, Volume 16, Issue 1, pp 9–20 | Cite as

Classification of prosthetics used in hernia repair based on weight and biomaterial

  • A. CodaEmail author
  • R. Lamberti
  • S. Martorana



The aim of this study was to classify the polymeric prosthetics used for hernia repair based on biomaterial composition and weight in an effort to clarify to surgeons what kinds of material they are dealing with and to provide a standardized system of categorization.

Materials and methods

An intensive research effort was carried out on prosthetics that are commercially available worldwide. We conducted a search of the medical literature and companies’ websites to find the weights and thicknesses of commercially available prosthetics. Where these data were lacking, we contacted manufacturers directly in order to render the research more complete. A total of 166 products were considered for classification based on biomaterial properties. Among these, a homogeneous group of 80 polypropylene monofilament knitted or woven prosthetics was selected for classification based on weight. Weights were provided for 70 prosthetics (87%), and both the weight and thickness was provided for 40 prosthetics (50%).


Classification based on weight: Ultra-light <35 g/m2, Light ≥35 < 70 g/m2, Standard ≥70 < 140 g/m2, Heavy ≥140 g/m2. Classification based on biomaterial composition: simple (prosthetics made of one pure biomaterial); composite (prosthetics made of two or more different layers); combined (prosthetics made of two materials knitted or woven together); and biologic.


Weight and biomaterial classifications were proposed after an extensive analysis of commercially available prosthetics. The need for a common terminology is important to avoid misunderstandings among clinicians and technicians.


Prosthetic Classification Weight Biomaterial Common language 



This paper concerning the classification of prosthetics used in hernia repair has been developed with the co-operation with Herniamesh Srl, [Via Fratelli Meliga 1/C, Chivasso (TO), Italy].


The authors apologize in advance for any imprecision, oversight or omission about products and companies and kindly request that companies contact them with any suggestions or comments that will further improve upon the database. A.C. declares that he received no grant support for this work.


  1. 1.
    Melick DW (1942) Nylon sutures. Ann Surg 115:475–476CrossRefGoogle Scholar
  2. 2.
    Aquaviva D, Bounet P (1944) Cure d’une volumineuse eventration par plaque de Crinofil. Extraits Bull Soc Chir de Marseille 1944. quoted by Zagdoun J–Sordinas A, L’utilisation des plaques de nylon dans la chirurgie des hernies inguinales, Academie de Chirurgie, Sèance du 25 Nov 1959, 747–54Google Scholar
  3. 3.
    Maloney GE, Gill WG, Barclay RC (1948) Operations for hernia: technique of nylon darn. Lancet 2:45–48Google Scholar
  4. 4.
    Usher FC, Wallace SA (1958) Tissue reaction to plastic: comparison of Nylon, Orlon, Teflon and Dacron. Arch Surg 76:997–999CrossRefGoogle Scholar
  5. 5.
    Usher FC, Ochsner J, Tuttle LLD (1959) Marlex mesh: a new plastic mesh for replacing tissue defects, experimental studies. Am Surg 24(12):969–974Google Scholar
  6. 6.
    Usher FC (1961) Knitted Marlex mesh. An improved Marlex prosthesis for repairing hernias and other tissue defects. Arch Surg 82:771–773PubMedCrossRefGoogle Scholar
  7. 7.
    King MW, Soares BM, Guidoin R (1994) The chemical, physical and structural properties of synthetic biomaterials used in hernia repair. In: Bendavid R (ed) Prostheses and abdominal wall hernias. Landes, Austin, pp 191–206Google Scholar
  8. 8.
    Klinge U, Klosterhalfen B, Schumpelick V (2001) Vypro®: a new generation of Polypropylene Mesh. In: Bendavid R et al (eds) Abdominal wall hernias: principles and management. Springer, New York, pp 286–291CrossRefGoogle Scholar
  9. 9.
    Udwadia TE (2007) Commercial mesh versus nylon mosquito net for hernia repair. A randomized double-blind study in Burkina Faso. World J Surg 31(4):858. []Google Scholar
  10. 10.
    Wilhelm TJ (2007) Sterilized mosquito net versus commercial mesh for hernia repair. an experimental study in goats in Mbarara/Uganda. Eur Surg Res 39(5):312–317. []
  11. 11.
    Clarke MG (2009) The use of sterilised polyester mosquito net mesh for inguinal hernia repair in Ghana. Hernia 13(2):155–159. doi: 10.1007/s10029-008-0460-3. []Google Scholar
  12. 12.
    Schumpelick V, Klinge U, Rosch R, Junge K (2006) Light weight meshes in incisional hernia repair. J Min Access Surg 2(3):117–123CrossRefGoogle Scholar
  13. 13.
    Klingensmith ME, Chen LE, Glasgow SC, Goers TA (eds) (2007) Hernias. In: The Washington manual of surgery. Lippincott Williams & Wilkins, Philadelphia, pp 442–452Google Scholar
  14. 14.
    The significance of a mesh thickness in the operation of inguinal hernia (2007–2009) []
  15. 15.
  16. 16.
    Klosterhalfen B, Junge K, Klinge U (2005) The lightweight and large porous mesh concept for hernia repair. Expert Rev Med Devices 2(1):103–117Google Scholar
  17. 17.
    Kraft B (2006) Meshes and mesh-fixation techniques in TAPP hernia-repair. Surg Laparosc Endosc Percutan Tech 16(6):448–449Google Scholar
  18. 18.
    Horstmann R (2006) Impact of polypropylene amount on functional outcome and quality of life after inguinal hernia repair by the TAPP procedure using pure, mixed, and titanium-coated meshes. World J Surg 30:1–8CrossRefGoogle Scholar
  19. 19.
    Lauscher JC (2008) Total extraperitoneal hernioplasty: does the long-term clinical course depend on the type of mesh? J Laparoendosc Adv Surg Tech 18:6–9Google Scholar
  20. 20.
    Karsten J (2002) Functional and morphologic properties of a modified mesh for inguinal hernia repair. World J Surg 26(12):1472–1480CrossRefGoogle Scholar
  21. 21.
    Schmidbauer S, Ladurner R, Hallfeldt KK, Mussack T (2005) Heavy-weight versus low-weight polypropylene meshes for open sublay mesh repair of incisional hernia. Eur J Med Res 10:247–253PubMedGoogle Scholar
  22. 22.
    Schug-Paß C, Tamme C, Sommerer F, Tannapfel A, Lippert H, Köckerling F (2008) A lightweight, partially absorbable mesh (Ultrapro) for endoscopic hernia repair: experimental biocompatibility results obtained with a porcine model. Surg Endosc 22:1100–1106PubMedCrossRefGoogle Scholar
  23. 23.
    Holzheimer RG (2004) First results of Lichtenstein hernia repair with Ultrapro-mesh as cost saving procedure—quality control combined with a modified quality of life questionnaire (SF-36) in a series of ambulatory operated patients. Eur J Med Res 9(6):323–327Google Scholar
  24. 24.
    Khan LR, Liong S, de Beaux AC, Kumar S, Nixon SJ (2010) Lightweight mesh improves functional outcome in laparoscopic totally extra-peritoneal inguinal hernia repair. Hernia 14:39–45PubMedCrossRefGoogle Scholar
  25. 25.
    Smietański M, Bigda J, Zaborowski K, Worek M, Sledziński Z (2009) Three-year follow-up of modified Lichtenstein inguinal hernioplasty using lightweight poliglecaprone/polypropylene mesh. Hernia 13:239–242PubMedCrossRefGoogle Scholar
  26. 26.
    Zieren J, Neuss H, Ablassmaier B, Müller JM (2002) Adhesions after intraperitoneal mesh repair in pigs: Prolene™ vs. Vypro™. J Laparoendosc Adv Surg Tech A 12(4):249–252PubMedCrossRefGoogle Scholar
  27. 27.
    Tamme C, Garde N, Klingler A, Hampe C, Wunder R, Köckerling F (2005) Totally extraperitoneal inguinal hernioplasty with titanium-coated lightweight polypropylene mesh: early results. Surg Endosc 19(8):1125–1129Google Scholar
  28. 28.
    Anderson JR (2006) Ultralightweight Polypropylene mesh for abdominal wall hernia repair. Annual Conference of the British Hernia Society, Abstract Book, British Hernia Society, NottinghamGoogle Scholar
  29. 29.
    Cobb WS et al (2006) Textile analysis of heavy weight, mid-weight, and light weight polypropylene mesh in a porcine ventral hernia model. J Surg Res 136(1):1–7Google Scholar
  30. 30.
    Earle DB, Mark LA (2008) Prosthetic material in inguinal hernia repair: how do I choose? Surg Cl N Am 88:179–201CrossRefGoogle Scholar
  31. 31.
    Cobb WS, Peindl RM, Zerey M, Carbonell AM, Heniford BT (2009) Mesh terminology 101. Hernia 13:1–6PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  1. 1.Surgical DepartmentClinica CelliniTurinItaly
  2. 2.Herniamesh S.r.l.Chivasso, TurinItaly

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