We have a a good choice of composite meshes for use.whenever i conduct a training programme,first question of participants is what mesh do you deploy /advice.As such there is no ideal mesh in my openion.However each brand has a one or more beneficial qualities.
Dear Prasanna:
without doub the best for laparoscopic incisional or ventral hernia repair in our experience is Gore-Tex Dual Mesh with holes.
best regards,
I would never consider using an e-PTFE product in intraperitoneal position for at least following three reasons: excessive shrinkage (you may call it scar compression), limited in-growth and therefore need for permanent fixation and the price. (besides the problematic behaviour in case of infection). As Prasanna said there is no ideal mesh for intraperitoneal position. Composite meshes with absorbable barrier like Ventralight ST or Parietex composite performed best in the past.
Probably the upcoming trend to avoid placement of intraperitoneal meshes even with endoscopic techniques will resolve the problem with some mesh related complications ( subacute or potential ones) faster than the industry could offer us the next best mesh ever.
of course, there is not any ideal mesh for intraperitoneal position, but in my long term experience the e-PTFE obtained the best results in order to relapse, intraabdominal adhesions, posibility of sepsis and confort for the patient (in spite of the costs).
in 1999 I publiseh the first prospective randomized study between open and laparoscopic surgery in incisional hernia repair. After, long-term follow-up of large series of patients confirm this criteria.
You can't answer this question in a paragraph - if at all - but let me make a suggestion: The large-pore hydrophilic synthetic meshes (polyester or polypropylene) have better ingrowth with the advantages this has for fixation and endurance and better elasticity. With a proper absorbable barrier they have the same anti-adhesive properties as ePTFE, are more infection resistant and have less shrinkage. I believe that the ePTFE mesh was ground breaking in development of intraperitoneal mesh application, but the time has passed for use of this material for hernia repair. Biological meshes and (other) absorbable synthetic meshes have no role in routine hernia surgery today. Fortunately, and for obvious reasons (uneven shrinkage and excessive material) dual-layer meshes with ePTFE and polypropylene are no longer competitive.
What is a proper barrier? In my experience the Collagen film is a proper barrier and has performed immaculately in my department for the last 14 years - in 3 generations of meshes. Alas, we are fortunate to be able to choose the best mesh for the patient - and not for the financial department; not everyone have this luxury. Good luck with the choice of mesh!