Which Mesh System

Hernia Discussion Forums Hernia Discussion Which Mesh System

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    • #10768
      goldenmsc
      Member

      For those patients with pre-existing autoimmune conditions which mesh systems and brands are preferred?
      Biologic best?
      Assume Prolene not recommended.

    • #13639
      pszotek
      Participant

      Which Mesh System

      Autoimmune conditions do not necessarily change my choice of mesh. What type of meds are you on? Steroids, etc.

      In my experience Bard SoftMesh or Covidien Pro-grip work fine in these cases. This depends on the overall case picture though. Opinions may differ on this subject but I do not believe there is good evidence to alter my choice of mesh based solely on an autoimmune condition. If other factors pushed me toward biologic then I would consider biologic. In either case the risk is elevated with such conditions to develop mesh infection or chronic drainage. I quite regularly use SoftMesh or Pro-grip in heart transplant patients who are on multiple immune suppressants and they do well. Probably any macroporous prolene would work but those are the two I use most often. I like the pro-grip in the transplant cases because I don’t have to use sutures and thus no knots. Knots often cause suture granulomas, chronic drainage in immune suppressed folks. Just my two cents. I hope it helps. Paul

    • #12442
      drtowfigh
      Keymaster

      Which Mesh System

      In my practice, I treat patients with known autoimmune disorder differently than others. These are patients with diagnoses such as lupus, rheumatoid arthritis, fibromyalgia. I have noticed that they respond with a heightened inflammatory repost we to injury (or surgery). Since mesh typically exerts an inflammatory response as part of the healing, I either perform a pure tissue repair or I implant mesh that has the lowest risk for inflammatory response. These include some biologic mesh, some new hybrid mesh products, and new PTFE or PVDF based mesh products.

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