Page 40 - herina surgery and possible lawsuits

inadequate fibrous tissue incorporation into the mesh before hydrolysis of the prosthesis, so it

is not suitable for permanent repair of abdominal wall defects [78]
Coated nonabsorbable prosthesis:
These are primarily designed for ventral hernia repair to avoid direct exposure with
viscera, so they may be used for TAPP to eliminate direct contact. The basic premise of these

prosthetics is that the coating decrease adherence of the protem coagulum, thus partially
inhibiting the inflammatory response of mesh, hence help m reducing chronic pain and

recurrence due to prosthetic shrinkage.
C-Qur mesh (Atrium Medical) is a midweight polypropylene mesh (50 or 85 g/m2) coated
with an absorbable omega-3 fatty acid preparation derived from fish oil. The coating
is about 70%absorbed in 120 days and has had all protein removed to avoid an

immune response.
Glucamesh (Brennen Medical) available only in Europe. It is a midweight polypropylene

mesh (50 g/m2) coated with the absorbable complex carbohydrate, oat beta glucan.
TiMESH (GFE, Germany) is a polypropylene mesh coated with titamum.[79]
There are some conflicting data, there are no obvious differences in connective tissue and
inflammatory markers with these meshes compared with bare polypropylene. Clinically, there

are minor symptom improvements compared with heavyweight and partially absorbable
prosthetics placed laparoscopically (TAPP). [79, 80]
Partially absorbable prosthetics:

To reduce the density of polymer and subsequent inflammatoiy response, yet maintain
the intra operative handling characteristics and long-term wound strength, prosthetics
have been developed that mix non absorbable polymers (e.g. polypropylene) with

absorbable polymers (e.g. polyglactm) Vypro U and Ultrapro. Schumpelick and
colleagues showed statistically significant less inflammation from polypropylene
polyglactm.[79]

Bellon and colleagues found that partially absorbable meshes for hernia repair offer
advantages over nonabsorbable meshes. [81]
Bioloeic prosthetics:
The emerging biologic prosthetics primarily been designed for use in contaminated

fields, limiting their role m inguinal hernia repair because the vast majority of these
operations are clean. There is no difference m outcome with this prosthesis (Surgisis)
compared to polypropylene prosthesis. With a theoretic mcreased nsk of long-term

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