, Volume 11, Issue 6, pp 481–492 | Cite as

Choice of mesh for laparoscopic ventral hernia repair




Surgical treatment of ventral hernias has changed dramatically over the past decades by the introduction of laparoscopy and prosthetic biomaterials for reinforcement of the abdominal wall. There are many meshes available on the market for laparoscopic ventral hernia repair (LVHR), and new meshes are introduced regularly. Experimental and clinical documentation for safety and efficacy are, however, often not available for the clinician. The choice of mesh may therefore be difficult in clinical practice. We present a review of the current literature regarding safety measures such as adhesions, fistulas, and infections as well as the available data on pain, recurrence, mesh shrinkage, and seroma formation after LVHR.


The literature was searched systematically using PubMed/MEDLINE and EMBASE for controlled studies, prospective descriptive series and retrospective case series.


The literature clearly points in the direction of very few mesh-related complications after LVHR. Experimental studies and theoretical considerations may argue for using a covered mesh, i.e., a composite mesh, or ePTFE for LVHR in humans, although it is important to stress that there are no human data at the moment to support this. Concerns about using pure polypropylene mesh in the intraperitoneal position may be re-evaluated with the experience of lightweight macropore meshes from open surgery in mind. There is a tendency towards greater shrinkage in ePTFE-based meshes but no differences seems to exist between different mesh materials in other relevant outcome parameters from clinical series.


The literature cannot give general recommendations for choice of mesh based on randomized controlled trials. The final choice of mesh for LVHR will therefore typically be based on surgeons’ preference and cost while we await further data from randomized controlled clinical trials.


Ventral hernia Surgical mesh Complications Laparoscopy Review 


  1. 1.
    Carbajo MA, Martin del Olmo JC, Blanco JI, de la Cuesta C, Toledano M, Martin F, Vaquero C, Inglada L (1999) Laparoscopic treatment vs open surgery in the solution of major incisional and abdominal wall hernias with mesh. Surg Endosc 13:250–252PubMedCrossRefGoogle Scholar
  2. 2.
    Misra MC, Bansal VK, Kulkarni MP, Pawar DK (2006) Comparison of laparoscopic and open repair of incisional and primary ventral hernia: results of a prospective randomized study. Surg Endosc (Epub ahead of print)Google Scholar
  3. 3.
    Barbaros U, Asoglu O, Seven R, Erbil Y, Dinccag A, Deveci U, Ozarmagan S, Mercan S (2006) The comparison of laparoscopic and open ventral hernia repairs: a prospective randomized study. Hernia (Epub ahead of print)Google Scholar
  4. 4.
    Robinson TN, Clarke JH, Schoen J, Walsh MD (2005) Major mesh-related complications following hernia repair: events reported to the Food and Drug Administration. Surg Endosc 19:1556–1560PubMedCrossRefGoogle Scholar
  5. 5.
    Amid PK (1997) Classification of biomaterials and their related complications in abdominal wall hernia surgery. Hernia 1:15–21CrossRefGoogle Scholar
  6. 6.
    Cobb GA, Shaffer J (2005) Cross-linked acellular porcine dermal collagen implant in laparoscopic ventral hernia repair: case-controlled study of operative variables and early complications. Int Surg 90:S24–S29PubMedGoogle Scholar
  7. 7.
    Franklin ME Jr, Gonzalez JJ Jr, Glass JL (2004) Use of porcine small intestinal submucosa as a prosthetic device for laparoscopic repair of hernias in contaminated fields: 2-year follow-up. Hernia 8:186–189PubMedGoogle Scholar
  8. 8.
    Butler CE, Langstein HN, Kronowitz SJ (2005) Pelvic, abdominal, and chest wall reconstruction with AlloDerm in patients at increased risk for mesh-related complications. Plast Reconstr Surg 116:1263–1275PubMedCrossRefGoogle Scholar
  9. 9.
    Majercik S, Tsikitis V, Iannitti DA (2006) Strength of tissue attachment to mesh after ventral hernia repair with synthetic composite mesh in a porcine model. Surg Endosc 20:1671–1674PubMedCrossRefGoogle Scholar
  10. 10.
    Klinge U, Klosterhalfen B, Birkenhauer V, Junge K, Conze J, Schumpelick V (2002) Impact of polymer pore size on the interface scar formation in a rat model. J Surg Res 103:208–214PubMedCrossRefGoogle Scholar
  11. 11.
    Greenawalt KE, Butler TJ, Rowe EA, Finneral AC, Garlick DS, Burns JW (2000) Evaluation of sepramesh biosurgical composite in a rabbit hernia repair model. J Surg Res 94:92–98PubMedCrossRefGoogle Scholar
  12. 12.
    LeBlanc KA, Bellanger D, Rhynes KV 5th, Baker DG, Stout RW (2002) Tissue attachment strength of prosthetic meshes used in ventral and incisional hernia repair. A study in the New Zealand White rabbit adhesion model. Surg Endosc 16:1542–1546PubMedCrossRefGoogle Scholar
  13. 13.
    Bellon JM, Bujan J, Contreras LA, Carrera-San Martin A, Jurado F (1996) Comparison of a new type of polytetrafluoroethylene patch (Mycro Mesh) and polypropylene prosthesis (Marlex) for repair of abdominal wall defects. J Am Coll Surg 183:11–18PubMedGoogle Scholar
  14. 14.
    Bujan J, Contreras LA, Carrera-San Martin A, Bellon JM (1997) The behavior of different types of polytetrafluoroethylene (PTFE) prostheses in the reparative scarring process of abdominal wall defects. Histol Histopathol 12:683–690PubMedGoogle Scholar
  15. 15.
    Young RM, Gustafson R, Dinsmore RC (2004) Sepramesh vs. Dualmesh for abdominal wall hernia repairs in a rabbit model. Curr Surg 61:77–79PubMedCrossRefGoogle Scholar
  16. 16.
    Johnson EK, Hoyt CH, Dinsmore RC (2004) Abdominal wall hernia repair: a long-term comparison of Sepramesh and Dualmesh in a rabbit hernia model. Am Surg 70:657–661PubMedGoogle Scholar
  17. 17.
    Burger JW, Halm JA, Wijsmuller AR, ten Raa S, Jeekel J (2006) Evaluation of new prosthetic meshes for ventral hernia repair. Surg Endosc 20:1320–1325PubMedCrossRefGoogle Scholar
  18. 18.
    McGinty JJ, Hogle NJ, McCarthy H, Fowler DL (2005) A comparative study of adhesion formation and abdominal wall ingrowth after laparoscopic ventral hernia repair in a porcine model using multiple types of mesh. Surg Endosc 19:786–790PubMedCrossRefGoogle Scholar
  19. 19.
    Silverman RP, Li EN, Holton LH III, Sawan KT, Goldberg NH (2004) Ventral hernia repair using allogenic acellular dermal matrix in a swine model. Hernia 8:336–342PubMedCrossRefGoogle Scholar
  20. 20.
    Bellon JM, Contreras LA, Bujan J, Pascual G, Carrera-San Martin A (1999) Effect of relaparotomy through previously integrated polypropylene and polytetrafluoroethylene experimental implants in the abdominal wall. J Am Coll Surg 188:466–472PubMedCrossRefGoogle Scholar
  21. 21.
    Matthews BD, Pratt BL, Backus CL, Kercher KW, Heniford BT (2002) Comparison of adhesion formation to intra-abdominal mesh after laparoscopic adhesiolysis in the New Zealand White rabbit. Am Surg 68:936–940PubMedGoogle Scholar
  22. 22.
    Memisoglu K, Saribeyoglu K, Pekmezci S, Karahasanoglu T, Sen B, Bayrak I, Arbak S, Sirvanci S (2006) Mesh fixation devices and formation of intraperitoneal adhesions. J Laparoendosc Adv Surg Tech A 16:439–444PubMedCrossRefGoogle Scholar
  23. 23.
    Matthews BD, Mostafa G, Carbonell AM, Joels CS, Kercher KW, Austin C, Norton HJ, Heniford BT (2005) Evaluation of adhesion formation and host tissue response to intra-abdominal polytetrafluoroethylene mesh and composite prosthetic mesh. J Surg Res 123:227–234PubMedCrossRefGoogle Scholar
  24. 24.
    Gonzalez R, Rodeheaver GT, Moody DL, Foresman PA, Ramshaw BJ (2004) Resistance to adhesion formation: a comparative study of treated and untreated mesh products placed in the abdominal cavity. Hernia 8:213–219PubMedCrossRefGoogle Scholar
  25. 25.
    Harrell AG, Novitsky YW, Peindl RD, Cobb WS, Austin CE, Cristiano JA, Norton JH, Kercher KW, Heniford BT (2006) Prospective evaluation of adhesion formation and shrinkage of intra-abdominal prosthetics in a rabbit model. Am Surg 72:808–813PubMedGoogle Scholar
  26. 26.
    Kiudelis M, Jonciauskiene J, Deduchovas O, Radziunas A, Mickevicius A, Janciauskas D, Petrovas S, Endzinas Z, Pundzius J (2006) Effects of different kinds of meshes on postoperative adhesion formation in the New Zealand White rabbit. Hernia (Epub ahead of print)Google Scholar
  27. 27.
    Duffy AJ, Hogle NJ, LaPerle KM, Fowler DL (2004) Comparison of two composite meshes using two fixation devices in a porcine laparoscopic ventral hernia repair model. Hernia 8:358–364PubMedCrossRefGoogle Scholar
  28. 28.
    Schug-Pass C, Tamme C, Tannapfel A, Kockerling F (2006) A lightweight polypropylene mesh (TiMesh) for laparoscopic intraperitoneal repair of abdominal wall hernias: comparison of biocompatibility with the DualMesh in an experimental study using the porcine model. Surg Endosc 20:402–409PubMedCrossRefGoogle Scholar
  29. 29.
    Borrazzo EC, Belmont MF, Boffa D, Fowler DL (2004) Effect of prosthetic material on adhesion formation after laparoscopic ventral hernia repair in a porcine model. Hernia 8:108–112PubMedCrossRefGoogle Scholar
  30. 30.
    Zieren J, Neuss H, Ablassmaier B, Muller JM (2002) Adhesions after intraperitoneal mesh repair in pigs: Prolene “vs. Vypro”. J Laparoendosc Adv Surg Tech A 12:249–252PubMedCrossRefGoogle Scholar
  31. 31.
    Balique JG, Benchetrit S, Bouillot JL, Flament JB, Gouillat C, Jarsaillon P, Lepere M, Mantion G, Arnaud JP, Magne E, Brunetti F (2005) Intraperitoneal treatment of incisional and umbilical hernias using an innovative composite mesh: four-year results of a prospective multicenter clinical trial. Hernia 9:68–74PubMedCrossRefGoogle Scholar
  32. 32.
    Moreno-Egea A, Torralba JA, Girela E, Corral M, Bento M, Cartagena J, Vicente JP, Aguayo JL, Canteras M (2004) Immediate, early, and late morbidity with laparoscopic ventral hernia repair and tolerance to composite mesh. Surg Laparosc Endosc Percutan Tech 14:130–5PubMedCrossRefGoogle Scholar
  33. 33.
    Bingener J, Kazantsev GB, Chopra S, Schwesinger WH (2004) Adhesion formation after laparoscopic ventral incisional hernia repair with polypropylene mesh: a study using abdominal ultrasound. JSLS 8:127–131PubMedGoogle Scholar
  34. 34.
    Arnaud JP, Hennekinne-Mucci S, Pessaux P, Tuech JJ, Aube C (2003) Ultrasound detection of visceral adhesion after intraperitoneal ventral hernia treatment: a comparative study of protected versus unprotected meshes. Hernia 7:85–88PubMedCrossRefGoogle Scholar
  35. 35.
    Koehler RH, Begos D, Berger D, Carey S, LeBlanc K, Park A, Ramshaw B, Smoot R, Voeller G (2003) Minimal adhesions to ePTFE mesh after laparoscopic ventral incisional hernia repair: reoperative findings in 65 cases. JSLS 7:335–340PubMedGoogle Scholar
  36. 36.
    Kyzer S, Alis M, Aloni Y, Charuzi I (1999) Laparoscopic repair of postoperation ventral hernia. Early postoperation results. Surg Endosc 13:928–931PubMedCrossRefGoogle Scholar
  37. 37.
    Draus JM Jr, Huss SA, Harty NJ, Cheadle WG, Larson GM (2006) Enterocutaneous fistula: are treatments improving? Surgery 140:570–576PubMedCrossRefGoogle Scholar
  38. 38.
    Leber GE, Garb JL, Alexander AI, Reed WP (1998) Long-term complications associated with prosthetic repair of incisional hernias. Arch Surg 133:378–382PubMedCrossRefGoogle Scholar
  39. 39.
    Bauer JJ, Harris MT, Kreel I, Gelernt IM (1999) Twelve-year experience with expanded polytetrafluoroethylene in the repair of abdominal wall defects. Mt Sinai J Med 66:20–25PubMedGoogle Scholar
  40. 40.
    Chew DK, Choi LH, Rogers AM (2000) Enterocutaneous fistula 14 years after prosthetic mesh repair of a ventral incisional hernia: a life-long risk? Surgery 127:352–353PubMedCrossRefGoogle Scholar
  41. 41.
    Vrijland WW, Jeekel J, Steyerberg EW, Den Hoed PT, Bonjer HJ (2000) Intraperitoneal polypropylene mesh repair of incisional hernia is not associated with enterocutaneous fistula. Br J Surg 87:348–352PubMedCrossRefGoogle Scholar
  42. 42.
    DeMaria EJ, Moss JM, Sugerman HJ (2000) Laparoscopic intraperitoneal polytetrafluoroethylene (PTFE) prosthetic patch repair of ventral hernia. Prospective comparison to open prefascial polypropylene mesh repair. Surg Endosc 14:326–329PubMedCrossRefGoogle Scholar
  43. 43.
    Bageacu S, Blanc P, Breton C, Gonzales M, Porcheron J, Chabert M, Balique JG (2002) Laparoscopic repair of incisional hernia: a retrospective study of 159 patients. Surg Endosc 16:345–348PubMedCrossRefGoogle Scholar
  44. 44.
    Carbajo MA, Martp del Olmo JC, Blanco JI, Toledano M, de la Cuesta C, Ferreras C, Vaquero C (2003) Laparoscopic approach to incisional hernia. Surg Endosc 17:118–122PubMedCrossRefGoogle Scholar
  45. 45.
    Yavuz N, Ipek T, As A, Kapan M, Eyuboglu E, Erguney S (2005) Laparoscopic repair of ventral and incisional hernias: our experience in 150 patients. J Laparoendosc Adv Surg Tech A 15:601–605PubMedCrossRefGoogle Scholar
  46. 46.
    Franklin ME Jr, Gonzalez JJ Jr, Glass JL, Manjarrez A (2004) Laparoscopic ventral and incisional hernia repair: an 11-year experience. Hernia 8:23–27PubMedCrossRefGoogle Scholar
  47. 47.
    Chowbey PK, Sharma A, Khullar R, Mann V, Baijal M, Vashistha A (2000) Laparoscopic ventral hernia repair. J Laparoendosc Adv Surg Tech A 10:79–84PubMedCrossRefGoogle Scholar
  48. 48.
    Lomanto D, Iyer SG, Shabbir A, Cheah WK (2006) Laparoscopic versus open ventral hernia mesh repair: a prospective study. Surg Endosc 20:1030–1035PubMedCrossRefGoogle Scholar
  49. 49.
    Park A, Birch DW, Lovrics P (1998) Laparoscopic and open incisional hernia repair: a comparison study. Surgery 124:816–821PubMedCrossRefGoogle Scholar
  50. 50.
    Eid GM, Prince JM, Mattar SG, Hamad G, Ikrammudin S, Schauer PR (2003) Medium-term follow-up confirms the safety and durability of laparoscopic ventral hernia repair with PTFE. Surgery 134:599–603PubMedCrossRefGoogle Scholar
  51. 51.
    Sanchez LJ, Bencini L, Moretti R (2004) Recurrences after laparoscopic ventral hernia repair: results and critical review. Hernia 8:138–143PubMedCrossRefGoogle Scholar
  52. 52.
    Aura T, Habib E, Mekkaoui M, Brassier D, Elhadad A (2002) Laparoscopic tension-free repair of anterior abdominal wall incisional and ventral hernias with an intraperitoneal Gore-Tex mesh: prospective study and review of the literature. J Laparoendosc Adv Surg Tech A 12:263–267PubMedCrossRefGoogle Scholar
  53. 53.
    Rosen M, Brody F, Ponsky J, Walsh RM, Rosenblatt S, Duperier F, Fanning A, Siperstein A (2003) Recurrence after laparoscopic ventral hernia repair. Surg Endosc 17:123–128PubMedCrossRefGoogle Scholar
  54. 54.
    Ujiki MB, Weinberger J, Varghese TK, Murayama KM, Joehl RJ (2004) One hundred consecutive laparoscopic ventral hernia repairs. Am J Surg 188:593–597PubMedCrossRefGoogle Scholar
  55. 55.
    Bower CE, Reade CC, Kirby LW, Roth JS (2004) Complications of laparoscopic incisional-ventral hernia repair: the experience of a single institution. Surg Endosc 18:672–675PubMedCrossRefGoogle Scholar
  56. 56.
    Ben-Haim M, Kuriansky J, Tal R, Zmora O, Mintz Y, Rosin D, Ayalon A, Shabtai M (2002) Pitfalls and complications with laparoscopic intraperitoneal expanded polytetrafluoroethylene patch repair of postoperative ventral hernia. Surg Endosc 16:785–788PubMedCrossRefGoogle Scholar
  57. 57.
    Kirshtein B, Lantsberg L, Avinoach E, Bayme M, Mizrahi S (2002) Laparoscopic repair of large incisional hernias. Surg Endosc 16:1717–1719PubMedCrossRefGoogle Scholar
  58. 58.
    Morales-Conde S, Cadet H, Cano A, Bustos M, Martin J, Morales-Mendez S (2005) Laparoscopic ventral hernia repair without sutures—double crown technique: our experience after 140 cases with a mean follow-up of 40 months. Int Surg 90:S56–S62PubMedGoogle Scholar
  59. 59.
    Toy FK, Bailey RW, Carey S, Chappuis CW, Gagner M, Josephs LG, Mangiante EC, Park AE, Pomp A, Smoot RT Jr, Uddo JF Jr, Voeller GR (1998) Prospective, multicenter study of laparoscopic ventral hernioplasty. Preliminary results. Surg Endosc 12:955–959PubMedCrossRefGoogle Scholar
  60. 60.
    Topart P, Ferrand L, Vandenbroucke F, Lozac′h P (2005) Laparoscopic ventral hernia repair with the Goretex Dualmesh: long-term results and review of the literature. Hernia 9:348–352PubMedCrossRefGoogle Scholar
  61. 61.
    Berger D, Bientzle M, Muller A (2002) Postoperative complications after laparoscopic incisional hernia repair. Incidence and treatment. Surg Endosc 16:1720–1723PubMedCrossRefGoogle Scholar
  62. 62.
    McKinlay RD, Park A (2004) Laparoscopic ventral incisional hernia repair: a more effective alternative to conventional repair of recurrent incisional hernia. J Gastrointest Surg 8:670–674PubMedCrossRefGoogle Scholar
  63. 63.
    Olmi S, Erba L, Magnone S, Bertolini A, Croce E (2006) Prospective clinical study of laparoscopic treatment of incisional and ventral hernia using a composite mesh: indications, complications and results. Hernia 10:243–247PubMedCrossRefGoogle Scholar
  64. 64.
    LeBlanc KA, Whitaker JM, Bellanger DE, Rhynes VK (2003) Laparoscopic incisional and ventral hernioplasty: lessons learned from 200 patients. Hernia 7:118–124PubMedCrossRefGoogle Scholar
  65. 65.
    Frantzides CT, Carlson MA, Zografakis JG, Madan AK, Moore RE (2004) Minimally invasive incisional herniorrhaphy: a review of 208 cases. Surg Endosc 18:1488–1491PubMedCrossRefGoogle Scholar
  66. 66.
    Cobb WS, Kercher KW, Matthews BD, Burns JM, Tinkham NH, Sing RF, Heniford BT (2006) Laparoscopic ventral hernia repair: a single center experience. Hernia 10:236–242PubMedCrossRefGoogle Scholar
  67. 67.
    Heniford BT, Park A, Ramshaw BJ, Voeller G (2003) Laparoscopic repair of ventral hernias: nine years’ experience with 850 consecutive hernias. Ann Surg 238:391–399PubMedGoogle Scholar
  68. 68.
    Aufenacker TJ, Koelemay MJ, Gouma DJ, Simons MP (2006) Systematic review and meta-analysis of the effectiveness of antibiotic prophylaxis in prevention of wound infection after mesh repair of abdominal wall hernia. Br J Surg 93:5–10PubMedCrossRefGoogle Scholar
  69. 69.
    Merritt K, Hitchins VM, Neale AR (1999) Tissue colonization from implantable biomaterials with low numbers of bacteria. J Biomed Mater Res 44:261–265PubMedCrossRefGoogle Scholar
  70. 70.
    Klinge U, Junge K, Spellerberg B, Piroth C, Klosterhalfen B, Schumpelick V (2002) Do multifilament alloplastic meshes increase the infection rate? Analysis of the polymeric surface, the bacteria adherence, and the in vivo consequences in a rat model. J Biomed Mater Res 63:765–771PubMedCrossRefGoogle Scholar
  71. 71.
    Carbonell AM, Matthews BD, Dreau D, Foster M, Austin CE, Kercher KW, Sing RF, Heniford BT (2005) The susceptibility of prosthetic biomaterials to infection. Surg Endosc 19:430–435PubMedCrossRefGoogle Scholar
  72. 72.
    Diaz JJ Jr, Gray BW, Dobson JM, Grogan EL, May AK, Miller R, Guy J, O’Neill P, Morris JA Jr (2004) Repair of giant abdominal hernias: does the type of prosthesis matter? Am Surg 70:396–401PubMedGoogle Scholar
  73. 73.
    Beldi G, Ipaktchi R, Wagner M, Gloor B, Candinas D (2006) Laparoscopic ventral hernia repair is safe and cost-effective. Surg Endosc 20:92–95PubMedCrossRefGoogle Scholar
  74. 74.
    LeBlanc KA, Whitaker JM (2002) Management of chronic postoperative pain following incisional hernia repair with Composix mesh: a report of two cases. Hernia 6:194–197PubMedCrossRefGoogle Scholar
  75. 75.
    Simmermacher RK, Schakenraad JM, Bleichrodt RP (1994) Reherniation after repair of the abdominal wall with expanded polytetrafluoroethylene. J Am Coll Surg 178:613–616PubMedGoogle Scholar
  76. 76.
    Susmallian S, Gewurtz G, Ezri T, Charuzi I (2001) Seroma after laparoscopic repair of hernia with PTFE patch: is it really a complication? Hernia 5:139–141PubMedCrossRefGoogle Scholar
  77. 77.
    Morales-Conde S (2004) Laparoscopic ventral hernia repair: advances and limitations. Semin Laparosc Surg 11:191–200PubMedGoogle Scholar
  78. 78.
    Tsimoyiannis EC, Siakas P, Glantzounis G, Koulas S, Mavridou P, Gossios KI (2001) Seroma in laparoscopic ventral hernioplasty. Surg Laparosc Endosc Percutan Tech 11:317–321PubMedCrossRefGoogle Scholar
  79. 79.
    Coda A, Bendavid R, Botto-Micca F, Bossotti M, Bona A (2003) Structural alterations of prosthetic meshes in humans. Hernia 7:29–34PubMedGoogle Scholar
  80. 80.
    Gonzalez R, Fugate K, McClusky D III, Ritter EM, Lederman A, Dillehay D, Smith CD, Ramshaw BJ (2005) Relationship between tissue ingrowth and mesh contraction. World J Surg 29:1038–1043PubMedCrossRefGoogle Scholar
  81. 81.
    Klinge U, Klosterhalfen B, Muller M, Ottinger AP, Schumpelick V (1998) Shrinking of polypropylene mesh in vivo: an experimental study in dogs. Eur J Surg 164:965–969PubMedCrossRefGoogle Scholar
  82. 82.
    Conze J, Krones CJ, Schumpelick V, Klinge U (2006) Incisional hernia: challenge of re-operations after mesh repair. Langenbecks Arch Surg (Epub ahead of print)Google Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  1. 1.Department of Surgical Gastroenterology D, Gentofte HospitalUniversity of CopenhagenHellerupDenmark

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