Is Hernia Mesh Safe?

Absolutely yes! Mesh is very safe and we use it every day.

Use of hernia mesh is safe and very effective.

What is mesh? 

What is it made of?

Are you going to use that recalled mesh I see on the TV commercials from law firms?

What happens if my body "rejects" the mesh?

Will I set off metal detectors?

What's the rationale, can't you just close the hole?

What mesh will you use for a hernia repair?

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Well, those are a lot of questions... Let's try to clear them up.

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Perhaps we should start at the beginning.... What is mesh and why do we use it?

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As noted in the "Tissue vs Mesh repair" and "Is it necessary to use mesh?" sections, mesh is man-made sheet of material used to reinforce or strengthen weak tissue for the purposes of providing a "durable" (long-lasting) repair of a hernia. Some hernias cannot even be effectively repaired without it. 

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But what is it really?

Well, the mainstay of our repairs for the last few decades has been, for lack of a better description, "permanent plastic materials" of a sort.  There are three main materials that most of our present meshes are built from right now.

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Without giving you a chemistry lesson, these are the big three:

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• Polypropylene

• Polyester

• Polytetrafluoroethylene (PTFE)

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As mentioned in other sections, there has been an explosion in the engineering of mesh in the last 10-15 years and the selection of mesh has increased substantially. We'll discuss more about that later.

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So "permanent" mesh is a form of high-tech plastic. Permanent means that it lasts forever. It will not degrade, break down, dissolve, or otherwise go away. It is meant to be very strong (to reinforce the repair), but it is also meant to be a scaffold or matrix for your body to lay down fibrin (scar tissue) on and around to make the repair even stronger than your body every could do on its own.

So does the mesh need to be permanent? We have recently been studying this question. At this point, we honestly don’t know how long a piece of mesh needs to be present in order to repair a hernia. But if you look at the studies mentioned in the section regarding "Tissue vs Mesh repair," your hernia recurrence rate (chance that it will come back) continues to increase over time, so it does suggest that a permanent material might be what is needed.

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But as our thoughts and techniques continue to evolve, things are getting more complicated....

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We not only have "permanent" plastic, but we now also have "reabsorbable" plastic.

• These materials are now being combined in different ways with permanent mesh, and we are making absorbable mesh out of these different plastics with different capabilities and characteristics.

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We also have "Biologic" materials:

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• These biologic materials are sourced from animals or humans:

  • Xenograft from an animal

  • Allograft from a human

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And these "Biologics" come from very different parts of the body, with very different collagen structures and other materials inside.

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So as far as the big three plastics:

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Polypropylene has always been the standard for hernia mesh (it still is) and has been the model for other meshes. Polypropylene (PP) is a thermoplastic “addition polymer” made from the combination of propylene monomers. It is used in a variety of applications to include packaging for consumer products, plastic parts for various industries including the automotive industry, special devices like living hinges, textiles, and you guessed it... the surgical implant industry. 

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Polyester is a category of polymers that contain the ester functional group in every repeat unit of their main chain. As a specific material, it most commonly refers to a type called polyethylene terephthalate (PET). Natural polyesters and a few synthetic ones are biodegradable, but most synthetic polyesters are not. Polyesters have evolved tremendously over the years, and now comes in multifilament and monofilament versions (Multiple strands (like cables) in different patterns that make of the sheet, or single strands).

Polytetrafluoroethylene (PTFE) is a synthetic fluoropolymer of tetrafluoroethylene and is most commonly known as "Gore-Tex". Being hydrophobic, non-wetting, high density and resistant to high temperatures, PTFE is an incredibly versatile material with a wide variety of applications, though it's perhaps best-known for its non-stick properties.

• it can be "extruded" in multiple different ways

• it can be a solid sheet with no pores, can be solid filaments, or can be this “expanded” version that we most commonly use, which is microporous (3 micron pores) on one side and macroporous (17 micron pores) on the other side.

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We have so many different types of mesh now, and each one can have many different characteristics

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Different characteristics of the mesh that we look at, and are studying:

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• Openings between the filaments (pores) and their sizes

• Diameter of the individual filaments that make up the mesh and how they are put together (some are woven together, some are knitted, some are monofilament, some are dual, and some are multifilament.

• Thickness of the mesh

• Density - the amount of actual foreign body

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Here you can see an example of different sheets of polypropylene mesh made by different companies. You can see many of the various characteristics I mentioned.

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