Page 40 - International guidelines for groin hernia management

Hernia

Key question Erosion

KQ10.d Does chronic inflammation occur at mesh/tissue Introduction
interfaces? Erosion of foreign bodies in human tissue is a well-known
phenomenon. Mesh is placed in soft tissues with rapid

Evidence in literature remodeling of adjacent tissues. When biomechanical strain
Tissue reaction to mesh has been studied in various animal occurs, mesh migration is often observed in the direction of
models (e.g. mice, rats, rabbits, sheep and others) with a the pulling forces. HerniaSurge only speaks of ‘‘erosion’’.
follow-up of up to 2 years in rodents and up to 3 years in
sheep. All these studies confirm persistent chronic inflam- Key question
mation at mesh/tissue interfaces as a consequence of
physiologic foreign-body reactions. Inflammatory intensity KQ10.e Is late-onset mesh erosion unavoidable?

varies with mesh location, animal species, mesh material, Evidence in literature
textile construction, time and individual host response. Mesh erosion has been reported with all current polymers
Studies of human mesh explants were published in 2007 and following all hernia repair procedures. 429–494 A major
366, 428
and 2012 with follow-ups of 3–15 years. Most message of all relevant studies is the fact that 20 postop-
meshes were explanted due to complications, which may erative years may pass before symptoms of mesh migration
lead to increases in local inflammation, whereas some occur.
mesh/tissue specimens were taken as biopsies during Risk of mesh movement is reduced by the use of large
revision procedures for other reasons. Although inflam- flat mesh in a tension-free setting. Smaller mesh surface
matory intensity varied considerably, a foreign-body area and tensile forces on the mesh increases the risk.
granuloma with macrophages and foreign-body giant cells Correspondingly, for groin hernias specifically, most
(reflecting persistent inflammation) has always been con- reports describe early (2–3 years) plug migration. Flat
firmed. Since chronic inflammation stimulates local fibrosis mesh erosion is uncommon.
and scar formation, long-term complications of this mesh- There are several reports of mesh erosion after hiatal
adjacent process must be considered. The risk/benefit ratio hernia and incisional hernia repair. 495
for patients is unknown presently. Up to now, there is no polymer or no mesh construction
known that is free from the risk of erosion if placed in a
setting with tensile forces.

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