Veterans Affairs Boston Healthcare System and Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Surg Infect (Larchmt). 2012 Aug;13(4):209-15. doi: 10.1089/sur.2012.123. Epub 2012 Aug 22.
A variety of mesh materials are available for ventral hernia repair (VHR), each with a unique set of characteristics. Surgeons are offered an ever-expanding selection of products, making a review of the available materials timely.
Current surgical literature is reviewed to describe the different types of synthetic mesh, the indications for the use of each type, their relative risks of infection, and other benefits and shortcomings. We also review clinical studies demonstrating outcomes, efficacy, and use of the meshes in different surgical settings, including laparoscopic hernia repair and special situations such as infection or large abdominal wall defects.
Three main types of prosthetic mesh are available. Synthetic mesh, such as polypropylene (PP) or polyester, is characterized by high tensile strength and vigorous tissue ingrowth, but is unsuitable for intra-abdominal placement because of its tendency to induce bowel adhesions. Composite, or barrier-coated, mesh is a dual-sided prosthetic having a synthetic parietal side to promote a strong repair and a visceral surface that repels tissue ingrowth and decreases adhesion formation. Biologic mesh is a collagen-based human, porcine, or bovine scaffold that may be implanted in the extra- or intra-peritoneal position. Biologic mesh is used frequently in the setting of infected or contaminated surgical incisions.
Synthetic PP mesh is an appropriate, durable material for extra-peritoneal placement in uncomplicated, clean VHR. Expanded polytetrafluoroethylene and composite meshes are suitable for intraperitoneal placement during laparoscopic VHR. Biologic meshes may be appropriate for contaminated fields or other special situations, but there is no consensus on when or how to use them.
有多种网片材料可用于腹疝修补术（VHR），每种材料都具有独特的特点。外科医生可选择的产品不断增加，因此及时对现有材料进行审查是必要的。
本文回顾了当前的外科文献，以描述不同类型的合成网片、每种类型的使用指征、其感染的相对风险，以及其他优缺点。我们还回顾了临床研究，这些研究展示了不同手术环境下（包括腹腔镜疝修补术和感染或大腹壁缺损等特殊情况）使用网片的结果、疗效和应用。
目前有三种主要类型的假体网片。合成网片，如聚丙烯（PP）或聚酯，具有高强度拉伸和旺盛的组织内生长特性，但由于其引起肠粘连的倾向，不适合腹腔内放置。复合或涂层网片是一种双面假体，具有合成壁层侧以促进强有力的修复，以及排斥组织内生长并减少粘连形成的内脏表面。生物网片是一种基于胶原蛋白的人、猪或牛支架，可以植入腹膜外或腹膜内位置。生物网片常用于感染或污染的手术切口。
PP 合成网片是一种适用于无并发症、清洁的 VHR 腹膜外放置的耐用材料。膨体聚四氟乙烯和复合网片适用于腹腔镜 VHR 时的腹膜内放置。生物网片可能适用于污染区域或其他特殊情况，但何时以及如何使用它们尚无共识。
