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Erschienen in:

01.01.2007

Improving Outcomes in Hernia Repair by the Use of Light Meshes—A Comparison of Different Implant Constructions Based on a Critical Appraisal of the Literature

verfasst von: Dirk Weyhe, MD, Orlin Belyaev, MD, Christophe Müller, MD, Kirsten Meurer, MD, Karl-Heinz Bauer, MD, Georgios Papapostolou, MD, Waldemar Uhl, MD

Erschienen in: World Journal of Surgery | Ausgabe 1/2007

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Abstract

Background

Despite convincing advantages offered by meshes, their use in hernia surgery remains controversial because of fears concerning the long-term effects of their implantation. To improve biocompatibility, a large variety of newly developed light meshes has been introduced to the market.

This overview of the literature aimed to establish whether absolute material reduction (g per implanted mesh), use of absorbable components, and coating by inert materials are evidence-based ways to improve biocompatibility of meshes.

Method

A review of the current English and German language literature on the outcome of groin und incisional hernia mesh repair was performed. Both basic research and clinical trials were used as sources of data. Meta-analyses and randomized controlled trials were given priority and were referred to whenever possible.

Results

Operative technique was an independent prognostic factor for the clinical outcome. Mesh construction and composition as characterized by pore size and filament structure appeared to be more important determinants of foreign body reaction after implantation than absolute material reduction of 1 g or more per implant. No data exist about an oncogenic effect of alloplastic materials in humans, but disturbed fertility in animal studies remains an issue of concern and should be further investigated.

Conclusions

According to data from current randomized controlled trials and retrospective studies, light meshes seem to have some advantages with respect to postoperative pain and foreign body sensation. However, their use is associated with increased recurrence rates. Light meshes offer no advantages with respect to alleviating severe chronic groin pain. At the same time, experimental data reveal that material composition and mesh structure may significantly affect foreign body reaction.

Bay-Nielsen M, Kehlet H, Strand L, et al. Danish Hernia Collaboration. Quality assessment of 26 304 herniorraphies in Denmark: a prospective nationwide study. Lancet 2001;358:1124–1128PubMedCrossRef

Grant A. EU Hernia Trialist Collaboration. Laparoscopic versus open groin hernia repair: meta- analysis of randomized trials based on individual patient data. Hernia 2002;6:2–10PubMedCrossRef

Grant A. EU Hernia Trialist Collaboration. Open mesh versus non-mesh repair of groin hernia: meta-analysis of randomized trials based on individual patient data. Hernia 2002;6:130–136PubMedCrossRef

Flum DR, Horvath K, Koepsell T. Have outcomes of incisional hernia repair improved with time? A population-based analysis. Ann Surg 2003;237:132–135CrossRef

Agrawal A, Avill R. Mesh migration following repair of inguinal hernia: a case report and review of literature. Hernia 2005;29:1–4

Schumpelick V, Klinge U, Schwab R. [Importance of various operative techniques in inguinal hernia repair] [in German]. Viszeralchirurgie 2004;39:13–19CrossRef

Klinge U, Schumpelick V. Prosthetic implants for hernia repair. Br J Surg 2003;90:1457–1458PubMedCrossRef

Klosterhalfen B, Junge K, Klinge U. The lightweight and large porous mesh concept for hernia repair. Expert Rev Med Devices 2005;2:103–117PubMedCrossRef

Shin D, Lipshultz LI, Goldstein M, et al. Herniorrhaphy with polypropylene mesh causing vasal obstruction: a preventable cause of obstructive azoospermia. Ann Surg 2005;241:553–558PubMedCrossRef

10.

Peiper C, Junge K, Klinge U, et al. Is there a risk of infertility after inguinal mesh repair? Experimental studies in the pig and the rabbit. Hernia 2006;10:7–12PubMedCrossRef

11.

Peiper C, Junge K, Klinge U, et al. The influence of inguinal mesh repair on the spermatic cord: a pilot study in the rabbit. J Invest Surg 2005;18:273–278PubMed

12.

Klosterhalfen B, Klinge U, Hermanns B, et al. [Pathology of traditional surgical nets for hernia repair after long-term implantation in humans][in German]. Chirurg 2000;71:43–51PubMed

13.

Hermanns B, Klinge U, Alfer J, et al. [Pro-oncogenesis and surgical meshes][in German]. Viszeralchirurgie 2004;39:42–47CrossRef

14.

Ghadimi BM, Langer C, Becker H. [Oncogenicity and synthetic meshes: contra][in German]. Viszeralchirurgie 2004;3:948–951

15.

Ghadimi BM, Langer C, Becker H. [The carcinogenic potential of biomaterials in hernia surgery][in German]. Chirurg 2002;73:833–837PubMedCrossRef

16.

Witherspoon P, Bryson G, Wright DM, et al. Carcinogenic potential of commonly used hernia repair prostheses in an experimental model. Br J Surg 2004;91:368–372PubMedCrossRef

17.

FDA, CDRH: Guidance for the Preparation of a Premarket Notification Application for a Surgical Mesh. March 2, 1999, http://www.fda.gov/cdrh/index.html

18.

Williams D. Revisiting the definition of biocompatibility. Med Device Technol 2003;14:10–13

19.

Scheidbach H, Tamme C, Tannapfel A, et al. In vivo studies comparing the biocompatibility of various polypropylene meshes and their handling properties during endoscopic total extraperitoneal (TEP) patchplasty: an experimental study in pigs. Surg Endosc 2004;18:211–220PubMedCrossRef

20.

Scheidbach H, Tannapfel A, Schmidt U, et al. Influence of titanium coating on the biocompatibility of a heavyweight polypropylene mesh. An animal experimental animal model. Eur Surg 2004;36:313–317CrossRef

21.

Junge K, Rosch R, Klinge U, et al. Titanium coating of a polypropylene mesh for hernia repair: effect on biocompatibility. Hernia 2005;9:115–119PubMedCrossRef

22.

Junge K, Klinge U, Rosch R, et al. Functional and morphologic properties of a modified mesh for inguinal hernia repair. World J Surg 2002;26:1472–1480PubMedCrossRef

23.

Junge K, Rosch R, Krones CJ, et al. Influence of polyglecaprone 25 (Monocryl) supplementation on the biocompatibility of a polypropylene mesh for hernia repair. Hernia 2005;9:212–217PubMedCrossRef

24.

Amici C, Rossi A, Santoro MG. Aspirin enhances thermotolerance in human erythroleukemic cells: an effect associated with the modulation of the heat shock response. Cancer Res 1995;55:4452–4457PubMed

25.

Rosch R, Junge K, Quester R, et al. VYPRO II^® mesh in hernia repair: impact of polyglactin on long-term incorporation in rats. Eur Surg Res 2003;35:445–450PubMedCrossRef

26.

Amid PK et al. Polypropylene prostheses. In: Bendavid R, Abrahamnson J, Arregui ME, editors, Abdominal Wall Hernias: Principles and Management, New York, Springer-Verlag, 2001:272–278

27.

Amid PK, Shulman AG, Lichtenstein IL, et al. Biomaterials for abdominal wall hernia surgery and principles of their applications. Langenbecks Arch Chir 1994;379:168–171PubMedCrossRef

28.

Klinge U, Klosterhalfen B, Birkenhauer V, et al. Impact of polymer pore size on the interface scar formation in a rat model. J Surg Res 2002;103:208–214PubMedCrossRef

29.

Greca FH, de Paula JB, Biondo-Simones MLP, et al. The influence of differing pore size on the biocompatibility of two polypropylene meshes in the repair of abdominal defects. Hernia 2001;5:59–64PubMedCrossRef

30.

Goldenberg A, Matone J, Marcondes W, et al. Comparative study of inflammatory response and adhesions formation after fixation of different meshes for inguinal hernia repair in rabbits. Acta Cir Bras 2005;20:347–352PubMed

31.

Weyhe D, Schmitz I, Belyaev O, et al. Experimental comparison of monofile light and heavy polypropylene meshes: less weight does not mean less biological response. World J Surg 2006;30:1586–1591PubMedCrossRef

32.

Taylor DF, Smith FB. Porous methyl methacrylate as an implant material. J Biomed Mater Res 1972;6:467–475PubMedCrossRef

33.

Kapischke M, Prinz K, Tepel J, et al. Comparative investigation of alloplastic materials for hernia repair with improved methodology. Surg Endosc 2005;19:1260–1265PubMedCrossRef

34.

Merrit K, Shafer JW, Brown SA. Implant-site infection rates with porous and dense material. J Biomed Mater Res 1979;13:101–108CrossRef

35.

Langer C, Schwartz P, Krause P, et al. [In-vitro study of the cellular response of human fibroblasts cultured on alloplastic hernia meshes. Influence of mesh material and structure][in German]. Chirurg 2005;76:876–885PubMedCrossRef

36.

Bellon JM, Garcia-Carranza A, Garcia-Honduvilla N, et al. Tissue integration and biomechanical behaviour of contaminated experimental polypropylene and expanded polytetrafluoroethylene implants. Br J Surg 2004;91:489–94PubMedCrossRef

37.

Kirkpatrick CJ. New aspects of biocompatibility testing: where should it be going? Med Device Technol 1998;9:22–29PubMed

38.

Kirkpatrick CJ, Otto M, van Knoten T, et al. Endothelial cell cultures as a tool in biomaterial research. J Mater Sci Mater Med 1999;10:589–594PubMedCrossRef

39.

Duchrow M, Windhövel U, Bethge T, et al. [Polypropylene synthetic mesh modifies growth of human cells in vitro. An experimental study][in German] Chirurg 2002;73:154–160PubMedCrossRef

40.

Weyhe D, Hoffmann P, Belyaev O, et al. The role of TGF-β1 as a determinant of foreign body reaction to alloplastic materials in rat fibroblast cultures: comparison of different commercially available polypropylene meshes for hernia repair. Regul Pept 2006, Sep 11; [Epub ahead of print]

41.

Bracco P, Brunella V, Trossarelli L, et al. Comparison of polypropylene and polyethylene terephthalate (Dacron) meshes for abdominal wall hernia repair: a chemical and morphological study. Hernia 2005;9:51–55PubMedCrossRef

42.

Tang L, Hu W. Molecular determinants of biocompatibility. Expert Rev Med Devices 2005;2:493–500PubMedCrossRef

43.

Ben-Izhak O, Vlodavsky E, Ofer A. Epitheloid angiosarcoma associated with a Dacron vascular graft. Am J Surg Pathol 1999;23:1418–1422PubMedCrossRef

44.

Brand KG, Buoen LC, Brand I. Foreign- body tumorigenesis by vinyl chloride vinyl acetate copolymer: no evidence for chemical cocarcinogenesis. J Natl Cancer Inst 1975;54:1259–1262PubMed

45.

Kirkpatrick CJ, Alves A, Kohler H, et al. Biomaterial-induced sarcoma: a novel model to study preneoplastic change. Am J Pathol 2000;156:1455–1467PubMed

46.

Kirkpatrick CJ. [Comment on the editorial paper][in German]. Chirurg 2002;73:158–160CrossRef

47.

Nakamura T, Shimizu Y, Okumura N, et al. Tumorgenicity of poly-L-lactide (PLLA) plates compared with medical-grade polyethylene. J Biomed Mater Res 1994;28:17–25PubMedCrossRef

48.

Peiper C, Klinge U, Junge K, et al. [Meshes in inguinal repair][in German]. Zentralbl Chir 2002;127:573–577PubMedCrossRef

49.

O‘Dwyer PJ, Kingsnorth AN, Molloy RG, et al. Randomized clinical trial assessing impact of a lightweight or heavyweight mesh on chronic pain after inguinal hernia repair. Br J Surg 2005;92:166–170PubMedCrossRef

50.

O’Dwyer PJ, Kingsnorth AN, Molloy RG, et al. Author reply: randomized clinical trial assessing impact of a lightweight or heavyweight mesh on chronic pain after inguinal hernia repair (Br J Surg 2005; 92: 166–170). Br J Surg 2005;92:655CrossRef

51.

Amalesh T, Cooper D, Singh A. Letter 1: randomized clinical trial assessing impact of a lightweight or heavyweight mesh on chronic pain after inguinal hernia repair (Br J Surg 2005; 92:166–170). Br J Surg 2005;92:655PubMedCrossRef

52.

Shoab SS. Letter 3: randomized clinical trial assessing impact of a lightweight or heavyweight mesh on chronic pain after inguinal hernia repair (Br J Surg 2005; 92: 166–170). Br J Surg 2005;92:655–656PubMedCrossRef

53.

Holzheimer RG. First results of Lichtenstein hernia repair with Ultrapro-mesh as cost saving procedure—quality control combined with a modified quality of life questionnaire (SF-36) in a series of ambulatory operated patients. Eur J Med Res 2004;9:323–327PubMed

54.

Post S, Wess B, Willer M, et al. Randomized clinical trial of lightweight composite mesh for Lichtenstein inguinal hernia repair. Br J Surg 2004;91:44–48PubMedCrossRef

55.

Conze J, Kingsnorth AN, Flament JB, et al. Randomized clinical trial comparing lightweight composite mesh with polyester or polypropylene mesh for incisional hernia repair. Br J Surg. 2005;92:1488–1493PubMedCrossRef

56.

Welty G, Klinge U, Klosterhalfen B, et al. Functional impairment and complaints following incisional hernia repair with different polypropylene meshes. Hernia 2001;5:142–147PubMedCrossRef

57.

Schmidbauer S, Ladurner R, Hallfeldt KK, et al. Heavy-weight versus low-weight polypropylene meshes for open sublay mesh repair of incisional hernia. Eur J Med Res 2005;10:247–253PubMed

58.

Bringman S, Wollert S, Osterberg J, et al. One year results of a randomised controlled multi-centre study comparing Prolene and Vypro II-mesh in Lichtenstein hernioplasty. Hernia 2005;9:223–227PubMedCrossRef

59.

Bringman S, Wollert S, Osterberg J, et al. Early results of a randomized multicenter trial comparing Prolene and Vypro II mesh in bilateral endoscopic extraperitoneal hernioplasty (TEP). Surg Endosc 2005;19:536–540PubMedCrossRef

60.

Heikkinen T, Wollert S, Osterberg J, et al. Early results of a randomised trial comparing Prolene and Vypro II-mesh in endoscopic extraperitoneal inguinal hernia repair (TEP) of recurrent unilateral hernias. Hernia 2006;10:34–40PubMedCrossRef

61.

Grant AM, Scott NW, O’Dwyer P, on behalf of the MRC Laparoscopic Groin Hernia Trial Group. Five- years follow- up of a randomised trial to assess pain and numbness after laparoscopic or open repair of groin hernia. Br J Surg 2004;91:1570–1574PubMedCrossRef

62.

Douek M, Smith G, Oshowo A, et al. Prospsective randomised controlled trial of laparoscopic versus open inguinal hernia mesh repair: five year follow up. BMJ 2003;326:1012–1013PubMedCrossRef

63.

Koninger J, Redecke J, Butters M. Chronic pain after hernia repair: a randomized trial comparing Shouldice, Lichtenstein and TAPP. Langenbecks Arch Surg 2004;389:361–365PubMedCrossRef

64.

Alfieri S, Rotondi F, Di Giorgio A, et al. Influence of preservation versus division of ilioinguinal, iliohypogastric, and genital nerves during open mesh herniorrhaphy: prospective multicentric study of chronic pain. Ann Surg 2006;243:553–558PubMedCrossRef

65.

Neumayer L, Giobbie- Hurder A, Jonasson O, et al. Open mesh versus laparoscopic mesh repair of inguinal hernia. N Engl J Med 2004;350:1819–1827PubMedCrossRef

66.

Schmedt C-G, Sauerland S, Bittner R. Comparsion of endoscopic procedures vs Lichtenstein and other open mesh techniques for inguinal hernia repair. A meta-analysis of randomized controlled trials. Surg Endosc 2005;19:188–199PubMedCrossRef

67.

Bittner R, Sauerland S, Schmedt C-G. Comparsion of endoscopic techniques vs Shouldice and other open nonmesh techniques for inguinal hernia repair. A meta-analysis of randomized controlled trials. Surg Endosc 2005;19:605–615PubMedCrossRef

68.

Decker D, Lindemann C, Springer W, et al. Endoscopic vs conventional hernia repair from an immunologic point of view. Surg Endosc 1999;13:335–339PubMedCrossRef

69.

Boulanger L, Boukerrou M, Lambaudie E, et al. Tissue integration and tolerance to meshes used in gynecologic surgery: an experimental study. Eur J Obstet Gynecol Reprod Biol 2006;125:103–108PubMedCrossRef

70.

Cobb WS, Kercher KW, Heniford BT. The argument for lightweight polypropylene mesh in hernia repair. Surg Innov 2005;12:63–69PubMedCrossRef

71.

Demirer S, Kepenekci I, Evirgen O, et al. The effect of polypropylene mesh on ilioinguinal nerve in open mesh repair of groin hernia. J Surg Res 2006;131:175–181PubMedCrossRef

Titel: Improving Outcomes in Hernia Repair by the Use of Light Meshes—A Comparison of Different Implant Constructions Based on a Critical Appraisal of the Literature
verfasst von: Dirk Weyhe, MD
Orlin Belyaev, MD
Christophe Müller, MD
Kirsten Meurer, MD
Karl-Heinz Bauer, MD
Georgios Papapostolou, MD
Waldemar Uhl, MD
Publikationsdatum: 01.01.2007
Verlag: Springer-Verlag
Erschienen in: World Journal of Surgery / Ausgabe 1/2007
Print ISSN: 0364-2313
Elektronische ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-006-0123-4

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Improving Outcomes in Hernia Repair by the Use of Light Meshes—A Comparison of Different Implant Constructions Based on a Critical Appraisal of the Literature