Progress in synthetic materials for abdominal wall repair

Abstract

To improve overall patient outcome after abdominal wall surgery, including patient discomfort, chronic pain and thus quality of life, 3 issues are the pillars of this thesis: 1. Facilitation of surgical technique and the role of the materials used 2. Importance of correct flat positioning of a mesh and the influence of the mesh surface area on subsequent mesh contraction 3. The inflammatory response and fibrotic tissue reaction during tissue integration and possible ways to improve this Using a modified preperitoneal technique using a memory ring containing mesh, surgical repair is facilitating reinforcement of the groin by a minimal invasive open surgical approach. Besides the technical advantages for the surgeon, the memory ring within the mesh has an influence on the inflammatory reaction and fibrosis formation during tissue integration, thereby limiting the mesh contraction and shrinkage. The development of megaporous meshes minimizes the inflammatory response and improves tissue ingrowth. In our analysis we found an equal patient discomfort in both groups 3 years after surgery, but applying a standardized surgical technique with at least 5cm of overlap in all circumstances, we observed also the same outcome regarding recurrences. Secondly, the positive results we obtained by using topical negative pressure therapy (NPT) in cases of mesh infections using these large pore meshes are described. For the small ventral hernias, we compared the conventional retromuscular mesh repair with this intraperitoneal device placement. Although the initial reports were favorable in outcome of the patients, we observed a relatively high recurrence rate after 2 years follow-up of 14%, mainly due to shrinkage and deformation of the patch. The interaction between an anti-adhesive barrier layer of ePTFE and small pore polypropylene causes an extremely intense inflammatory reaction and fibrosis formation leading to shrinkage, inadequate mesh overlap and clinical recurrences. In conclusion, new materials with a reliable intrinsic mesh memory facilitating surgical techniques and consisting of megaporous material with better tissue integration will improve patient discomfort and quality of life