Prosthetic material in ventral hernia repair: how do I choose?
Several factors must be considered in deciding which mesh to use for a ventral hernia repair. Open hernia repairs with no exposure of mesh to viscera can be performed with unprotected synthetic mesh, preferably a "lightweight" option. For open repair with high risk for fascial dehiscence and visceral exposure to mesh, and for open underlay repair and laparoscopic underlay repair, recommendations call for a tissue-separating mesh that prevents ingrowth of intra-abdominal contents into the mesh. Although no long-term data are available about biologic (acellular collagen scaffold) meshes, these may have good results when used in contaminated or well-drained infected fields, and do best when used according to the principles of a high-quality synthetic mesh repair (wide mesh overlap, frequent fixation points). Evidence is still insufficient to support the use of biologic materials for primary hernia repair.
Bachman
Sharon
S
Department of General Surgery, University of Missouri-Columbia, Columbia, MO 65212, USA.
Ramshaw
Bruce
B
D003657:Decision Making; D006555:Hernia, Ventral / Q000601:surgery*; D006801:Humans; D011474:Prosthesis Design; D019651:Plastic Surgery Procedures / Q000295:instrumentation*; D013526:Surgical Mesh