Aspects on the use of slowly degradable mesh in inguinal hernia surgery

Background: Synthetic non-degradable mesh used in inguinal hernia surgery can cause chronic inflammation, which in turn can lead to chronic post-operative pain (CPP). Theoretically, a degradable mesh could reduce the risk of chronic pain. Aims: Explore the possibility of keeping viable human peritoneum in contact with hernia meshes in an ex vivo model for several weeks. Evaluate the feasibility and the safety of a slowly degradable mesh in open and endoscopy inguinal hernia repair. Methods: Four publications are included in the doctoral thesis: an experimental method study with peritoneal tissue and three prospective clinical safety studies using a slowly degradable mesh in the repair of patients with inguinal hernias. Results: Ex-vivo model: Peritoneal tissue in contact with a mesh could be kept viable between 26 and 56 days. Safety Studies: At 3-year control, no patient experienced CPP. The recurrence rates in patients operated with the open technique were 44% for medial inguinal hernias and 0% for lateral inguinal hernias. In patients operated with the endoscopy technique, the recurrence rate for lateral inguinal hernias was 8.8%. Conclusions: Peritoneal tissue can be kept viable in contact with mesh during weeks in a human ex vivo model. Using slowly degradable mesh in the repair of medial inguinal hernia is not safe due to an increased recurrence risk. This mesh seems safe regarding the risk of chronic post-operative pain in patients with lateral inguinal hernias, but the risk of hernia recurrence should be further studied

An ex vivo model using human peritoneum to explore mesh-tissue integration

Biological compatibility, in terms of implantation of foreign mesh material in hernia surgery, still needs experimental investigation. Present study develops an experimental model using human peritoneum to study the integration between tissue and different mesh material. The ex vivo model using peritoneal tissue was studied with different mesh material, and integration was monitored over time using microscopy.It could be demonstrated that the peritoneal model may be kept viable in culture for several weeks. Cell migration was seen after 7-10 days in culture and could be further monitored over several weeks. The use of a human artificial model environment enabling the investigation of tissue/mesh integration has, to our knowledge, not been described previously.This proof-of-concept model was developed, for the investigation of peritoneal biology and the integration between tissue and different mesh material. It has the potential to be useful in studies on other important biological mechanisms involving the peritoneum