Meshes: Benefits and Risks

The 3rd Suvretta meeting in January 2003 was intended to give an overview of the of meshes in hernia operations. After the first meeting in 1995 on Ingui­ current use nal Hernia and the second on Incisional Hernia in 1998, the current congress was focused on the benefits and risks of hernia meshes, the reason being that meshes have more and more become the standard in open as well as in laparoscopic hernia operations. During the past 10 years new indications for the use of mesh as well as new types of mesh have been developed. Considerable experience with meshes has been published in the literature, including controlled trials of different results, dif­ ferent techniques, and last but not least, case reports of complications. We there­ fore felt it was timely and appropriate to hold a state-of-the-art meeting on meshes used in hernia curative procedures. During 3 intense working days which included presentations, demonstrations, and extensive discussions, the current role and the future potential development of artificial mesh implants were discussed by both traditional and laparoscopic sur­ geons. The most renowned hernia specialists of the world came together to discuss the use of meshes relating to construction, material, technique, experimental stu­ dies and clinical results. Each participant was invited to give a special talk on his favorite subject for discussion among the attending specialists.

 

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.