Design strategies and applications of biomaterials and devices for Hernia repair

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Abstract

Hernia repair is one of the most commonly performed surgical procedures worldwide, with a multi-billion dollar global market. Implant design remains a critical challenge for the successful repair and prevention of recurrent hernias, and despite significant progress, there is no ideal mesh for every surgery. This review summarizes the evolution of prostheses design toward successful hernia repair beginning with a description of the anatomy of the disease and the classifications of hernias. Next, the major milestones in implant design are discussed. Commonly encountered complications and strategies to minimize these adverse effects are described, followed by a thorough description of the implant characteristics necessary for successful repair. Finally, available implants are categorized and their advantages and limitations are elucidated, including non-absorbable and absorbable (synthetic and biologically derived) prostheses, composite prostheses, and coated prostheses. This review not only summarizes the state of the art in hernia repair, but also suggests future research directions toward improved hernia repair utilizing novel materials and fabrication methods.

Graphical abstract

This review summarizes the evolution of surgical techniques and prosthetic mesh design toward successful hernia repair. It also outlooks strategies for future development of biomaterials and hernia meshes exemplified by the citrate-based biodegradable photoluminescent polymer (BPLP) coating strategy for possibly addressing the common problems of mesh-triggered severe chronic inflammation and tissue adhesion.

Highlights

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Hernia repair is one of the most commonly performed surgical procedures worldwide, with a multi-billion dollar global market.
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This review summarizes the evolution of surgical techniques and prostheses design toward successful hernia repair beginning with a description of the anatomy of the disease and the classifications of hernias.
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It also suggests future research directions toward improved hernia repair.

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Most cited references 169

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On the mechanisms of biocompatibility.

David Williams (2008)

The manner in which a mutually acceptable co-existence of biomaterials and tissues is developed and sustained has been the focus of attention in biomaterials science for many years, and forms the foundation of the subject of biocompatibility. There are many ways in which materials and tissues can be brought into contact such that this co-existence may be compromised, and the search for biomaterials that are able to provide for the best performance in devices has been based upon the understanding of all the interactions within biocompatibility phenomena. Our understanding of the mechanisms of biocompatibility has been restricted whilst the focus of attention has been long-term implantable devices. In this paper, over 50 years of experience with such devices is analysed and it is shown that, in the vast majority of circumstances, the sole requirement for biocompatibility in a medical device intended for long-term contact with the tissues of the human body is that the material shall do no harm to those tissues, achieved through chemical and biological inertness. Rarely has an attempt to introduce biological activity into a biomaterial been clinically successful in these applications. This essay then turns its attention to the use of biomaterials in tissue engineering, sophisticated cell, drug and gene delivery systems and applications in biotechnology, and shows that here the need for specific and direct interactions between biomaterials and tissue components has become necessary, and with this a new paradigm for biocompatibility has emerged. It is believed that once the need for this change is recognised, so our understanding of the mechanisms of biocompatibility will markedly improve.

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Injectable citrate-based mussel-inspired tissue bioadhesives with high wet strength for sutureless wound closure.

Mohammadreza Mehdizadeh, Hong Weng, Dipendra Gyawali … (2012)

The existing surgical adhesives are not ideal for wet tissue adhesion required in many surgeries such as those for internal organs. Developing surgical adhesives with strong wet tissue adhesion, controlled degradability and mechanical properties, and excellent biocompatibility has been a significant challenge. Herein, learning from nature, we report a one-step synthesis of a family of injectable citrate-based mussel-inspired bioadhesives (iCMBAs) for surgical use. Within the formulations investigated, iCMBAs showed 2.5-8.0 folds stronger wet tissue adhesion strength over the clinically used fibrin glue, demonstrated controlled degradability and tissue-like elastomeric mechanical properties, and exhibited excellent cyto/tissue-compatibility both in vitro and in vivo. iCMBAs were able to stop bleeding instantly and suturelessly, and close wounds (2 cm long×0.5 cm deep) created on the back of Sprague-Dawley rats, which is impossible when using existing gold standard, fibrin glue, due to its weak wet tissue adhesion strength. Equally important, the new bioadhesives facilitate wound healing, and are completely degraded and absorbed without eliciting significant inflammatory response. Our results support that iCMBA technology is highly translational and could have broad impact on surgeries where surgical tissue adhesives, sealants, and hemostatic agents are used.

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Laparoscopic repair of ventral hernias: nine years' experience with 850 consecutive hernias.

Adrian Park, B. J. Ramshaw, B. Todd Heniford … (2003)

To evaluate the efficacy and safety of laparoscopic repair of ventral hernias. The recurrence rate after standard repair of ventral hernias may be as high as 12-52%, and the wide surgical dissection required often results in wound complications. Use of a laparoscopic approach may decrease rates of complications and recurrence after ventral hernia repair. Data on all patients who underwent laparoscopic ventral hernia repair (LVHR) performed by 4 surgeons using a standardized procedure between November 1993 and October 2002 were collected prospectively (85% of patients) or retrospectively. LVHR was completed in 819 of the 850 patients (422 men; 428 women) in whom it was attempted. Thirty-four percent of completed LVHRs were for recurrent hernias. The patient mean body mass index was 32; the mean defect size was 118 cm2. Mesh, averaging 344 cm2, was used in all cases. Mean operating time was 120 min, mean estimated blood loss was 49 mL, and hospital stay averaged 2.3 days. There were 128 complications in 112 patients (13.2%). One patient died of a myocardial infarction. The most common complications were ileus (3%) and prolonged seroma (2.6%). During a mean follow-up time of 20.2 months (range, 1-94 months), the hernia recurrence rate was 4.7%. Recurrence was associated with large defects, obesity, previous open repairs, and perioperative complications. In this large series, LVHR had a low rate of conversion to open surgery, a short hospital stay, a moderate complication rate, and a low risk of recurrence.

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Author and article information

Contributors

Jian Yang

Journal

Journal ID (nlm-ta): Bioact Mater

Journal ID (iso-abbrev): Bioact Mater

Title: Bioactive Materials

Publisher: KeAi Publishing

ISSN (Electronic): 2452-199X

Publication date PMC-release: 30 May 2016

Publication date Collection: September 2016

Publication date (Electronic): 30 May 2016

Volume: 1

Issue: 1

Pages: 2-17

Affiliations

[a ]Department of Biomedical Engineering, Materials Research Institute, The Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, PA 16802, USA

[b ]Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA 17033, USA

Author notes

[∗ ]Corresponding author. W340 Millennium Science Complex, University Park, PA 16802, USA. jxy30@ 123456psu.edu

Article

Publisher ID: S2452-199X(16)30009-3

DOI: 10.1016/j.bioactmat.2016.05.002

PMC ID: 5365083

PubMed ID: 28349130

SO-VID: 78bedce5-b3e5-4cd8-9407-3608be114903

License:

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

History

Date received : 8 March 2016

Date revision received : 10 May 2016

Date accepted : 20 May 2016

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Design strategies and applications of biomaterials and devices for Hernia repair

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Most cited references 169

On the mechanisms of biocompatibility.

Injectable citrate-based mussel-inspired tissue bioadhesives with high wet strength for sutureless wound closure.

Laparoscopic repair of ventral hernias: nine years' experience with 850 consecutive hernias.

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Cited by 27

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