Biomaterials for Inguinal Hernia Repair

Abstract

Biomaterial has been used for hernia repair since the beginning of hernia treatment. The idea to implant a material with high biocompatibility was already in the mind of surgeons since Billroth: “If we could artificially produce tissues of the density and toughness of the fascia and tendon, the secret of radical cure of hernia can be discovered”. Injection of gold particles and transplantation of autografts such as the lata fascia and dura patches have been used to deal with the defect in the abdominal wall. Pre-fabricated prosthetics made from tantalum gauze and silver-coated wire meshes were abandoned due to high complication rates. Francis Usher implanted the first synthetic mesh made of polypropylene and published his first experimental series of hernia repairs with Marlex mesh in 1959 [1]. Since then the development of meshes has exploded and resulted in biophysical and clinical research in order to find the ideal mesh. Today more than 500 different meshes are on the market offering meshes of different material, size, composition, coating, density and weight, pore-size, structure, flexibility, tensile strength and durability, preformed anatomical shape, self-fixing surface and visibility in imaging techniques. The tremendous choices challenge surgeons and patients on which mesh to choose for the repair of an individual hernia. Detailed knowledge of available biomaterials became therefore a necessary requirement for every hernia surgeon.