The Hernia Cinic
Choice of Mesh
There is an enormous choice of mesh available for hernia repair.  In principle the mesh is designed to reinforce the area of weakness preventing the protrusion of the internal structures through the hernia defect.
Meshes are usually of two different types, synthetic non absorbable or biological.  Mostly we use synthetic meshes either made of polypropylene or expanded PTFE.

The polypropylene meshes are knitted into a mesh design.  They vary in terms of size of the polypropylene fibers and the size of the pores, giving heavyweight and light weight meshes.  The advantage of lightweight  larger pore meshes are improved integration of the mesh into the tissues and a significantly reduced tissue foregin body reaction.  this reduced reaction leads to less scarring and mesh shrinkage which have been associated with hernia recurrence and chronic pain after hernia surgery.

Composite meshes are manufactured using a blend of poypropylene fibers and absorbable fibers, such as monocryl (Ultrapro) or vicryl (Vypro).  this results in a partly absorbable lightweight mesh, where less of the foreign body remains permanently in the body.

Intrabdominal mesh
Meshes that are placed inside the abdominal cavity need to be designed in such a way that the bowel does not stick to the mesh.  One choice is to use a multi layer mesh eg Proceed (Ethicon products)or Dynamesh IPOM. The outer layer is a larger pore non-absorbable polypropylene mesh, the inner layer which is in contact with the bowel is absorbable layer of methyl cellulose or polyvinylidene fluoride.  

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