Meshes: Benefits and Risks

Book excerpt: Within a few years the surgical approach to abdominal wall hernias has focused on mesh-based treatment options. This dramatic change has set the stage for the third Suvretta meeting. All aspects of the mesh world have been discussed in detail by more than 50 international experts during an intense week resulting in an assessment of success and failures. After posing the question, whether meshes have defeated recurrences in the groin, epidemiological clinical data on recurrences were presented and show that this problem still exists. In particular, novel molecular biology-based research results stress the pathophysiological importance of a defective scarring process in these patients with inherent conclusions for future therapies. Regarding the variety existing meshes, there are already more than 100 different mesh devices, a comprehensive review of their chemical and textile properties was presented, with emphasis on their impact on biological responses. However, more than 90% of the participants articulated the need for improved mesh prosthesis, because their characteristic inflammatory and fibrotic foreign body reaction cause minor and major complications, e.g. pain, infections, adhesions, damage of the spermatic cord. The differentiated use of meshes in various procedures was discussed, including groin, incisional, parastomal, diaphragmal and hiatal hernias as well as their use in extended abdominal wall defects or in paediatric or plastic surgery. In summary this book summarizes the most up-to-date knowledge about meshes and hopefully serve as manual for both practical surgeons and scientists involved in the growing world of mesh.