3Rd Department of Surgery, Motol University Hospital, Prague, Czech Republic.
Department of Immunology, Motol University Hospital, Prague, Czech Republic.
Hernia. 2023 Aug;27(4):741-749. doi: 10.1007/s10029-023-02749-4. Epub 2023 Feb 4.
There is an increasing number of patients following hernia surgery with implanted mesh reporting symptoms that could indicate autoimmune or allergic reactions to mesh. 'Allergy' to metals, various drugs, and chemicals is well recognised. However, hypersensitivity, allergy or autoimmunity caused by surgical mesh has not been proven by a scientific method to date. The aim of this study was twofold: to describe the pathophysiology of autoimmunity and foreign body reaction and to undertake a systematic review of surgical mesh implanted at the time of hernia repair and the subsequent development of autoimmune disease.
A systematic review using the PRISMA guidelines was undertaken. Pubmed (Medline), Google Scholar and Cochrane databases were searched for all English-written peer-reviewed articles published between 2000 and 2021. The search was performed using the keywords "hernia", "mesh", "autoimmunity", "ASIA", "immune response", "autoimmune response".
Seven papers were included in the final analysis-three systematic reviews, three cohort studies and one case report. Much of the current data regarding the association of hernia mesh and autoimmunity relies on retrospective cohort studies and/or case reports with limited availability of cofounding factor data linked to autoimmune disease such as smoking status or indeed a detailed medical history of patients. Three systematic reviews have discussed this topic, each with a slightly different approach and none of them has identified causality between the use of mesh and the subsequent development of autoimmune disease.
There is little evidence that the use of polypropylene mesh can lead to autoimmunity. A large number of potential triggers of autoimmunity along with the genetic predisposition to autoimmune disease and the commonality of hernia, make a cause and effect difficult to unravel at present. Biomaterials cause foreign body reactions, but a chronic foreign body reaction does not indicate autoimmunity, a common misunderstanding in the literature.
越来越多的疝修补术后植入补片的患者出现可能表明对补片发生自身免疫或过敏反应的症状。对金属、各种药物和化学物质的“过敏”是众所周知的。然而，迄今为止，尚未通过科学方法证明外科补片引起的超敏反应、过敏或自身免疫。本研究的目的有两个：描述自身免疫和异物反应的病理生理学，并对疝修补术中植入的外科补片及其随后发生的自身免疫性疾病进行系统回顾。
采用 PRISMA 指南进行系统评价。在 Pubmed（Medline）、Google Scholar 和 Cochrane 数据库中，检索了 2000 年至 2021 年间发表的所有英文同行评议文章。使用“疝”、“补片”、“自身免疫”、“ASIA”、“免疫反应”、“自身免疫反应”等关键词进行搜索。
最终分析纳入了 7 篇论文，包括 3 篇系统评价、3 项队列研究和 1 篇病例报告。目前关于疝补片与自身免疫之间关联的大部分数据都依赖于回顾性队列研究和/或病例报告，这些研究中有关自身免疫性疾病的混杂因素数据（如吸烟状况或患者详细病史）有限。3 篇系统评价讨论了这个话题，每个系统评价的方法略有不同，它们都没有确定使用补片与随后发生自身免疫性疾病之间的因果关系。
几乎没有证据表明使用聚丙烯补片会导致自身免疫。大量潜在的自身免疫触发因素，加上自身免疫性疾病的遗传易感性和疝的普遍性，使得目前很难理清因果关系。生物材料会引起异物反应，但慢性异物反应并不表明存在自身免疫，这是文献中的一个常见误解。
