Ventral Hernia Repair with Synthetic, Composite, and Biologic Mesh: Characteristics, Indications, and Infection Profile

Abstract

A variety of mesh materials are available for ventral hernia repair (VHR), each with a unique set of characteristics. Surgeons are offered an ever-expanding selection of products, making a review of the available materials timely. Current surgical literature is reviewed to describe the different types of synthetic mesh, the indications for the use of each type, their relative risks of infection, and other benefits and shortcomings. We also review clinical studies demonstrating outcomes, efficacy, and use of the meshes in different surgical settings, including laparoscopic hernia repair and special situations such as infection or large abdominal wall defects. Three main types of prosthetic mesh are available. Synthetic mesh, such as polypropylene (PP) or polyester, is characterized by high tensile strength and vigorous tissue ingrowth, but is unsuitable for intra-abdominal placement because of its tendency to induce bowel adhesions. Composite, or barrier-coated, mesh is a dual-sided prosthetic having a synthetic parietal side to promote a strong repair and a visceral surface that repels tissue ingrowth and decreases adhesion formation. Biologic mesh is a collagen-based human, porcine, or bovine scaffold that may be implanted in the extra- or intra-peritoneal position. Biologic mesh is used frequently in the setting of infected or contaminated surgical incisions. Synthetic PP mesh is an appropriate, durable material for extra-peritoneal placement in uncomplicated, clean VHR. Expanded polytetrafluoroethylene and composite meshes are suitable for intraperitoneal placement during laparoscopic VHR. Biologic meshes may be appropriate for contaminated fields or other special situations, but there is no consensus on when or how to use them.