The Biomechanical Response of Lightweight vs Heavyweight Mesh in Ventral Hernia Repair: A Systematic Review of Animal Studies

Abstract

Background

There is currently insufficient evidence to determine whether lightweight or heavyweight mesh is the better choice for ventral hernias. Recurrence and postoperative pain are associated with biomechanical responses such as inflammation, foreign body reaction, cell ingrowth, and tensile strength, which can be examined in animal studies. This study aimed to compare the biomechanical differences between light- and heavyweight meshes in animal models.

Methods

A systematic search was conducted on August 14, 2023, in PubMed and Embase for studies comparing light- and heavyweight meshes implanted on animal abdominal walls. We included studies reporting on non-coated polypropylene or polyester meshes in an onlay placement. Studies were excluded if the mesh was coated, absorbable, fixated with fibrin glue, implanted in a contaminated field, or if it was an in vitro study. The study was reported according to PRISMA 2020 guideline, and risk of bias was assessed using the SYRCLE bias assessment tool.

Results

Our search yielded 4050 records, which resulted in 91 reports for full-text screening, and 20 studies were included in the final analyses. Heavyweight meshes caused more inflammation and foreign body reaction compared with lightweight meshes but displayed similar tensile strength post-implantation. There was insufficient evidence regarding cell ingrowth.

Conclusion

Heavyweight meshes caused increased inflammation and foreign body reaction compared with lightweight meshes. Although heavyweight meshes preimplantation have increased tensile strength compared with lightweight meshes, no difference was found post-implantation. This suggests that lightweight meshes may be a good option for ventral hernia repair.