Prosthetic material in ventral hernia repair: how do I choose?

Area of Science:

• Surgical Innovation
• Biomaterials Science
• Gastroenterology

Background:

• Ventral hernia repair necessitates careful mesh selection based on surgical technique and potential complications.
• Unprotected synthetic mesh is viable for open repairs without visceral exposure.
• Tissue-separating meshes are indicated for high-risk open repairs and laparoscopic underlay repairs to prevent intra-abdominal content ingrowth.

Purpose of the Study:

• To outline mesh selection criteria for various ventral hernia repair scenarios.
• To review current recommendations for synthetic and biologic mesh usage.
• To assess the evidence supporting different mesh types in hernia surgery.

Main Methods:

• Review of current literature and surgical guidelines on mesh selection for ventral hernia repair.
• Analysis of mesh properties and their implications for different surgical approaches.
• Evaluation of outcomes associated with synthetic and biologic meshes.

Main Results:

• Lightweight synthetic mesh is appropriate for open repairs without mesh-viscera contact.
• Tissue-separating mesh is recommended when visceral exposure or fascial dehiscence is a risk.
• Biologic meshes show potential in contaminated fields but require further long-term data and adherence to synthetic mesh principles.

Conclusions:

• Mesh choice for ventral hernia repair is dictated by surgical approach and risk of complications.
• While synthetic meshes have established roles, biologic meshes show promise in specific settings but lack long-term validation.
• Further research is needed to establish definitive guidelines for biologic mesh use in primary hernia repair.