Biomaterials for "tension-free" hernioplasties and principles of their applications

Although decreasing, there exists an unjustified fear of mesh for the repair of inguinal and incisional hernias. This is due to the negative experience of the past when ideal biomaterials were not available. At the time of introduction of Marlex mesh by Francis Usher, three decades ago, ideal suture material for fixation of the mesh was not available and created undesirable complications. This compounded the fear of mesh for the repair of abdominal wall hernias. With the variety of prosthetic and suture materials available today, the importance of biomaterials in abdominal wall hernia surgery is increasingly appreciated. The purpose of this paper is to discuss some important requirements of ideal biomaterials and principles of their surgical application.