Abstract
Due to the high cost of synthetic surgical meshes, sterilized non-medical-grade nets are being used for hernia repair in less developed countries, even if a prior in vitro evaluation of their mechanical behavior is still lacking. In this work, two multifilament polyester nets, with material composition, pore size and fiber diameter similar to surgical meshes, are studied. The mechanical properties are compared with the ones of a standard surgical mesh made of a monofilament polyester fiber. Uniaxial tensile tests are performed to evaluate the mechanical behavior, investigating specific aspects as the effect of sample size and strain rate. Mechanical tests highlight an anisotropic behavior in both industrial nets, with stiffness largely depending on test direction. The surgical mesh exhibits a linear anisotropic response, with a different stiffening behavior and a lower degree of anisotropy than industrial nets. Therefore, a different global mechanical response may be expected in vivo. This investigation of the mechanical properties of polyester industrial nets provides a preliminary support to their use for abdominal surgery, even though a different mechanical response is found respect to surgical mesh due to their different structural conformation.
Similar content being viewed by others
References
Shankaran, V., Weber, D. J., Reed, R. L., & Luchette, F. A. (2011). A review of available prosthetics for ventral hernia repair. Annals of Surgery, 253(1), 16–26.
Frey, D. M., Wildisen, A., Hamel, C. T., Zuber, M., Oerti, D., & Metzger, J. (2007). Randomized clinical trial of Lichtenstein’s operation versus mesh plug for inguinal hernia repair. British Journal of Surgery, 94(1), 36–41.
Franneby, U., Sandblom, G., Nordin, P., Olof, N., & Ulf, G. (2006). Risk factors for long-term pain after hernia surgery. Annals of Surgery, 244(2), 212–219.
Wilhelm, T. J., Anemana, S., Kyamanywa, P., Rennie, J., Post, S., & Freudenberg, S. (2006). Anaesthesia for elective inguinal hernia repair in rural Ghana—appeal for local anaesthesia in resource-poor countries. Tropical Doctor, 36(3), 147–149.
Clarke, M. G., Oppong, C., Simmermacher, R., Park, K., Kurzer, M., Vanotoo, L., et al. (2009). The use of sterilised polyester mosquito net mesh for inguinal hernia repair in Ghana. Hernia, 13(2), 155–159.
Kingsnorth, A. (2007). Commercial mesh vs. nylon mosquito net for hernia repair. World Journal of Surgery, 31(4), 859.
Gundre, N. P., Iyer, S. P., & Subramaniyan, P. (2012). Prospective randomized controlled study using polyethylene mesh for inguinal hernia meshplasty as a safe and cost-effective alternative to polypropylene mesh. Updates in Surgery, 64(1), 37–42.
Freudenberg, S., Sano, D., Ouangre, E., Weiss, C., & Wilhelm, T. J. (2006). Commercial mesh versus nylon mosquito net for hernia repair. A randomized double-blind study in Burkina Faso. World Journal of Surgery, 30(10), 1784–1789.
Wilhelm, T. J., Freudenberg, S., Jonas, E., Grobholz, R., Post, S., & Kyamanywa, P. (2007). Sterilized mosquito net versus commercial mesh for hernia repair. An experimental study in goats in Mbarara/Uganda. European Surgical Research, 39(5), 312–317.
Sanders, D. L., Kingsnorth, A. N., & Stephenson, B. M. (2013). Mosquito net mesh for abdominal wall hernioplasty: A comparison of material characteristics with commercial prosthetics. World Journal of Surgery, 37(4), 737–745.
Ambroziak, A., Szepietowska, K., & Lubowiecka, I. (2016). Mechanical properties of mosquito nets in the context of hernia repair. Computer Methods in Biomechanics and Biomedical Engineering, 19(3), 286–296.
Klinge, U., Klosterhalfen, B., Conze, J., Limberg, W., Obolenski, B., Ottinger, A. P., et al. (1998). Modified mesh for hernia repair that is adapted to the physiology of the abdominal wall. European Journal of Surgery, 164(12), 951–960.
Saberski, E. R., Orenstein, S. B., & Novitsky, Y. W. (2011). Anisotropic evaluation of synthetic surgical meshes. Hernia, 15(1), 47–52.
Deeken, C. R., Abdo, M. S., Frisella, M. M., & Matthews, B. D. (2011). Physicomechanical evaluation of polypropylene, polyester, and polytetrafluoroethylene meshes for inguinal hernia repair. Journal of the American College of Surgeons, 212(1), 68–79.
Deeken, C. R., Thompson, D. M., Jr., Castile, R. M., & Lake, S. P. (2014). Biaxial analysis of synthetic scaffolds for hernia repair demonstrates variability in mechanical anisotropy, non-linearity and hysteresis. Journal of the Mechanical Behavior of Biomedical Materials, 38, 6–16.
Wolf, M. T., Carruthers, C. A., Dearth, C. L., Crapo, P. M., Huber, A., Burnsed, O. A., et al. (2014). Polypropylene surgical mesh coated with extracellular matrix mitigates the host foreign body response. Journal of Biomedical Materials Research, Part A, 102(1), 234–246.
Rohrnbauer, B., & Mazza, E. (2014). Uniaxial and biaxial mechanical characterization of a prosthetic mesh at different length scales. Journal of the Mechanical Behavior of Biomedical Materials, 29, 7–19.
Todros, S., Pavan, P. G., Pachera, P., & Natali, A. N. (2017). Synthetic surgical meshes used in abdominal wall surgery: Part II—biomechanical aspects. Journal of Biomedical Materials Research. Part B, Applied Biomaterials, 105(4), 892–903.
Klosterhalfen, B., Junge, K., & Klinge, U. (2005). The lightweight and large porous mesh concept for hernia repair. Expert Review of Medical Devices, 2(1), 103–117.
Snyder, C. W., Graham, L. A., Vick, C. C., Gray, S. H., Finan, K. R., & Hawn, M. T. (2011). Patient satisfaction, chronic pain, and quality of life after elective incisional hernia repair: Effects of recurrence and repair technique. Hernia, 15(2), 123–129.
Maurer, M. M., Rohrnbauer, B., Feola, A., Deprest, J., & Mazza, E. (2014). Mechanical biocompatibility of prosthetic meshes: A comprehensive protocol for mechanical characterization. Journal of the Mechanical Behavior of Biomedical Materials, 40, 42–58.
Hernández-Gascón, B., Peña, E., Pascual, G., Rodríguez, M., Bellón, J. M., & Calvo, B. (2012). Long-term anisotropic mechanical response of surgical meshes used to repair abdominal wall defects. Journal of the Mechanical Behavior of Biomedical Materials, 5(1), 257–271.
Pachera, P., Pavan, P. G., Todros, S., Cavinato, C., Fontanella, C. G., & Natali, A. N. (2016). A numerical investigation of the healthy abdominal wall structures. Journal of Biomechanics, 49(9), 1818–1823.
Szymczak, C., Lubowiecka, I., Tomaszewska, A., & Smietański, M. (2012). Investigation of abdomen surface deformation due to life excitation: Implications for implant selection and orientation in laparoscopic ventral hernia repair. Clinical Biomechanics, 27(2), 105–110.
Velayudhan, S., Martin, D., & Cooper-White, J. (2009). Evaluation of dynamic creep properties of surgical mesh prostheses-uniaxial fatigue. Journal of Biomedical Materials Research. Part B, Applied Biomaterials, 91(1), 287–296.
Ben Abdelounis, H., Nicolle, S., Otténio, M., Beillas, P., & Mitton, D. (2013). Effect of two loading rates on the elasticity of the human anterior rectus sheath. Journal of the Mechanical Behavior of Biomedical Materials, 20, 1–5.
Kirilova, M. (2012). Time-dependent properties of human umbilical fascia. Connective Tissue Research, 53(1), 21–28.
Li, X., Kruger, J. A., Jor, J. W., Wong, V., Dietz, H. P., Nash, M. P., et al. (2014). Characterizing the ex vivo mechanical properties of synthetic polypropylene surgical mesh. Journal of the Mechanical Behavior of Biomedical Materials, 37, 48–55.
Pavan, P. G., Pachera, P., Todros, S., Tiengo, C., & Natali, A. N. (2016). Mechanical characterization of animal derived grafts for surgical implantation. Journal of Mechanics in Medicine and Biology, 16, 1650023.
Hernández-Gascón, B., Peña, E., Grasa, J., Pascual, G., Bellón, J. M., & Calvo, B. (2013). Mechanical response of the herniated human abdomen to the placement of different prostheses. Journal of Biomechanical Engineering, 135(5), 51004.
Todros, S., Pavan, P. G., & Natali, A. N. (2017). Synthetic surgical meshes used in abdominal wall surgery: Part I—materials and structural conformation. Journal of Biomedical Materials Research. Part B, Applied Biomaterials, 105(3), 689–699.
Pélissier, E. P. (2001). Inguinal hernia: The size of the mesh. Hernia, 5(4), 169–171.
Guérin, G., & Turquier, F. (2013). Impact of the defect size, the mesh overlap and the fixation depth on ventral hernia repairs: A combined experimental and numerical approach. Hernia, 17(5), 647–655.
Todros, S., Natali, A. N., Pace, G., & Di Noto, V. (2013). Correlation between chemical and mechanical properties in renewable poly(ether-block-amide)s for biomedical applications. Macromolecular Chemistry and Physics, 214(18), 2061–2072.
Todros, S., Venturato, C., Natali, A. N., Pace, G., & Di Noto, V. (2014). Effect of steam on structure and mechanical properties of biomedical block copolymers. Journal of Polymer Science Part B: Polymer Physics, 52(20), 1337–1346.
Sharma, M., Sharma, D. B., Chandrakar, S. K., & Sharma, D. (2015). Histopathological comparison of mosquito net with polypropylene mesh for hernia repair: An experimental study in rats. Indian Journal of Surgery, 77(2), 511–514.
Acknowledgements
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
The authors declare that they have no conflicts of interest.
Rights and permissions
About this article
Cite this article
Todros, S., Pachera, P., Pavan, P.G. et al. Investigation of the Mechanical Behavior of Polyester Meshes for Abdominal Surgery: A Preliminary Study. J. Med. Biol. Eng. 38, 654–665 (2018). https://doi.org/10.1007/s40846-017-0337-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40846-017-0337-y