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