The lightweight and large porous mesh concept for hernia repair

TLDR

Modern hernia surgery debates heavyweight small‑porous versus lightweight large‑porous meshes, while recent data link extracellular matrix alterations to long‑term recurrence. The review aims to compare the rationale of both mesh concepts and to assess whether mesh material amount and mechanical strength influence recurrent hernia risk. The authors compare experimental data and initial clinical findings on both mesh concepts to evaluate their rationale. Experimental evidence and early clinical data show the lightweight large‑porous mesh reduces long‑term complications, improves comfort and quality of life, and optimizes foreign‑body reaction by using less material and a smaller surface area.

Abstract

In modern hernia surgery, there are two competing mesh concepts which often lead to controversial discussions, on the one hand the heavyweight small porous model and on the other, the lightweight large porous hypothesis. The present review illustrates the rationale of both mesh concepts and compares experimental data with the first clinical data available. In summary, the lightweight large porous mesh philosophy takes into consideration all of the recent data regarding physiology and mechanics of the abdominal wall and inguinal region. Furthermore, the new mesh concept reveals an optimized foreign body reaction based on reduced amounts of mesh material and, in particular, a significantly decreased surface area in contact with the recipient host tissues by the large porous model. Finally, recent data demonstrate that alterations in the extracellular matrix of hernia patients play a crucial role in the development of hernia recurrence. In particular, long-term recurrences months or years after surgery and implantation of mesh can be explained by the extracellular matrix hypothesis. However, if the altered extracellular matrix proves to be the weak area, the decisive question is whether the amount of material as well as mechanical and tensile strength of the surgical mesh are really of significant importance for the development of recurrent hernia. All experimental evidence and first clinical data indicate the superiority of the lightweight large porous mesh concept with regard to a reduced number of long-term complications and particularly, increased comfort and quality of life after hernia repair.