after hernia repair with mesh. Patients were asked to fill out the CCS and the generic SF-36 questionnaires, four questions comparing the two surveys, and their overall satisfaction relating to their hernia repair and mesh. The reliability of the CCS was confirmed by Cronbach's alpha coefficient (0.97). Test-retest validity was supported by the correlation found between two different administrations of the CCS; both Spearman's correlation coefficient and the kappa coefficient were important for each question of the CCS. Assessment of its discriminant validity showed that both the mean and median scores for satisfied patients were considerably lower than those for dissatisfied patients. Concurrent validity was demonstrated by the marked correlations found between the CCS and SF-36 questionnaire scales. When comparing the two surveys, 72% of patients preferred the CCS questionnaire, 80% believed it was easier to understand, 66% thought it was more reflective of their condition, and 69% said they would rather fill it out over the SF-36. The CCS better assesses quality of life and satisfaction of patients who have undergone surgical hernia repair than the generic SF-36.

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The lightweight and large porous mesh concept for hernia repair.

Bernd Klosterhalfen, Karsten Junge, Uwe Klinge (2004)

In modern hernia surgery, there are two competing mesh concepts which often lead to controversial discussions, on the one hand the heavyweight small porous model and on the other, the lightweight large porous hypothesis. The present review illustrates the rationale of both mesh concepts and compares experimental data with the first clinical data available. In summary, the lightweight large porous mesh philosophy takes into consideration all of the recent data regarding physiology and mechanics of the abdominal wall and inguinal region. Furthermore, the new mesh concept reveals an optimized foreign body reaction based on reduced amounts of mesh material and, in particular, a significantly decreased surface area in contact with the recipient host tissues by the large porous model. Finally, recent data demonstrate that alterations in the extracellular matrix of hernia patients play a crucial role in the development of hernia recurrence. In particular, long-term recurrences months or years after surgery and implantation of mesh can be explained by the extracellular matrix hypothesis. However, if the altered extracellular matrix proves to be the weak area, the decisive question is whether the amount of material as well as mechanical and tensile strength of the surgical mesh are really of significant importance for the development of recurrent hernia. All experimental evidence and first clinical data indicate the superiority of the lightweight large porous mesh concept with regard to a reduced number of long-term complications and particularly, increased comfort and quality of life after hernia repair.

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Author and article information

Contributors

: +46-8-55024101 , Sven.Bringman@ki.se

: +49-241-8089332 , jconze@ukaachen.de

: +39-33-97077288 , Diego.Cuccurullo@ospedalemonaldi.it

: +32-16-344215 , Jan.Deprest@uzleuven.be

: +49-241-8089500 , kjunge@ukaachen.de

: +49-241-301720 , bernd.klosterhalfen@web.de

: +1-561-3952626 , parra11@bellsouth.net

: +1-573-8825609 , ramshawb@health.missouri.edu

: +49-241-8089332 , VSchumpelick@ukaachen.de

Journal

Journal ID (nlm-ta): Hernia

Title: Hernia

Publisher: Springer-Verlag (Paris )

ISSN (Print): 1265-4906

ISSN (Electronic): 1248-9204

Publication date (Electronic): 11 December 2009

Publication date PMC-release: 11 December 2009

Publication date (Print): February 2010

Volume: 14

Issue: 1

Pages: 81-87

Affiliations

[1 ]Department of Surgery, Clintec, Karolinska Institutet, Södertälje Hospital, 152 86 Södertälje, Sweden

[2 ]Chirurgische Universitätsklinik u. Poliklinik der RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany

[3 ]Department of General and Laparoscopic Surgery, Monaldi Hospital, Via Cilea 136, 80127 Naples, Italy

[4 ]Pelvic Floor Unit, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, 3000 Leuven, Belgium

[5 ]Department of Surgery, RWTH Aachen, University Hospital Aachen, Pauwelsstraße 30, 52074 Aachen, Germany

[6 ]Institut für Pathologie, Krankenhaus Düren gem. GmbH, Roonstrasse 30, 52351 Düren, Germany

[7 ]Surgical Associates of Palm Beach County, 800 Meadows Road, Boca Raton, FL 33486 USA

[8 ]Division of General Surgery, University of Missouri, MC4144 McHaney Hall, Columbia, MO 655212 USA

[9 ]Department of Surgery, Medical Faculty, Rheinish-Westphalian Technical University, 52074 Aachen, Germany

Article

Publisher ID: 587

DOI: 10.1007/s10029-009-0587-x

PMC ID: 2815300

PubMed ID: 20012333

SO-VID: 4cb01b44-5688-47c6-a3a3-d4f34f706c5d

History

Date received : 1 May 2009

Date accepted : 6 November 2009

Custom metadata

ScienceOpen disciplines: Gastroenterology & Hepatology

Keywords: prosthesis design,complications,surgical mesh,operative surgical procedure,animal models

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ScienceOpen disciplines: Gastroenterology & Hepatology

Keywords: prosthesis design, complications, surgical mesh, operative surgical procedure, animal models

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Hernia repair: the search for ideal meshes

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Abstract

Background

Discussion

Conclusion

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Karger: Gastroenterology

Most cited references 22

Classification of biomaterials and their related complications in abdominal wall hernia surgery

Comparison of generic versus specific quality-of-life scales for mesh hernia repairs.

The lightweight and large porous mesh concept for hernia repair.

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Cited by 29

Most referenced authors 156