The purpose of this paper is to communicate two new concepts with the potential to cause major morbidity in hernia repair, effective porosity and biofilm. These 2 concepts are interrelated and have the potential to result in mesh-related complications. Effective porosity is a term well described in the textile industry. It is best defined as the changes to pore morphology after implantation of mesh in situ. It is heavily dependent on mesh construct and repair technique and has the potential to impact hernia repair by reducing mesh tissue integration and promoting fibrosis. Bacterial biofilm is a well-described condition affecting prosthesis in breast and join replacement surgery with catastrophic consequences. There is a paucity of information on bacterial biofilm in mesh hernia repair. We speculate that bacterial biofilm has the potential to reduce the effective porosity of mesh, resulting in non-suppurative mesh-related complications as well as the potential for late suppurative infections. We describe the aetiology, pathogenesis, diagnosis, treatment and preventative measures to address bacterial biofilm in mesh hernia surgery. Hernia surgeons should be familiar with these two new concepts which have the potential to cause major morbidity in hernia repair and know how to address them.
Ovid Medline and PubMed were searched for communications on “effective porosity” and “bacterial biofilm”.
There is a paucity of information in the literature of these conditions and their impact on outcomes following mesh hernia repair.
We discuss the two concepts of effective porosity and biofilm and propose potential measures to reduce mesh-related complications. This includes choosing mesh with superior mesh construct and technical nuances in implanting mesh to improve effective porosity. Furthermore, measures to reduce bacterial biofilm and its consequences are suggested.
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The Microscopy Department, School of Biological Sciences, Macquarie University is kindly acknowledged for providing expertise in electron microscopy. KR is recipient of a CJ Martin Biomedical Early Career Fellowship (#1163634) by the National Health and Medical Research Council, Australia. Chris Hensman is a consultant for Medtronic. Bernd Klosterhalfen is a consultant to FEG Textiltechnik and also an expert witness in the US and Australia in mesh litigation cases.
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Jacombs, A.S.W., Karatassas, A., Klosterhalfen, B. et al. Biofilms and effective porosity of hernia mesh: are they silent assassins?. Hernia 24, 197–204 (2020). https://doi.org/10.1007/s10029-019-02063-y
- Effective porosity
- Mesh infection
- Mesh pore size