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Archive August 2019 XX, No. 8

Achieving Better Hernia Outcomes

Choosing the most appropriate surgical mesh for each individual patient.

Dan O

Dan O'Connor, Editor-in-Chief


CHOOSE YOUR MESH Some say that choosing the most appropriate surgical mesh for each patient is key to successful hernia outcomes.

What type of immune response does your surgical mesh elicit in patients? That's a question you and your surgeons should ask, says Stephen F. Badylak, DVM, MD, PhD, professor of surgery at the University of Pittsburgh School of Medicine and deputy director of the McGowan Institute for Regenerative Medicine.

“There is no biomaterial, regardless of what it’s made of, that is inert. Nothing is inert,” he says. “Everything that you put into the body elicits some type of a response. The question is, is it a favorable or a non-favorable response? The host’s response to the material is the primary determinant of success. The choice of the most appropriate surgical mesh for each individual patient is the primary determinant of downstream outcomes. The bigger question is, how do surgeons select the best mesh for each patient?”

In talking to Dr. Badylak, a pioneer in his field of regenerative medicine and tissue engineering, about the role mesh material plays in successful hernia repair, he laments the polypropylene mindset among surgeons: settling for the good-but-not-great outcomes that are predictable of synthetic mesh material — strong and quickly incorporated into host tissue — yet eliciting a pro-inflammatory immune response that leads to scar tissue and such resulting complications as pain, infection and recurrence.

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