Page 41 - International guidelines for groin hernia management

Hernia

A 2015 MRI-based study of mesh erosion at 3 months patients. However, this has not been reported as of this
following TAPP did not detect any substantial change in chapter’s writing.
mesh location. 429
Mesh degradation
Mesh rejection reactions Introduction
Introduction Degradation here refers to complete or partial fragmenta-
While it is true that hernia meshes induce immunological tion (after placement in living tissue) of a non-absorbable
reactions, there is no strong evidence of adaptive polymer used for hernia mesh fiber construction (e.g.
immunological reaction, i.e. leading to allergic reactions. If ePTFE, polyester, polypropylene, and polyvinylidene flu-
so-called mesh ‘‘rejection’’ seems to be occurring, a bac- oride). Over time, most polymers do show alteration or
terial infection should be suspected. degradation of their polymeric structure. These changes
may become clinically relevant when mechanical loading
Key question occurs. It may be prudent to assume that hernia mesh
implant instability can occur after several decades.
KQ10.f Do mesh polymers elicit rejection reactions?

Evidence in literature Key question
In the medical literature, there is no human study of the
immunogenicity of hernia mesh polymers. Some animal KQ10.g Does mesh degradation occur?
studies do exist, only one demonstrating antibodies against

polyester textiles in rats. 496 There are no reports of Evidence in literature
detectable B-cell or T-cell responses to mesh of any type. Under electron microscopy, human mesh explants (polye-
In light of current knowledge, there is no need to consider ster, polypropylene or ePTFE) all show signs of degrada-
allergic reactions to mesh. tion. 197, 428, 497–500 PVDF has the highest resistance to
Notably, only a few polymers (e.g. PVDF) can be used degradation. 501 Local infection or exposure to bodily fluids
without additives and these are supplemented with color and cells can accelerate mesh degradation. 502
particles. It may be that some of these adjuvants might Several investigators have studied textile structure
stimulate an allergic or autoimmune syndrome in some resistance during repetitive loading in vitro and have found

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