Journal of Materials Science

, Volume 35, Issue 19, pp 4769–4776 | Cite as

Polymers in hernia repair–common polyester vs. polypropylene surgical meshes

  • B. Klosterhalfen
  • U. Klinge
  • V. Schumpelick
  • L. Tietze


Within the last years meshes have become essential for the repair ofabdominal wall hernias. While the type of mesh obviously influencesthe clinical result, the selection of the best suitablemesh-modification should have favourable effects onto the rate ofcomplications. Available surgical meshes mainly differ in the typeand amount of the basic polymers. The most common meshes are madeeither out of monofilament polypropylene (PP) or multifilamentpolyester (PET). In the following contribution we studied thefunctional and histological results of standard and commerciallyavailable surgical meshes: a standard heavyweight, large pore-sizedPP-mesh (Prolene®), a heavyweight, large pore-sized PET-mesh(Parietex®, coated with bovine collagen) and a low weightsmall pore-sized PET-mesh (Mersilene®) in a standardised ratmodel. The meshes are studied by three dimensional stereography,tensiometry, light-(LM) and transmission electron microscopy (TEM),as well as morphometry over implantation intervals of 3, 7, 14, 21and 90 days. The results proved marked differences between thetested meshes in regard to textile properties, the mechanicalfunction (tensile strength, abdominal wall mobility), as well as thehistologically proved tissue reaction. Both heavyweight meshes (PPand PET) revealed an enormous and most similar strength whereas thelow weight PET-mesh primarily showed a considerable increase offlexibility. Despite their different structures and their diversehistological response all tested meshes led to a similar andsignificant reduction of the abdominal wall flexibility. However, thelocal tissue response of the interface mesh/recipient tissuesrevealed a significant reduction of the acute inflammatory activity anda significant decrease of connective tissue formation in the case ofthe low weight PET-mesh Mersilene® compared to both heavyweightmesh-modifications. Mersilene® showed an excellent andrelatively inert tissue reaction of the interface compared toProlene® and Parietex®. Modifications of the mesh-structure(e.g. larger pores) should improve the functional results, inparticular, abdominal wall flexibility. However, the use of PET inhernia surgery is at least questionable in respect to the obligatelong-term degradation of this polymer.


Tensile Strength Polypropylene Hernia Repair Inflammatory Activity Tissue Reaction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    P. K. Amid, A. G. Shulman and I. L. Lichtenstein, Am. Surg. 60 (1994) 934.Google Scholar
  2. 2.
    P. K. Amid, A. G. Shulman, I. L. Lichtenstein and M. Hakakha, Langenbecks Arch Chir 379 (1994) 168.Google Scholar
  3. 3.
    D. J. Waldrep, M. M. Shabot and J. R. Hiatt, Am. Surg. 59 (1993) 716.Google Scholar
  4. 4.
    D. Mclanahan, L. T. King, C. Weems, M. Novotney and K. Gibson, Am. J. Surg. 173 (1997) 445.Google Scholar
  5. 5.
    K. Vestweber, F. Lepique, F. Haaf, M. Horatz and A. Rink, Zentralblatt f¨ur Chirurgie 122 (1997) 885.Google Scholar
  6. 6.
    A. W. Trupka, L. Schweiberer, K. Hallfeldt and H. Waldner, Zentralbl Chir 122 (1997) 879.Google Scholar
  7. 7.
    G. E. Leber, J. L. Garb, A. I. Alexander and W. P. Reed, Arch. Surg. 133 (1998) 378.Google Scholar
  8. 8.
    R. G. Molloy, K. T. Moran, R. P. Waldron, M. P. Brady and W. O. Kirwan, Br. J. Surg. 78 (1991) 242.Google Scholar
  9. 9.
    R. P. Bleichrodt, R. K. Simmermacher, B. Van DER LEI and J. M. Schakenraad, Surg. Gynecol. Obstet. 176 (1993) 18Google Scholar
  10. 10.
    H. S. Matloub, P. Jensen, B. K. Grunert, J. R. Sanger and N. J. Yousif, Ann. Plast. Surg. 29 (1992) 508.Google Scholar
  11. 11.
    M. H. Seelig, R. Kasperk, L. Tietze and V. Schumpelick, Chirurg 66 (1995) 739.Google Scholar
  12. 12.
    G. J. Morris Stiff and L. E. Hughes, J. Am. Coll. Surg. 186 (1998) 352.Google Scholar
  13. 13.
    P. Amid, Hernia 1 (1997) 5.Google Scholar
  14. 14.
    B. Klosterhalfen, U. Klinge and V. Schumpelick, Biomaterials 19 (1998) 2235.Google Scholar
  15. 15.
    U. Klinge, J. Conze, W. Limberg, C. Brucker, A. P. Ottinger and V. Schumpelick, Chirurg 67 (1996) 229.Google Scholar
  16. 16.
    U. Klinge, A. Prescher, B. Klosterhalfen and V. Schumpelick, ibid. 68 (1997) 293.Google Scholar
  17. 17.
    U. Klinge, B. Klosterhalfen, J. Conze, W. Limberg, B. Obolenski, A. P. Öttinger and V. Schumpelick, Eur. J. Surg. 164 (1998) 951.Google Scholar
  18. 18.
    U. Klinge, M. MÑller, C. BrÑcker and V. Schumpelick, Hernia 2 (1998) 11.Google Scholar
  19. 19.
    B. Klosterhalfen, U. Klinge, U. Henze, R. Bhardwaj, J. Conze and V. Schumpelick, Langenbecks Arch Chir 382 (1997) 87.Google Scholar
  20. 20.
    M. E. Arregui, C. J. Davis, O. Yucel and R. F. Nagan, Surg. Laparosc. Endosc. 2 (1992) 53.Google Scholar
  21. 21.
    H. Kjeldsen and B. N. Gregersen, Scand. J. Plast. Reconstr. Surg. 20 (1986) 119.Google Scholar
  22. 22.
    A. Fernandez and O. L. Kh, Surg. Laparosc. Endosc. 4 (1994) 425.Google Scholar
  23. 23.
    T. S. Layman, R. P. Burns, K. E. Chandler, W. L. Russell and R. G. Cook, Am. Surg. 59 (1993) 13.Google Scholar
  24. 24.
    K. K. Nagy, J. J. Fildes, C. Mahr, R. R. Roberts, S. M. Krosner, K. T. Joseph and J. Barrett, ibid. 62 (1996) 331.Google Scholar
  25. 25.
    V. Schumpelick and G. Kingsnorth, “Incisional Hernia of the Abdominal Wall,” 1st ed. (Berlin, Springer-Verlag, 1999).Google Scholar
  26. 26.
    G. E. Wantz, Surg. Gynecol. Obstet. 172 (1991) 129.Google Scholar
  27. 27.
    Idem., Arch. Surg. 133 (1998) 1137.Google Scholar
  28. 28.
    J. M. Bellon, J. Bujan, L. Contreras and A. Hernando, Biomaterials 16 (1995) 381.Google Scholar
  29. 29.
    U. Klinge, J. Conze, B. Klosterhalfen, W. Limberg, B. Obolenski, A. P. Ottinger and V. Schumpelick, Langenbecks Arch Chir 381 (1996) 323.Google Scholar
  30. 30.
    S. Lipton, J. Estrin and I. Nathan, J. Am. Coll. Surg. 178 (1994) 595.Google Scholar
  31. 31.
    M. Amgwerd, M Decurtins, F Largadèr, Helv Chir Acta 59 (1992) 345.Google Scholar
  32. 32.
    A. Loh, J. S. Rajkuma and L. M. South, Ann. Royal Coll. Surg. Engl. 74 (1992) 100.Google Scholar
  33. 33.
    R. C. Read and G. Yoder, Arch. Surg. 124 (1989) 485.Google Scholar
  34. 34.
    D. M. Grace, Can. J. Surg. 30 (1987) 282.Google Scholar
  35. 35.
    L. Tang, T. P. Ugarova, E. F. Plow and J. W. Eaton, J. Clin. Invest. 97 (1996) 1329.Google Scholar
  36. 36.
    B. M. Soares, M. W. King, Y. Marois, R. G. Guidoin, G. Laroche, J. Charara and J. F. Girard, J. Biomed. Mater. Res. 32 (1996) 259.Google Scholar
  37. 37.
    R. Smith, C. Olivier and D. Williams, ibid. 21 (1987) 991.Google Scholar
  38. 38.
    K. Schwertassek and J. Dvorak, Biomed Technik 17 (1972) 105.Google Scholar
  39. 39.
    J. Maarek, R. Guidon, M. Aubin and R. Prud'homme, J. Biomed. Mat. Res. 18 (1984) 881.Google Scholar
  40. 40.
    G. Riepe, J. Loos, H. Imig, A. Schroder, E. Schneider, J. Petermann, A. Rogge, M. Udwig, A. Schenke, R. Nassutt, N. Chakfe and M. Morlock, Eur. J. Vasc. Endovasc. Surg. 13 (1997) 540.Google Scholar
  41. 41.
    E. Trabucchi, F. Corsi, C. Meinardi, P. Cellerino, R. Allevi and D. Foschi, Hernia 2 (1998) 107.Google Scholar
  42. 42.
    B. Klosterhalfen, U. Klinge, B. Hermanns and V. Schumpelick, Chirurg 71 (2000) 43.Google Scholar

Copyright information

© Kluwer Academic Publishers 2000

Authors and Affiliations

  • B. Klosterhalfen
    • 1
  • U. Klinge
    • 2
  • V. Schumpelick
    • 2
  • L. Tietze
    • 3
  1. 1.The Institute of Pathology and IZKF-BIOMATThe Technical University of AachenAachenGermany
  2. 2.The Department of Surgery and IZKF-BIOMATThe Technical University of AachenAachenGermany
  3. 3.The Institute of PathologyThe Technical University of AachenAachenGermany

Personalised recommendations