Abstract
Inguinal hernia repairs are among the most frequent operations performed worldwide. This study aims to provide further understanding of structural characteristics of hernia prostheses, and better comprehensive evaluation. Weight, porosity, pore size and other physical characteristics were evaluated; warp knitting structures were thoroughly discussed. Two methods referring to ISO 7198:1998, i.e., weight method and area method, were employed to calculate porosity. Porosity ranged from 37.3% to 69.7% measured by the area method, and 81.1% to 89.6% by the weight method. Devices with two-guide bar structures displayed both higher porosity (57.7%–69.7%) and effective porosity (30.8%–60.1%) than single-guide bar structure (37.3%–62.4% and 0%–5.9%, respectively). Filament diameter, stitch density and loop structure combined determined the thickness, weight and characteristics of pores. They must be well designed to avoid zero effective porosity regarding a single-bar structure. The area method was more effective in characterizing flat sheet meshes while the weight method was perhaps more accurate in describing stereoscopic void space for 3D structure devices. This article will give instructive clues for engineers to improve mesh structures, and better understanding of warp knitting meshes for surgeons.
Highlights
Hernias occur when parts of an organ protrude through the abdomen wall, causing defects in either the groin or abdomen
All devices examined here were warp-knitted fabrics. Their structures were formed by interlacing filament loops. They were different from woven fabrics, which were formed by the lengthwise yarns and widthwise yarns crossing each other
Warp knitting does not limit the use of only 1 guide bar in structure design: multi-guide bars can create more sophisticated fabric patterns and produce symmetric loop structures as well as larger pores
Summary
Hernias occur when parts of an organ protrude through the abdomen wall, causing defects in either the groin or abdomen. Synthetic prostheses date back to 1948 when nylon was introduced, with the advent of polyester and polypropylene mesh in the 1950s [2,3] Their use increased considerably after convincing tension-free hernioplasties [4]. Many devices developed over the last few decades are available commercially, resulting in a tremendous increase of prostheses types with various designs [7] They include polypropylene (monofilament), polyester (multifilament) and polytetrafluoroethylene (membrane) polymers. Composite barrier patches are available as well: they are synthetic fabrics combined with a permanent or absorbable layer This plethora of devices is a clear-cut indication that no consensus has been reached in identifying the most appropriate device for specific patients [8]. Hernia recurrence varies between 10% and 20% [9,10,11]
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