امروز : یکشنبه   ۲۸. آبان ۱۳۹۶   /    29. صفر 1439   /    19. نوامبر 2017

Caution Over Use of Synthetic Mesh in Repairing the Incisional Hernia

Dear Editor,

Varieties of meshes are available, which are used for the treatment of ventral hernia repair by surgeons. Three main types of prosthetic meshes are used in the repair of abdominal hernias (1-4).

These types are:

1- Synthetic meshes, such as polypropylene (pp) or poly ester with vigorous tissue ingrowth and high tensile strength.

2- Biologic mesh is a collagen based human, bovine or porcine scaffold (4, 5). This type of mesh is used in contaminated or infected surgical incisions; and can be implanted intra or extra-peritoneal positions.

3- Composite, or barrier–coated is a dual sided prosthetic having a visceral surface that repels growing tissues and the parietal sides to provide a strong repair (4). The visceral side decreases the adhesive formation. Synthetic mesh such as polyester are made by appropriate durable materials for extra peritoneal placements(4-6), but if we use intraperitonealy, it could cause severe adhesions to the bowel and cause enterocutaneous fistula (2, 7). This phenomenon is confirmed by many studies. Even mesh related fistula or complications have reported in the patients treated by composite dual sided prosthetic meshes (2, 3).

In the study done by Hosseini et al. (8) nylon type mesh is used, which is categorized in the first group and should not be used for intra peritonealy. How the author have not seen any complication is a question (8). In the mentioned method, it is better to put the mesh on the peritoneal layer, beneath the transversalis fascia to prevent the mesh-related complications such as bowel fistula (3-5). It may be due to short follow-up time. But their using method could be useful in patients with ventral hernia and patients with thin or distracted fascia, because it can anchor the stitches in two sided implanted meshes.

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