With the rapid development of material science in recent years, various hernia repair materials have been widely used in clinical practice, which has led to fundamental changes in the treatment of hernia. The synthetic materials that have been widely used for hernia repair internationally are divided into two categories: the first category is non-absorbable polyester patch, polypropylene patch and expanded PTFE patch; the second category is composite patch.
Dacron, Mersilene): Invented in 1939, it is the first synthetic patch that has been widely used. Although it has been nearly 50 years old, it is still used by some surgeons because of its low price and easy access to many advantages. However, because of the fiber structure of polyester silk, in the resistance to infection than the monofilament polypropylene mesh, polyester material inflammation and foreign body reaction is also the heaviest.
2, polypropylene patch (Polypropylene Mesh. Marlex, PP): woven from polypropylene fibers, a single-layer mesh structure, is currently the preferred material for repair of abdominal wall defects. between 1958 and 1963, Usher wrote several articles about a new material called Marlex 50, which is comparable to any other type of Compared to any other type of metallic or nonmetallic material of the same period, this material has been shown in animal studies and clinical studies to have the following distinct advantages.
(1) It is softer and more resistant to bending and folding;
(2) Can be cut to size as needed;
(3) Stimulation of fibrous tissue proliferation is more obvious, the mesh pore size is large, more conducive to fibrous tissue growth through, easy to be infiltrated by connective tissue, and can be embedded with tissue early;
(4) The foreign body reaction is mild, and the patient has no obvious foreign body and discomfort, with a very low recurrence rate and complication rate.
(5) More resistant to infection, even in purulent infected wounds, granulation tissue can still proliferate in the mesh of the patch without causing mesh erosion or sinus tract formation;
(6) Higher tensile strength;
(7) Unaffected by water and most chemicals;
(8) High temperature resistance, can be sterilized by boiling;
(9) Relatively inexpensive.
In addition to inguinal hernia surgery, polypropylene patches have been used for infected abdominal wall battle wounds, giant abdominal wall hernias, abdominal wall defects due to electrical shock injuries or infection, parastomal hernias, reconstruction after total abdominal wall resection for metastatic abdominal wall tumors, after necrotizing fasciitis of the abdominal wall, abdominal wall incision dehiscence, and laparoscopic hernia repair.
Over the past 50 years, polypropylene mesh has had a tremendous impact on the field of surgery, with countless patients’ lives being saved and many surgical problems being solved by its use, and it has proven to be the most popular implant in the field of surgery today. Nevertheless, there are some problems in the application of polypropylene mesh.
First, when used for repair of full abdominal wall defects, the patch has to be isolated from the visceral tissues, and if it is in direct contact with the visceral organs it can cause more serious abdominal adhesions, gastrointestinal obstruction, and may even erode the intestinal wall and cause intestinal fistula; second, if large abdominal wall defects are repaired, late scar contraction can cause distortion of the mesh, and its irregular surface may irritate and damage the surrounding tissues, causing infected shed skin sinus tract formation.
Expanded Polytetrafluoroethylene patch (e-PTFE): This patch is softer than the previous two patches, less likely to form adhesions when in contact with abdominal organs, and causes the least inflammatory reaction. e-PTFE patch allows bacteria to pass through, but phagocytes cannot pass through and tissues cannot grow. It cannot tolerate infection and contamination, and cannot be used for contaminated wounds. Once the patch is infected, it must be removed, otherwise the wound will be difficult to heal.
e-PTFE patch is now mostly used for recurrent inguinal hernia; it is also used for incisional hernia because its direct contact with viscera hardly causes adhesion; it is used for young inguinal hernia patients with little hernia ring defect to avoid some complications such as postoperative spermatic cord adhesion and painful ejaculation discomfort.
4, polypropylene and e-PTFE materials combined patch: the commonly used Bard composix patch is composed of two layers of polypropylene and one layer of e-PTFE material, which is characterized by the advantages of both polypropylene and e-PTFE materials, i.e. polypropylene mesh grows into the tissue well and grows firmly in the abdominal wall after implantation, while e-PTFE material can be placed in contact with the viscera in the abdominal cavity and has a better anti-adhesion effect. good anti-adhesion effect. Therefore, these materials are divided into contact surfaces with the abdominal wall and contact surfaces with the viscera and are often used as repair materials for giant abdominal wall incisional hernias.
5, polypropylene combined with absorbable materials for patches: these materials are designed with a polypropylene mesh as the skeleton, and then compounded with absorbable materials, with the aim of reducing the amount of foreign material (polypropylene), anti-adhesion and anti-infection.
Manufacturers.
Ten years ago, the hernia patches used in domestic clinics were mainly imported from abroad. After 2005, the hernia patches with good performance – “ShanShi” hernia patches have been produced in China, the price of which is more suitable for domestic patients and the actual use effect has been highly praised by domestic and foreign experts. Its R&D capability is in the leading position in China. It has reduced the medical burden for the majority of patients.
Surgical application.
At present, hernia patch has been widely used in tension-free hernia repair, and it is listed in the medical preservation reimbursement catalog in most provinces and cities in China. They are relatively well applied in most provinces and cities such as Beijing, Shanghai, Guangdong, Jiangsu and Shanxi, with mature surgical techniques and more professional academic exchanges, which have led to the rapid development of this type of surgery. Tension-free hernia repair in Beijing Chaoyang Hospital Hernia Surgery Department, Beijing Century Temple Hospital, Shanghai Huadong Hospital, Shanghai Huashan Hospital, Shandong Provincial Hospital of Traditional Chinese Medicine, Shaanxi Provincial People’s Hospital and Shanxi Provincial Hospital No. 109 has a greater influence in the country.