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Types of mesh and their manufacturers
I think that most people who have hernia repair do not realize the vast number of different types of mesh that are out there. Here is a Topic to try to show the number and variety, and the manufacturers, along with some of the industry consolidation that is happening. two of the big players in the field are now under new management, apparently. Bard Davol has been purchased by Becton Dickinson, and Covidien is now part of Medtronic.
First a simple text list, with some comments. I’ll add links about these companies in following posts.
Medtronic – Recently purchased Covidien
BD – Might stand for Bard Davol or Becton Dickinson. Bard Davol was purchased by Becton Dickinson
Dynamesh Their mesh niche is a polyvinylideneflouride fiber mesh, PVDF. This is a fluoropolymer so should have the poorest tissue adhesion of three main types of thermplastic fiber. It’s main quality is probably being different than the others. Market differentiation.
Gore – Another fluorpolymer mesh. Polytetrafluorethylene. PTFE. An oddball product portfolio. their original products were of the same technology as their GoreTex fabric. They seem to be expanding in to PTFE fibers now.
Ethicon – one of the originals in the field. They seem to be waffling between beong called Johnson & Johnson again or Ethcion. They are a subsidiary of Johnson & Johnson. One of the major drivers of mesh for hernia repair, with extensive influence in the conferences and the Guidelines development.
Atrium – main claim to fame seems to be their Omega 3 oil coated hernia mesh. Apparently they have been purchased or their mesh division has, by Getringe. The Atrium products are not found on Getringe’s main page but can be found using Google.
Getinge – now handles Atrium products
One brand, one source.
Under the name Getinge we are now unifying our offering and combining all our brands.
With brands like Maquet, Lancer, Atrium, Pulsion, Datascope, Getinge, Steritec, Stericool and Trans – just to name a few – the group has grown to become a global market leader in many healthcare and life science segments. We are now unifying our offering and combining all of our talent and resources under one brand. -
55 Replies
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Here’s another one. BD’s (Bard) Ventrio ST, used by Dr. Reinhorn of Boston Hernia, in his TREPP procedure.
By the literature it would be an “off-label” usage since it is specified for ventral hernias.
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SAGES recently, March 8 2023, created a document attempting to explain the different types of mesh to their members. Many authors. The document is a good general primer about mesh but doesn’t seem to offer much advice on how to choose one. It’s a good start though, and they do acknowledge that much is still unknown about the materials in general. They end with a hopeful statement about registries, similar to what Dr. Heniford was calling for about five years ago.
https://www.sages.org/publications/tavac/mesh-review-and-catalog/
“…
Considerations for the Future
Given the current wide use of products in many clinical situations by surgeons with differing expertise, it is critical that surgeons follow patients over time to determine the outcome of interventions. The implantation of a device with the intent of lifelong placement carries with it a responsibility to ensure safety and efficacy of the product over the long-term. This is especially true in the off-label use of these products. By combining the rich clinical data obtained through well-designed registries with administrative data linkages and patient reported outcomes, we can help ensure that innovations in our field ultimately benefit our patients while minimizing harm.…”
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Here is another mesh product from a company I had not heard of, Betatech. Based in Turkey.
It has on odd pattern, it looks like a combination of braided material with monofilament.
https://www.betatechmedical.com/en-US/Contact/Contact-Info
A forum member was looking for a surgeon to remove it recently.
https://herniatalk.com/forums/topic/inguinal-hernia-mesh-removal-stats/
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Jnomesh posted about a prosthetic made from a person’s own tissue.
https://herniatalk.com/forums/topic/new-personalized-hernia-patch-made-out-of-skin/
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newagehernia are you referring to a type of cloning? I wasn’t aware that tissue cloning was available for the general public at this time. I know tissue expansion has been used to increase daughter cells thus overall volume for burn victims graphs, etc. for a long time.
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Can they take some fascia from the same person , amplify it in a lab, and then use that laparascopically? similar to hair follicle multiplication in transplants…
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SN’s recent query about the types of mesh used in hernia repair sent me out on the internet to review what’s out there, and to see who, if anybody, specifies theirs for Lichtenstein repair. Most manufacturers only distinguish between laparoscopy and open, and many don’t distinguish beyond “soft tissue repair” or “hernia repair”. You can understand why many surgeons just use whatever is in the cupboard at the ambulatory surgery center. It’s a mad-house.
Here is another absorbable that I didn’t really notice in the past. It is, somewhat ironically, from the company that makes what is probably the most stable material, the fluoropolymers. Gore Medical.
The description is kind of funny. Why would “shiny” be important? I assume that the word gives the impression that adhesions are less likely on a shiny surface.
They have two forms, one for inside the peritoneum and one for outside.
https://www.goremedical.com/products/enform
The GORE® ENFORM Biomaterial is used to reinforce soft tissue during the phases of wound healing by filling soft-tissue deficits. Typical procedures include:
– Abdominal wall reconstruction
– Hernia repair
– Muscle flap (i.e. TRAM, DIEP) proceduresThe GORE® ENFORM Preperitoneal Biomaterial is designed with a textured porous fibrous web surface on both sides.
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The GORE® ENFORM Intraperitoneal Biomaterial is a dual-sided device where one side is textured and the other is a smooth, shiny surface. ”
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Surgimesh is part of a new polypropylene material lawsuit. This is from March 2022.
Typical mesh implanted, major problems, mesh removed.
https://www.lawsuit-information-center.com/surgimesh-hernia-mesh-lawsuits.html
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I just came across a type of mesh that I had not seen before. Some of these new products get introduced but don’t get much publicity. Hard to compete with the big guys.
Dr. Ramshaw was involved. The video is from seven years ago. It’s not clear if “Advanced Hernia Solutions” was a side venture. 2016.
The mesh is made via a non-woven method. Fibers are spun (molten material squirted from a spinneret) in a random pattern. The fibers stick together to form a flat sheet.
https://surgimesh.com/products/
https://surgimesh.com/videos/ramshaw-laparoscopic-lih-repair/
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yes that’s it. so is crosslinking any different than a standard propylene mesh?
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Here are some links that I tried to add to the Getinge post above. Too many, I guess, didn’t get through.
https://hollislawfirm.com/atrium-sells-c-qur-hernia-mesh-line/
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The link in the post after that one about the Omega-3 coated C-QUR mesh is also broken. It turns out that Getinge sold the C-QUR product line to a venture capital firm because the litigation costs were too high, soon after they bought the product line from Atrium. Pretty fascinating…the birth, life, and death of a novel hernia repair mesh all within about 10 years.
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The link in Reply #20099 above is broken. Here is another. Getinge’s Proloop product.
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Here is another recent review article covering the wide variety of hernia repair meshes. It is very wide-ranging, the primary author is a graduate student at Stony Brook. Looks like the foundation for a thesis.
Some of the summary points are outdated though, at least for the United States. She says that open Lichtenstein is the predominant repair method but that was probably true 10-15 years ago. Today if you get referred to a surgeon you’re probably going to get a laparoscopic mesh implantation. And, in the collection of biological meshes, the new venture, Tela Bio, is not even mentioned. Things move fast in the new mesh product world though, easy to get left behind. It’s a good thorough review though, of materials, methods, and hernia types.
https://www.sciencedirect.com/science/article/pii/S2666138120300025#!
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Thank you , that makes sense. A little bit like homeopathy, where it is not the quantity of a substance but its mere presence in small quantities that is the issue.
I just wish the scientists would get their act together and develop a non-rejectable, non immunogenic, collagen-self cell or alternative biosubstance that is more biocompatible than petroleum product, and do it faster! The concept of mesh does seem to have advantages, but so does actual tissue.
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No, I mean the area of polymer fiber exposed to the body’s fluids. Macrophages, etc., the things that react to foreign material. More fiber surface means more macrophage reaction. There’s no weight involved, just exposed area. The body can’t detect what’s under the surface it only reacts to surfaces, not interior.
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by surface area do you mean pore size? the widest size polypropylene only mesh I’ve seen is a Polish mesh optomesh ultralight which has 6mm pores.
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BD’s advertising doesn’t even really give a reason to use their lightweight mesh. Notice how they refer to actual weight. 60% lighter. Bad rationale.
“For surgeons who may prefer to implant less material, it is approximately 60% lighter than traditional polypropylene mesh*,”
“* As compared to other traditional polypropylene mesh, such as Classic Bard™ Mesh”
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The Seri material does look interesting. I think that Dr. Brown uses silk sutures for his pure tissue repairs.
The lightweight mesh concept is an idea based on the assumption that if the mass of material is reduced that the inflammatory response will be reduced. But the body cannot “see” mass, it can only respond to surface area. Thinner filaments actually have more surface area per unit of mass. The idea was not proven through long-term studies it was authorized through the 510(k) process and immediately introduced to market as a potentially better product. Overall, it looks like an attempt to show that the pain problem was being addressed, plus an increase in market share for the company that first introduced it. The data is inconclusive as far as the claims being made. I had lightweight mesh implanted, Bard Soft Mesh, and had the typical chronic pain problems described for heavyweight mesh.
https://scholar.google.com/scholar?hl=en&as_sdt=0%2C48&q=lightweight+hernia+mesh&btnG=
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I like this mesh but it´s not available in na. 21gm and 2.3mm pore size, for thin people who want less inflammation.
https://www.cjmedical.com/products/specialties/laparoscopy/ami-laparoscopy/hexapro-mesh
I am not sure if this can be used for hernias but looks interesting
https://www.seri.com/about/seri-at-a-glance.html
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