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A review of the composition, characteristics, and effectiveness of barrier mesh prostheses utilized for laparoscopic ventral hernia repair

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Abstract

Background

The objective of this review was to provide an overview of the components that comprise each of the eight barrier mesh prostheses commonly utilized for LVHR and to review the current literature related to the characteristics and effectiveness of these materials to guide the general surgeon in selecting the most appropriate material for LVHR.

Methods

Composite prostheses with permanent barriers (Bard™ Composix™ E/X, Bard™ Composix™ L/P, and DUALMESH® Biomaterial) were compared to composite prostheses with absorbable barriers (C-QUR™ Mesh, PROCEED™ Surgical Mesh, Bard™ Sepramesh™ IP Composite, Parietex™ Composite, and PHYSIOMESH™) using scanning electron microscopy and a review of the current preclinical and clinical literature.

Results

Clinical studies and preclinical animal models have attempted to determine the adhesion characteristics and effectiveness of barrier mesh prostheses available for ventral hernia repair applications. However, it is difficult to make any definitive statements about the adhesion characteristics and effectiveness of these materials because all meshes were not included in all studies and likewise not compared under identical conditions. Overall, Parietex™ Composite and DUALMESH® Biomaterial were cited most frequently for improvement of adhesion characteristics, followed closely by Bard™ Sepramesh™ IP Composite and C-QUR™ Mesh. Bard™ Composix™, PROCEED™ Surgical Mesh, and uncoated polypropylene were cited most frequently as having the most tenacious and extensive adhesions.

Conclusions

Differences observed between the various barrier prostheses are likely attributable to the chemical composition of the barrier or the conditions required for resorption and metabolism of the barrier components. It is likely that the components of these barriers incite a wide range of inflammatory responses resulting in the range of adhesion coverage and tenacity observed in the preclinical and clinical studies reviewed. Clinical trials are needed to more appropriately define the clinical effectiveness of these barriers.

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Acknowledgments

The authors acknowledge the efforts of Hilda Kabiru and Jocelyn Prowse at Atrium Medical Corporation for technical expertise and assistance with the scanning electron micrographs.

Disclosures

Dr. Deeken is a consultant for Atrium Medical Corporation and Davol Incorporated. Dr. Faucher is an employee of Atrium Medical Corporation. Dr. Matthews is a consultant for Atrium Medical Corporation and Ethicon Incorporated. He also receives honoraria and research/equipment support from Atrium Medical Corporation, Ethicon EndoSurgery, Karl Storz Endoscopy, Stryker Endoscopy, and W.L. Gore & Associates, Incorporated.

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Authors and Affiliations

  1. Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8109, St. Louis, MO, 63110, USA

    Corey R. Deeken & Brent D. Matthews

  2. Atrium Medical Corporation, Hudson, NH, USA

    Keith M. Faucher

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  1. Corey R. Deeken
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Correspondence to Corey R. Deeken.

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Deeken, C.R., Faucher, K.M. & Matthews, B.D. A review of the composition, characteristics, and effectiveness of barrier mesh prostheses utilized for laparoscopic ventral hernia repair. Surg Endosc 26, 566–575 (2012). https://doi.org/10.1007/s00464-011-1899-3

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