A look at hernia repair procedures

When breaches in the abdominal muscle occur, causing the organs to protrude from the abdominal cavity, a mesh or graft may be necessary to reinforce the facial repair. To repair a hernia, the surgeon must replace the protruding organ and then reinforce the tissue breach in the wall by inserting a mesh to close the gap and form a protective barrier. The choice of material used is crucial, as inappropriate materials can cause further complications for the patient, including infection or recurrence. Traditionally, repairing soft tissue breaches in contaminated cases has often involved follow-up procedures six months after the initial surgery. This has largely been due to complications which can arise from the use of synthetic mesh. With around 90,0001 people in England having an operation to repair an inguinal hernia every year, at a cost of approximately £56 million annually,2 the drive to produce new and more efficient methods to treat soft tissue breaches has increased. The development of biological grafts in recent years has provided surgeons with a viable alternative to using synthetic mesh.

Synthetic mesh or biological graft

If hernias are left untreated they can lead to further complications such as gangrene, bowel obstruction, strangulated hernia and even death. Using materials to repair tissue breach damage is generally seen as the preferred method of repair over traditional plication, as suturing weakened tissue can lead to constricted or anatomically incorrect results. Biological graft or synthetic mesh use permits a broader base of support and eliminates the need to rely on the existing weakened tissue. Traditionally, surgeons have repaired hernias and other large breaches of soft tissue and muscle using synthetic mesh such as stainless steel, expanded polytetra-fluoroethylene (ePTFE), polypropylene and other plastics. These inert materials work well as a strengthening barrier but complications can arise due to infection, rejection or recurrence of the hernia, resulting in the need for further repairs and a higher risk to the patient. For example, laparoscopic paraoesophageal hernia repair is associated with a high recurrence rate. Where a synthetic mesh has been used to treat it, dysphasia and visceral erosions can occur. However, a recent study involving Biodesign (Surgisis),3 a biological graft, found that adding a biological prosthesis reduces the likelihood of recurrence without meshrelated complications or side effects such as dysphasia or post-prandial pain. Biological grafts for soft tissue repair are now being used more frequently. These new grafts are an alternative to traditional synthetic mesh, offering a long-term solution without the use of permanent material. Biological grafts are revolutionising the way in which surgeons use materials for the body to restore itself. As these grafts are able to offer the added advantages of both tissue remodelling and resistance to infection, it makes them an attractive choice for soft tissue repair procedures.