The Crucial Role of Mesh Selection in Hernia Surgery - Understanding the Impact

Introduction

Suppose you or your loved ones feel or see any bulge in the abdomen or groin, discomfort with physical exertion, pain, pressure in the affected area, or burning or aching sensation. In that case, it is advisable to consult your doctor for hernia diagnosis. Such diagnosis helps rule out the potential occurrence of hernia or detect the root cause of such symptoms to treat them timely.

Hernia is a common condition that isn't life-threatening but does not go on its own. It may result in persistent pain and discomfort, leading to adverse effects and medical complications if not addressed on time. Often, hernia requires surgical treatment for its removal.

Hernia repair surgery has become a safer and more predictable procedure to treat hernia due to advances in its treatment procedure, laparoscope and robotic assistance, meshes, and expert medical intervention.

The role of suitable meshes in hernia repair surgery is medically risk-saving and complication-preventive when performed by an experienced surgeon.

How the selection of the most suitable mesh has a crucial role in hernia surgery needs to be understood. Continue reading the blog for an in-depth understanding of the topic.

Hernia and Its Types

Hernia is when an organ protrudes out of the muscle or the tissue containing it. There is a muscle tear that causes a weak spot for the internal organ or intestine to bulge out. The condition is common in men and women; however, the symptoms may vary depending on the type of hernia. However, a bulge or lump and discomfort or pain at the site of the hernia are the common symptoms. The different types of hernia are-

• Inguinal hernia- Inguinal hernia is caused when the intestine pushes through a weak spot in the lower abdomen wall into the inguinal canal (found in the groin).
• Hiatal hernia- In the case of a hiatal hernia, the opening of the diaphragm (the muscle that separates the chest cavity and the abdomen) widens. The upper portion of the stomach protrudes through this opening in the chest. Burning sensation, chest pain, or difficulty swallowing are typical symptoms of hiatal hernia.
• Umbilical hernia- Mostly found in children and babies, the intestine bulges through the weak spot in the abdomen wall near the belly button. It goes away with age as the abdomen muscles get stronger. An umbilical hernia is also found in obese people and pregnant women.
• Incisional hernia- After abdominal surgery, the abdominal wall may weaken, and the tissue could protrude from the weakened wall, causing an incisional hernia.
• Femoral hernia- Femoral hernia is a type of groin hernia where the fatty tissue or part of the bowel pushes through into the groin at the top of the inner thigh. The tissue bulges in the femoral canal (within the femoral triangle and contains lymphatic vessels, connective tissue, and adipose tissue).

 

Hernia Repair

Since hernia does not heal on its own, hernia surgery is the only effective option to treat it to prevent it from getting worse. Hernia can be repaired through open surgery or laparoscopic surgery.

• Herniorrhaphy is an open surgical procedure to treat a hernia. The surgery is through a long incision near the hernia, under general or local anesthesia. The surgeon pushes the herniated area back into its proper place, repairs the abdominal wall with stitches, and closes the skin incision. This is known as tension hernia repair, without using the hernia mesh.
  Tension-free hernia repair is when the surgeon, after positioning the hernia properly, puts a surgical mesh over it that acts as a bridge or scaffold, enabling the new tissues to grow and reinforce the abdominal wall. It creates a strong and permanent support for the repaired hernia, preventing its reoccurrence.
• Laparoscopic hernia repair is a procedure to treat hernia through smaller incisions under general anesthesia. For more room to perform and a better view, the surgeon inserts harmless gas in the abdomen and, with a laparoscope inserted through a small incision, views the herniated area. The camera in the laparoscope transmits images on the screen for the surgeon to view the hernia. The surgeon then gently pushes back the hernia to its proper place and places a surgical mesh to shield it with support.

 

Role of Surgical Mesh in Hernia Repair

A surgical mesh is a flat and flexibly woven medical device that protects and supports the weakened tissues surrounding the hernia. Surgical mesh plays a prime role in tension-free hernia repair. Some of the benefits of this surgical mesh are-

• As mentioned above, the mesh acts as a support and bridge for the new tissues to grow and reinforce the abdominal wall.
• Using mesh in hernia repair results in stronger repair, faster healing, faster recovery, and proper tissue integration.
• Unlike traditional tension repair, where the chances of hernia recurrence are greater, mesh strengthens the abdominal wall and prevents the repaired hernia from protruding. Thus, preventing hernia reoccurrence.

 

Types of Mesh for Hernia Repair

In light of the significant role of surgical mesh in hernia repair, the selection of the proper hernia mesh is of utmost importance for positive surgical and patient outcomes. The various types of hernia mesh are-

• Absorbable and Non-Absorbable Mesh
  Absorbable mesh dissolves in the body over time. The mesh degradation enables tissue growth and integration, providing strength and support to the tissue surrounding the repaired hernia.
  Non-absorbable mesh stays in the body permanently but provides the required extended strength to the repaired area.
• Hybrid Mesh
  Hybrid mesh has a combination of layers of polymers and biological materials. Synthetic polymers provide strength, and biological materials help limit inflammation, reducing infection and increasing tissue growth.
• Coated or Composite Mesh
  Mesh with the coating of collagen, absorbable fatty acids, or cellulose helps reduce the chances of adhesion of the mesh to the intestine and hence avoid adverse complications of infection or inflammation.
• Animal-derived or Synthetic Mesh
  Animal-derived mesh is made from the skin or intestine of cows or pigs. Synthetic mesh is made from polypropylene or polyester that provides high tensile strength. Still, the chemical properties of such mesh may change during its implantation. Such meshes are often coated with other materials to create a composite surgical mesh.
• Composite Mesh
  This mesh combines more than one material, and the new design meshes are generally composite. The mesh comes in the combination of polypropylene (PP), polyester (POL) extended polytetrafluoroethylene (ePTFE), or any of these with other materials.

 

Selection of Mesh for Hernia Repair

The selection of the ideal mesh is the decision the surgeon arrives at after considering factors like the type, severity, location of the hernia, the patient's age, the chance of reoccurrence of the hernia, and the overall health of the patient. The selection of the ideal mesh is crucial to the success of the treatment.

From the various types of meshes available, the surgeon's decision of an ideal mesh will be based on-

• The material composition of the mesh- The material should be biocompatible, strong, resistant to infection, possessing minimum bioreactivity, and ensuring tissue integration.
• The size of the mesh pores- The size of the mesh pores affects the tissue growth. Mesh with large pores enables tissue ingrowth and is more flexible. Smaller pore mesh may lead to a stiff scar plate, reduction in flexibility, and prevent cell ingrowth.
• Weight of the mesh- Heavyweight or lightweight meshes have peculiar properties of tensile strength, pore size, elasticity, and reaction to foreign bodies.
• Elasticity and Mesh Strength – If the tensile strength of the mesh diminishes or its ability to stretch increases, it may cause a potential risk of hernia reoccurrence. The mesh should withstand the pressure put on the abdominal wall, ensuring that some flexibility is retained.

 

The selection of an ideal mesh is a difficult proposition for surgeons who must weigh the pros and cons of all the above factors. However, it is crucial to the success of hernia treatment and patient care.

MERINEUM^TM MESH FROM MERIL

Polypropylene/Polylactide-Caprolactone Mesh
MERINEUM™ Mesh is a sterile, tissue-separating, layered, partially absorbable surgical mesh consisting of knitted, non-absorbable polypropylene mesh and absorbable, non-adhesive polylactide-caprolactone film.

The polypropylene mesh side of the device allows for tissue growth. It provides additional support to weakened or damaged tissue. At the same time, the polylactide-caprolactone film acts as an anti-adhesive layer. It physically separates the polypropylene mesh from underlying tissue/organ surfaces during the healing to minimize the risk of unintended tissue attachment to the mesh. The MERINEUMTM MESH is available in various sizes.

Conclusion

Hernia, a common medical condition of a protruded organ through the weak muscle or tissue surrounding it, cannot heal independently. When symptoms are severe, hernia repair becomes necessary. Free-tension hernia repair, using hernia mesh, is the most recommended repair option due to the resultant low rates of hernia reoccurrence post-treatment. Mesh comes in different types, size, material composition, weight, and properties. They are selected considering the above-referred factors that affect surgical performance, efficacy, and outcomes. The mesh selection is crucial and challenging but equally essential and inevitable. However, the skill, expertise, and experience of the surgeon are paramount to the success of any medical intervention.