Surgical Mesh

Definition
Demographics
Description
Mesh Used for Tissue Support
Mesh Used for Hernia Repair
Risks Associated with Surgical Mesh

Definition

Surgical mesh is a sterile woven piece of netting that is used in surgical procedures to help repair sites of surgical incision, tissue herniation, or to provide support to internal parts of the body.

Demographics

Surgical mesh is used in many different types of surgical procedures. Hernia repair is one of the most frequently performed general surgeries world wide, and usually involves the use of surgical mesh. Mesh is also used to assist in surgical correction of urinary incontinence, uterine suspension, vertebral reconstruction, tissue reconstruction, vaginal prolapse, and provides support for devices implanted to support the heart.

Description

Surgical mesh can be used in many different surgical procedures to provide wound closure or support for internal body parts. Also known as a patch or screen, surgical mesh is implanted in the body for repair or reinforcement. Surgical mesh may be absorbable or non-absorbable. Some types of repair procedures using surgical mesh may also be called a “Lichtenstein Repair,” because of a surgeon named Irving Lichtenstein whose influence in the medical field increased the widespread use of surgical mesh. A Lichtenstein Repair is specifically a flat piece of surgical mesh used as a patch placed on top of a tissue defect.

Surgical mesh is usually a sterile, woven material made of a type of synthetic plastic. Surgical mesh can be made of various different types of synthetic material, such as Gore-Tex, polyprolene, or knitted polyester. Mesh is very sturdy and strong, yet extremely thin. It is soft and flexible to allow it to easily conform to the movement of the body. Surgical mesh is available in various measurements and can be cut to size for each surgical application. Depending on the type of repair that is needed, a patch of mesh is placed under, over, or within a defect in the body and sewn in place by a few sutures. The mesh acts as a type of scaffold for the body tissue that grows around and into the mesh. Mesh is also used like a sling to support internal body parts and hold them in place.

Once inserted, mesh is eventually incorporated into the surrounding tissue as if it is part of the body. For this reason, mesh is considered a tension-free type of repair, as opposed to sutures. Sutures hold flesh together through the tension they create by pulling tissues together to close a wound. Because sutures create tension in the tissue they repair, too much movement early on in the recovery period after surgery can re-open the repair site and cause internal bleeding. Mesh is different in that it does not rely on tension to hold tissue together. Rather the mesh itself fills the wound and allows tissue to grow into and around it. Patients in which surgical mesh has been used may resume activity much sooner after the surgical procedure than is usually seen with tension repair techniques such as sutures. Surgical mesh may be used in the form of a patch that goes under or over a weakness in body tissues, or a plug that goes inside a hole in the tissue. The patient cannot feel the internal mesh, and is able to move freely.

Mesh Used for Tissue Support

Surgical mesh may be used to help physically support body tissues that are weak or damaged in some way. One example of a procedure that may benefit from mesh in this way is uterine suspension. Uterine suspension is necessary when the uterus is tipped out of its normal position and causes medical complications. Uterine suspension is performed to put the uterus back into its normal position. Surgical mesh may be used as a sling to support the uterus and hold it in place. A second example of mesh used for tissue support is as a sling for the urethra in some types of urinary incontinence where the urethra has fallen out of its normal position. In surgery done for urinary incontinence, a sling is put in place to lift the urethra back into its normal position and create a type of pressure that helps prevent the incontinence. A mesh sling may be used and attached to the abdominal wall, where the body tissue will grow around and into it to provide strength and support.

Mesh Used for Hernia Repair

Hernia repair is the most common use for surgical mesh. A hernia is a protrusion of body tissues through a defect in a muscle or other containing body parts. Mesh may be used to repair the defect that allowed the herniation of body tissue. Hernias used to be commonly repaired using sutures and other types of tension-based tissue closure techniques. However, sutures do not allow for free movement as soon after the surgery. Sutures also create a higher post-operative intra-abdominal pressure and consequent breathing problems than mesh. Sutures are associated with a higher rate of hernia recurrence than mesh. Mesh hernia repair also causes less pain after surgery than suture repair. Mesh hernia repair clearly has many advantages over hernia repair using sutures.

Almost all hernia repairs are performed today using tension-free surgical mesh. Polyprolene is one of the most commonly used synthetic meshes in hernia repair, with each type of mesh material having advantages and disadvantages for hernia repair. Some hernia repair techniques using mesh include the Lichtenstien Repair where mesh is placed over the defect in the tissue, the Kugel Method where mesh is placed behind the defect, and the Prolene Hernia System where two

KEY TERMS

Adhesions— Scar tissue.

Intra-abdominal Pressure— The pressure present in the abdominal cavity that affects the pressure on the diaphragm and the ability to breathe easily.

Prolapse— A condition where the organs fall out of their normal location in the body.

Sutures— Stiches that are used in surgical procedures to bring two pieces of flesh together or close a wound.

Urinary Incontinence— Disorder where urination is uncontrolled and involuntary.

Uterine Suspension— Procedure that places a sling under the uterus and holds it in place.

Vertebral Reconstruction— Procedure for reconstruction and support of the vertebrae of the skeletal system.

layers of mesh are placed around the defect, one behind and one over the defect. Another method of mesh-based hernia repair is the Plug and Patch Method, where mesh is placed like a plug into the tissue defect and then covered over the top with another mesh patch. Hernia repairs using mesh may be done as same day surgery using only local anesthesia. Because surgical mesh is a type of tension-free repair, patients can resume normal physical activity much sooner after the operation.

Risks Associated with Surgical Mesh

While the use of surgical mesh has many advantages over other techniques, it is also associated with risk of some medical complications. One of the greatest risks of the use of surgical mesh is mesh infection. Mesh infections tend to be resistant to wound care techniques and antibiotics, and are generally removed upon discovery. Removal of infected mesh necessittates a new surgical procedure and the replacement of the mesh with a new repair. Surgical mesh may also cause tissue inflammation, which can be painful. Mesh may also cause adhesions, or scar tissue. Adhesions sometimes cause medical problems in the surrounding area. For example, adhesions in the abdominal cavity may cause obstruction of the bowels, and adhesions in the pelvic region may contribute to infertility in females. All types of hernia repair are associated with the risk of hernia recurrence, the protrusion of tissue through the repaired defect from failure of the mesh or suture repair. Mesh repairs have a lower risk of hernia recurrence than sutures.

Resources

BOOKS

Kumar, Vinay, Nelson Fausto, and Abul Abbas. Robbins & Cotran: Pathologic Basis of Disease, Seventh Edition. Saunders, Elsevier, 2005.

PERIODICALS

Burger, J. W. A., R. W. Luijendijk, W. Hop, J. A. Halm, E. G. Verdaasdonk, J. Jeekel. “Long-term Follow-up of a Randomized Controlled Trial of Suture Versus Mesh Repair of Incisional Hernia.” Ann Surg 240(4):578-585, 2004.

Frey, D. M., A. Wildisen, C. T. Hamel, M. Zuber, D. Oertli, J. Metzger. “Randomized Clinical Trial of Lichtenstein’s Operation Versus Mesh Plug for Inguinal Hernia Repair.” Br J Surg. 2007;94:36–41.

OTHER

“Health Adhesions, General and After Surgery.” eMedicine. October 16, 2005. http://www.emedicinehealth.com/adhesions_general_and_after_surgery/article_em.htm [Accessed April 15, 2008].

Maria Basile, PhD