[The "ideal" mesh--more than a mosquito net].

Modern meshes permit a radical treatment of hernias, an expectation that Billroth articulated already more than 100 years ago. Because clinical trials are insufficient to evaluate the distinct effects of modified mesh materials in regard to tissue biocompatibility and functionality, a basic understanding of the physico-chemical properties is essential for a rational selection of the most appropriate device. Experimental data indicate that particularly the mesh's porosity is of outstanding importance, resulting from the demanded tensile strength as well as the employed fibre material. Considering that different operation techniques require different mesh materials, specific requirements are discussed using the example of intraabdominal meshes, of parastomal meshes, of meshes in areas with bacterial contamination and of meshes in the hiatus region. Considering the late manifestation of some complications even after many years, any thorough quality control should include an assessment of explanted implant failures in addition to clinical experience.