Prosthetic abdominal wall hernia repair in emergency surgery: from polypropylene to biological meshes

There are still difficulties to find correct indication for prosthetic implant in emergency hernia surgery: as a matter of fact there is still a great debate if to use non-absorbable prostheses in potentially or truly infected operating fields [e.g. after intestinal resections].All these problems can be avoided with the use of absorbable prosthetic materials such as those composed of lactic acid polymers or lactic and glycolic acid copolymers: however, the use of these absorbable prosthesis exposes the patient to a rapid and inevitable hernia recurrence.It is important to remember that prosthetic repair has been proven to have a significant less risk of recurrence than repair with direct sutures.Recently, new "biologic" prosthetic materials have been developed and proposed for the clinical use in infected fields. These materials can be called "remodeling" for the way by which they are replaced after their placement within the patient. The "remodeling" process is made possible through a process of incorporation, where a reproduction of a site-specific tissue similar to the original host tissue is created.In the last 30 years with the introduction of the "tension-free" techniques in hernia repair based on the use of alloplastic, nonabsorbable prosthetic materials, we have witnessed to a significant reduction in postoperative pain degree and incidence of hernia recurrences when confronted with the older nonprosthetic hernioplasties.The use of nonabsorbable prosthetic materials such as polypropylene, polyester, and ePTFE, have hence expanded and are now widely used in reparative surgery for abdominal wall hernias [1,2]. When implanted, these nonabsorbable materials –although extremely biocompatible-stimulate a foreign-bodies reaction within the host.After the initial inflammatory phase, the reaction is followed by an intense deposition of nonspecific fibrotic tissue and concluded by a permanent encapsulation of the alloplastic material in the host's tissues.If these are