Page 42 - International guidelines for groin hernia management

Hernia

rapid and irreversible deformation of the textile struc- There is inadequate evidence in humans for the car-
ture. 367–369 The clinical relevance of this finding is cinogenicity of non-metallic implants other than those
unknown. made of silicone. 511
In summary, there is no evidence that meshes mean-
Mesh risk for carcinogenesis
ingfully increase carcinogenesis risk. Thus, the risk for
mesh-related carcinogenesis need not be considered in the
Introduction
risk/benefit evaluation of a mesh repair.
If mesh implants confer an increased carcinogenic risk,
Patient age risks
this will severely affect the risk/benefit ratio of mesh-based
surgery.
Introduction
Patient age is often a critical consideration in many sur-
Key question
gical procedures. Many IH surgery patients have years of
productive life ahead of them. Therefore, it is important to
KQ10.h Is there a risk for carcinogenesis at meshes’
know if patient age affects the complication risk profile.
interfaces?

Evidence in literature Key question
It is clear that foreign bodies like textile mesh can induce
malignancies in rodents, particularly in rats. 503–508 KQ10.i Is there an age-associated risk for mesh-related
Thankfully though, there is no evidence that hernia meshes complications?

measurably increase the malignant transformation rate in Evidence in literature
humans. There are no adequately age-adjusted studies of compli-
There are, however, two reports worthy of mention. In cations following mesh-based IH repair. Also, no data exist
one, abdominal wall fibromatosis developed in two patients on length of implantation period as an independent risk
after laparoscopic mesh placement. 509 In another, aggres- factor for complications.
sive squamous cell cancer occurred at the site of chronic There are, however, registry data indicating that
mesh infection, and this may be regarded as mesh-induced increased patient age (especially [ 65 years) is a risk
510
cell proliferation/malignancy. factor for complications. 78
In 2000, The International Agency for Research on Several studies indicate that complications following
Cancer stated that ‘‘Polymeric implants prepared as thin mesh repair can occur after years. Mesh explantation, for
smooth films (with the exception of poly-glycolic acid)) example, usually occurs 2–3 years after
are possibly carcinogenic to humans (Group 2B)’’. 511 implantation. 366, 512

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