From the Guidelines
The indication for a fish mesh (synthetic mesh) implant is for emergency hernia repair in patients with intestinal incarceration and no signs of intestinal strangulation or concurrent bowel resection, as it is associated with a lower recurrence rate and no increase in wound infection rate, as recommended by the 2017 update of the WSES guidelines 1. The use of synthetic mesh in clean surgical fields (CDC wound class I) is supported by high-quality evidence, which shows that it can reduce the risk of recurrence without increasing the risk of wound infection.
- Key benefits of synthetic mesh include:
- Lower recurrence rate compared to tissue repair
- No increase in wound infection rate in clean surgical fields
- Suitable for patients with intestinal incarceration and no signs of intestinal strangulation or concurrent bowel resection In contrast, the use of synthetic mesh in clean-contaminated surgical fields (CDC wound class II) is also supported by evidence, which shows that it can be performed without increasing 30-day wound-related morbidity and is associated with a lower risk of recurrence 1.
- However, the question specifically asks about fish mesh, which is not explicitly mentioned in the provided evidence, and therefore, the recommendation is based on the available evidence for synthetic mesh. The recommendation is to use synthetic mesh for emergency hernia repair in clean surgical fields, as it is the most supported by high-quality evidence 1.
From the Research
Indications for Fish Mesh (Synthetic Mesh) Implant
- The use of synthetic meshes, such as polypropylene or polyester, is indicated for hernia repair, particularly in cases where high tensile strength and vigorous tissue ingrowth are required 2.
- Synthetic mesh is suitable for extra-peritoneal placement in uncomplicated, clean ventral hernia repair (VHR) 2.
- Polypropylene mesh is a commonly used synthetic mesh for inguinal hernia repair using the Lichtenstein technique 3.
- Synthetic mesh can be used for the reconstruction of complicated large abdominal wall hernias, either as an onlay or inlay implantation 4.
Characteristics of Synthetic Mesh
- Synthetic mesh is characterized by high tensile strength and vigorous tissue ingrowth 2.
- However, synthetic mesh can induce bowel adhesions and is therefore unsuitable for intra-abdominal placement 2.
- Synthetic mesh can cause foreign body reactions, which can lead to material hardening and recurrent hernias 5.
Comparison with Other Types of Mesh
- Synthetic mesh is compared to biological mesh, which is a collagen-based human, porcine, or bovine scaffold that may be implanted in the extra- or intra-peritoneal position 2, 6.
- Biological mesh has low risks of graft rejection, complications, and infection, but is more expensive than synthetic mesh 6.
- Composite mesh, which is a dual-sided prosthetic with a synthetic parietal side and a visceral surface that repels tissue ingrowth, is also compared to synthetic mesh 2, 4.