Permanent Prosthetics: Polypropylene, Polyester, ePTFE, and Hybrid Mesh

  • Sean B. OrensteinEmail author


While primary suture repair remains an option for select hernias, mesh prosthetics have shown to greatly reduce the incidence of hernia recurrence [1, 2]. Because of this significant benefit, the vast majority of modern hernia repairs utilize some form of mesh reinforcement. Surgeons strive to find and utilize the “ideal” mesh. Up until relatively recently, little has changed over the last half century with regard to the evolution of mesh. Dr. Francis Usher popularized the use of polypropylene mesh in the 1950s, [3] while Dr. René Stoppa and Dr. Jean Rives published their use of polyester meshes in the 1980s, among other great surgeons using various mesh prosthetics [4]. Currently, polypropylene and polyester remain the most commonly utilized materials in modern meshes, with a reduction in the use of expanded polytetrafluorethylene (ePTFE). Newer synthetic materials have been developed, including polyvinylidene fluoride (PVDF); however, long-term data is still being accrued. A variety of composite and hybrid meshes have also been developed that share characteristics of different materials to aid in mesh integration, impede adhesion formation, and/or provide some degree of resorption.


Mesh Synthetic mesh Hernia mesh Mesh prosthetic Herniorrhaphy Hernia repair Ventral hernia repair 


  1. 1.
    Luijendijk RW, Hop WC, van den Tol MP, de Lange DC, Braaksma MM, JN IJ, Boelhouwer RU, de Vries BC, Salu MK, Wereldsma JC, Bruijninckx CM, Jeekel J. A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med. 2000;343(6):392–8. Scholar
  2. 2.
    Burger JW, Luijendijk RW, Hop WC, Halm JA, Verdaasdonk EG, Jeekel J. Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg. 2004;240(4):578–83; discussion 583–575.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Usher FC, Ochsner J, Tuttle LL Jr. Use of marlex mesh in the repair of incisional hernias. Am Surg. 1958;24(12):969–74.PubMedGoogle Scholar
  4. 4.
    Stoppa RE, Rives JL, Warlaumont CR, Palot JP, Verhaeghe PJ, Delattre JF. The use of Dacron in the repair of hernias of the groin. Surg Clin North Am. 1984;64(2):269–85.CrossRefGoogle Scholar
  5. 5.
    Orenstein SB, Saberski ER, Kreutzer DL, Novitsky YW. Comparative analysis of histopathologic effects of synthetic meshes based on material, weight, and pore size in mice. J Surg Res. 2012;176(2):423–9. Scholar
  6. 6.
    Klinge U, Klosterhalfen B, Ottinger AP, Junge K, Schumpelick V. PVDF as a new polymer for the construction of surgical meshes. Biomaterials. 2002;23(16):3487–93.CrossRefGoogle Scholar
  7. 7.
    Klink CD, Junge K, Binnebosel M, Alizai HP, Otto J, Neumann UP, Klinge U. Comparison of long-term biocompability of PVDF and PP meshes. J Investig Surg. 2011;24(6):292–9. Scholar
  8. 8.
    Earle DB, Mark LA. Prosthetic material in inguinal hernia repair: how do I choose? Surg Clin North Am. 2008;88(1):179–201., x. Scholar
  9. 9.
    Cobb WS, Kercher KW, Heniford BT. The argument for lightweight polypropylene mesh in hernia repair. Surg Innov. 2005;12(1):63–9. Scholar
  10. 10.
    Petro CC, Nahabet EH, Criss CN, Orenstein SB, von Recum HA, Novitsky YW, Rosen MJ. Central failures of lightweight monofilament polyester mesh causing hernia recurrence: a cautionary note. Hernia. 2015;19(1):155–9. Scholar
  11. 11.
    Junge K, Klinge U, Rosch R, Klosterhalfen B, Schumpelick V. Functional and morphologic properties of a modified mesh for inguinal hernia repair. World J Surg. 2002;26(12):1472–80. Scholar
  12. 12.
    Donati M, Brancato G, Grosso G, Li Volti G, La Camera G, Cardi F, Basile F, Donati A. Immunological reaction and oxidative stress after light or heavy polypropylene mesh implantation in inguinal hernioplasty: a CONSORT-prospective, randomized, clinical trial. Medicine (Baltimore). 2016;95(24):e3791. Scholar
  13. 13.
    Bona S, Rosati R, Opocher E, Fiore B, Montorsi M, Group SS. Pain and quality of life after inguinal hernia surgery: a multicenter randomized controlled trial comparing lightweight vs heavyweight mesh (Supermesh Study). Updat Surg. 2017;70:77–83. Scholar
  14. 14.
    Burgmans JP, Voorbrood CE, Simmermacher RK, Schouten N, Smakman N, Clevers G, Davids PH, Verleisdonk EM, Hamaker ME, Lange JF, van Dalen T. Long-term results of a randomized double-blinded prospective trial of a lightweight (Ultrapro) versus a heavyweight mesh (Prolene) in laparoscopic total extraperitoneal inguinal hernia repair (TULP-trial). Ann Surg. 2016;263(5):862–6. Scholar
  15. 15.
    Carbonell AM, Criss CN, Cobb WS, Novitsky YW, Rosen MJ. Outcomes of synthetic mesh in contaminated ventral hernia repairs. J Am Coll Surg. 2013;217(6):991–8. Scholar
  16. 16.
    Klinge U, Junge K, Spellerberg B, Piroth C, Klosterhalfen B, Schumpelick V. 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. 2002;63(6):765–71. Scholar
  17. 17.
    Kalaba S, Gerhard E, Winder JS, Pauli EM, Haluck RS, Yang J. Design strategies and applications of biomaterials and devices for hernia repair. Bioact Mater. 2016;1(1):2–17. Scholar
  18. 18.
    Bittner JG IV, El-Hayek K, Strong AT, LaPinska MP, Yoo JS, Pauli EM, Kroh M. First human use of hybrid synthetic/biologic mesh in ventral hernia repair: a multicenter trial. Surg Endosc. 2017;32:1123–30. Scholar
  19. 19.
    Molegraaf M, Kaufmann R, Lange J. Comparison of self-gripping mesh and sutured mesh in open inguinal hernia repair: a meta-analysis of long-term results. Surgery. 2017;163:351–60. Scholar
  20. 20.
    Zwaans WAR, Verhagen T, Wouters L, Loos MJA, Roumen RMH, Scheltinga MRM (2017) Groin pain characteristics and recurrence rates: three-year results of a randomized controlled trial comparing self-gripping Progrip mesh and sutured polypropylene mesh for open inguinal hernia repair. Ann Surg. Scholar
  21. 21.
    Molegraaf MJ, Grotenhuis B, Torensma B, de Ridder V, Lange JF, Swank DJ. The HIPPO trial, a randomized double-blind trial comparing self-gripping parietex progrip mesh and sutured parietex mesh in Lichtenstein hernioplasty: a long-term follow-up study. Ann Surg. 2017;266:939–45. Scholar
  22. 22.
    Saberski ER, Orenstein SB, Novitsky YW. Anisotropic evaluation of synthetic surgical meshes. Hernia. 2011;15(1):47–52. Scholar
  23. 23.
    Anurov MV, Titkova SM, Oettinger AP. Biomechanical compatibility of surgical mesh and fascia being reinforced: dependence of experimental hernia defect repair results on anisotropic surgical mesh positioning. Hernia. 2012;16(2):199–210. Scholar

Copyright information

© Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) 2019

Authors and Affiliations

  1. 1.Division of Gastrointestinal and General Surgery, Department of SurgeryOregon Health and Science UniversityPortlandUSA

Personalised recommendations