Biomesh

Biologic mesh originates from the need of a material addressing the problems associated with permanent synthetic mesh, including chronic inflammation and foreign body reaction, stiffness and fibrosis, and mesh infection.[1][2][3] It is sometimes made of human or animal dermis or porcine small intestinal submucosa. Data on biologic mesh comprises mainly animal studies and small series evidence.[4]

Indications

The theoretical advantage of biologic mesh over synthetic mesh has appealed to surgeons. Over the last decade, surgeons have utilized biologic mesh in a variety of cases ranging from primary ventral and inguinal hernia repair in non-infected fields, recurrent hernias, reinforced hernia repair, hernia prophylaxis, and the most widely used application, hernia repair in the contaminated or potentially contaminated field.[5]

Contaminated Setting

The presence of contamination may limit the applicability of permanent synthetic mesh in some hernia repairs. Biologic mesh may be acceptable for this purpose or for placement in open wounds as a staged closure in complex abdominal wall reconstruction. There is limited data in both of these areas, with some noting a high risk of hernia recurrence and associated infection. The data is mostly limited to animal models and case series.[6][7] However, the lack of suitable alternatives has made biologic mesh attractive for contaminated field hernia repair.

Conclusion

In summary, biologic grafts represent a major advancement in hernia repair. Further investigation regarding the appropriate indications, performance of the grafts based on individual properties, and potential complications is needed. The FDA reported complications of these materials warrant caution and sound surgical judgment.[8][9]

References

  1. ↑ Volker Schumpelick, Robert J. Fitzgibbons, Joachim Conze-Hernia Repair Sequelae Springer 2010
  2. ↑ Parviz K. Amid, MD Radiologic Images of Meshoma: A New Phenomenon Causing Chronic Pain After Prosthetic Repair of Abdominal Wall Hernias Arch Surg. 2004;139:1297-1298
  3. ↑ Klosterhalfen B, Klinge U, Hermanns B, Schumpelick V. Pathology of traditional surgical nets for hernia repair after long-term implantation in humans Chirurg. 2000 Jan;71(1):43-51.
  4. ↑ Gina Adrales, M.D. Biological Meshes – Indications and Shortcomings. Challenging Hernias Post-Graduate Course. 12thWorld Congress of Endoscopic Surgery. April 15, 2010
  5. ↑ Gina Adrales, M.D. Biological Meshes – Indications and Shortcomings. Challenging Hernias Post-Graduate Course. 12thWorld Congress of Endoscopic Surgery. April 15, 2010
  6. ↑ Saettele TM, Bachman SL, Costello CR, Grant SA, Cleveland DS, Loy TS, Kolder DG, Ramshaw BJ. Use of porcine dermal collagen as a prosthetic mesh in a contaminated field for ventral hernia repair: a case report. Hernia. 2007 Jun;11(3):279-85.
  7. ↑ Candage R, Jones K, Luchette FA, Sinacore JM, Vandevender D, Reed RL 2nd. Use of human acellular dermal matrix for hernia repair: friend or foe? Surgery. 2008 Oct;144(4):703-9.
  8. ↑ Rosen MJ. Biologic mesh for abdominal wall reconstruction: a critical appraisal. Am Surg. 2010 Jan;76(1):1-6.
  9. ↑ Harth KC, Rosen MJ. Major complications associated with xenograft biologic mesh implantation in abdominal wall reconstruction. Surg Innov. 2009 Dec;16(4):324-9.