Biodegradable Meshes in Abdominal Wall Surgery

  • Garth JacobsenEmail author
  • Christopher DuCoin


Tension-free hernia repair with reinforcement by synthetic, nonresorbable mesh has led to a drastic reduction in the rate of hernia recurrence. However, these permanent foreign materials have been implicated in post-operative complications and shunned from the use in contaminated operative fields. Acellular biological mesh was developed as an alternative, and popularized for the use in contaminated fields. Yet, these biological meshes were extremely expensive to develop and produce, thus burdening the health care system with an elevated cost. It has also been found that with time, biological meshes are associated with higher rates of hernia recurrence.

Thus, various synthetic bioabsorbable meshes have now been developed that provide the strength of synthetic mesh along with the low infection rates associated with the use of biologic mesh. These meshes are extremely durable and have been developed at a reduced cost. It also appears that they can be used in contaminated surgical fields with outcomes similar to those of biological mesh. It is of note that the majority of current studies in regard to synthetic bioabsorbable mesh have been performed in either animal models or small human case series, and we are just now starting to analyze the data on larger human population studies. Currently these meshes include Ethicon Vicryl Mesh (Ethicon Inc., Somerville, NJ), Phasix Mesh (C. R. Bard, Inc./Davol Inc., Warwick, RI), Tigr Matrix (Novus Scientific, Uppsala, Sweden), and Gore Bio-A (W.L. Gore and Associates, Inc., Flagstaff, AZ). The specifics of these meshes will be addressed within the chapter. We will also review which synthetic bioabsorbable mesh is best to use in a contaminated field and if there is any merit to impregnating mesh with antibiotics. A synopsis of our algorithm for which type of mesh to use, when to use it, and what type of hernia repair we prefer, is also included in this chapter.


Abdominal wall hernia Mesh Bioabsorbable Vicryl Phasix TIGR Matrix Gore Bio-A 


  1. 1.
    Kingsnorth A, LeBlanc K. Hernias: inguinal and incisional. Lancet. 2003;362:1561.CrossRefPubMedGoogle Scholar
  2. 2.
    Binnebose M, Von Trotha KT, Jansen PL, Conze J, Neumann UP, Junge K. Biocompatibility of prosthetic meshes in abdominal surgery. Semin Immunopathol. 2011;33:235.CrossRefGoogle Scholar
  3. 3.
    Peeters E, Barneveld K, Schreinemacher M, Hertogh G, Ozog Y, Bouvy N, Miserez M. One-year outcome of biological and synthetic bioabsorbable meshes for augmentation of large abdominal wall defects in a rabbit model. J Surg Res. 2013;180(2):274–83.CrossRefPubMedGoogle Scholar
  4. 4.
    Engelsman AF, Van Der Mei HC, Ploeg RJ, et al. The phenomenon of infection with abdominal wall reconstruction. Biomaterials. 2007;28:2314–24.CrossRefPubMedGoogle Scholar
  5. 5.
    Badylak SF. The extracellular matrix as a biologic scaffold material. Biomaterials. 2007;28:3587.CrossRefPubMedGoogle Scholar
  6. 6.
    Cavallaro A, Lo Menzo E, Di Vita M, et al. Use of biological meshes for abdominal wall reconstruction in highly contaminated fields. World J Gastroenterol. 2010;16(15):1928–33.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Reynolds D, Davenport DL, Korosec RL, Roth JS. Financial implications of ventral hernia repair: a hospital cost analysis. J Gastrointest Surg. 2013;17(1):159–66.CrossRefPubMedGoogle Scholar
  8. 8.
    Carbonell AM, Criss CN, Cobb WS, Novisky YW, Rosen MJ. Outcomes of synthetic mesh in contaminated ventral hernia repairs. J Am Coll Surg. 2013;217(6):991–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Rice RD, Ayubi FS, Shaub ZJ, Parker DM, Armstrong PJ, Tsai JW. Comparison of surgisis, AlloDerm, and Vicryl Woven Mesh grafts for abdominal wall defect repair in an animal model. Aesthetic Plast Surg. 2010;34(3):290–6.CrossRefPubMedGoogle Scholar
  10. 10.
    Laschke MW, Häufel JM, Scheuer C, Menger MD. Angiogenic and inflammatory host response to surgical meshes of different mesh architecture and polymer composition. J Biomed Mater Res B. 2009;91(2):497–507.CrossRefGoogle Scholar
  11. 11.
    Deeken CR, Matthews BD. Characterization of the mechanical strength, resorption properties, and histologic characteristics of a fully absorbable material (poly-4-hydroxybutyrate—PHASIX mesh) in a porcine model of hernia repair. ISRN Surg. 2013;2013:238–67.CrossRefGoogle Scholar
  12. 12.
    Martin DP, Williams SF. Medical applications of poly-4-hydroxybutyrate: a strong flexible absorbable biomaterial. Biochem Eng J. 2003;16(2):97–105.CrossRefGoogle Scholar
  13. 13.
    Hjort H, Mathisen T, Alves A, Clermont G, Boutrand JP. Three-year results from a preclinical implantation study of a long-term resorbable surgical mesh with time-dependent mechanical characteristics. Hernia. 2012;16:191.CrossRefPubMedGoogle Scholar
  14. 14.
    Ruizjasbon F. Norrby six months results of first-in-man trial of a new synthetic long-term resorbable mesh for inguinal hernia repair. Istanbul: European Hernia Society; 2010.Google Scholar
  15. 15.
    Zemlyak AY, Colavita PD, Tsirline VB, Belyansky I, El-Djouzi S, Norton HJ, Lincourt AE, Heniford BT. Absorbable glycolic acid/trimethylene carbonate synthetic mesh demonstrates superior in-growth and collagen deposition. Abdominal Wall Reconstruction Conference, June 13–16, 2012, Washington, DC.Google Scholar
  16. 16.
    Blatnik JA, Krpata DM, Jacobs MR, Novitsky YW, Rosen MJ. Effect of wound contamination on modern absorbable synthetic mesh. Abdominal Wall Reconstruction, June 2011.Google Scholar
  17. 17.
    Suarez JM, Conde SM, Galan VG, Cartes JA, Durantez FD, Ruiz FJ. Antibiotic embedded absorbable prosthesis for prevention of surgical mesh infection: experimental study in rats. Hernia. 2012;19(2):187–94.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of SurgeryUniversity of California, San DiegoLa JollaUSA

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