Polypropylene-containing synthetic mesh devices in soft tissue repair: a meta-analysis

The acute and chronic host tissue response to synthetic and biologic mesh devices for abdominal hernia repair is thought to ultimately determine clinical outcomes such as adhesion formation, device shrinkage, cellular response, and neotissue formation. A meta-analysis of 38 publications was performed to assess these outcomes in six different treatment groups depending on mesh composition: polypropylene (PP), PP in combination with nonabsorbable polymers, PP in combination with absorbable polymers, non-PP polymers, non-PP in combination with absorbable polymers, and natural materials. Despite showing the least device shrinkage, meshes made entirely from PP generally showed the most adverse host tissue response. PP devices with an absorbable component elicited a more beneficial host response with respect to connective tissue adhesion and tissue inflammation than devices made from PP alone. These devices also provided a high level of mechanical stability resulting in a reduced level of adhesion formation and device shrinkage postapplication. However, the compositional heterogeneity within certain groups, that is, devices of non-PP polymers, non-PP in combination with absorbable polymers, and natural materials, did not allow for a more detailed evaluation or the identification of a single composition with superior host tissue response characteristics.