Surgical mesh is a medical device, typically a woven or knitted screen-like material, used by surgeons to provide internal scaffolding for damaged or weakened tissues. The material can be synthetic or derived from animal tissue, and its primary function is to offer structural support where native tissue is no longer strong enough to bear the normal physiological load. The mesh acts as a framework, encouraging the patient’s own tissue to grow into and around it, thus reinforcing the area over time. This technique has become a standard approach in numerous surgical fields, improving durability.
Reinforcing Internal Structures
The most frequent application of surgical mesh is in the repair of hernias, which occur when an organ or tissue pushes through a weak spot in a muscle or fascial wall. This includes common types like inguinal (groin), umbilical (navel), and ventral (abdominal wall) hernias. The mesh is placed over the defect, functioning as a patch to bridge the gap and provide immediate mechanical strength.
Using mesh for hernia repair creates a tension-free closure, meaning the surgeon does not need to pull the patient’s native tissue tightly together. This approach significantly lowers the rate of hernia recurrence compared to older repair methods that relied solely on sutures. The material’s porous structure allows for fibrous tissue ingrowth, which ultimately integrates the mesh into the body’s wall, forming a strong, permanent scar plate.
Tubular Applications: Vascular and Urological Grafts
Beyond flat-sheet reinforcement, mesh materials are engineered into tubular forms for specific applications where a conduit or sling is required. In vascular surgery, synthetic grafts made of materials like expanded polytetrafluoroethylene (ePTFE) or polyester are used to replace or bypass diseased large blood vessels, such as the aorta. These grafts function as artificial tubes to maintain blood flow where the natural artery is compromised.
In urology, mesh material is fashioned into thin, ribbon-like slings to treat conditions like stress urinary incontinence (SUI) and pelvic organ prolapse (POP). For SUI, the mesh sling is placed underneath the urethra to provide support and stabilize its position, restoring normal function. The material acts as a tension-free support system for the organs and structures of the pelvic floor.
Composition: Absorbable Versus Permanent Mesh
Surgical mesh is composed of either synthetic polymers or biological materials, and it is categorized based on its intended longevity inside the body. Permanent mesh, often made from materials like polypropylene or ePTFE, is designed to remain in the body indefinitely, providing long-term reinforcement. This non-absorbable material is the standard for most elective hernia repairs where lasting strength is desired.
Absorbable mesh is engineered from polymers like polyglactin or polyglycolic acid, or from processed animal tissue. This material is temporary, providing a scaffold for native tissue growth before slowly dissolving completely over a period of weeks or months. Absorbable mesh is often reserved for situations where a foreign body reaction must be minimized, such as in contaminated surgical fields. Its temporary nature can result in higher recurrence rates if the tissue does not fully heal before the mesh degrades.
Adverse Events and Patient Considerations
The implantation of surgical mesh is associated with potential complications. Common adverse events include chronic pain, which can result from nerve entrapment or inflammation, and infection, which may necessitate removal of the mesh. Chronic pain is one of the most frequently reported post-operative issues.
Other serious complications involve the mesh eroding into adjacent organs, such as the bowel or bladder, or the formation of adhesions that bind internal tissues together. Mesh migration and shrinkage are also reported issues that can occur over time, sometimes leading to the recurrence of the original condition.