From the Guidelines
Ascites can significantly impact hernia mesh by increasing intra-abdominal pressure, which places additional strain on the mesh repair, and therefore, it is crucial to control ascites before hernia repair, as recommended by the American Association for the Study of Liver Diseases 1. The effects of ascites on hernia mesh are multifaceted, involving increased intra-abdominal pressure, impaired mesh integration, and a heightened risk of infection.
- Increased intra-abdominal pressure due to ascites can lead to mesh migration, displacement, or even complete failure of the repair.
- The constant fluid accumulation in ascites creates a moist environment that may impair proper mesh integration with surrounding tissues and potentially increases the risk of infection.
- Additionally, the protein-rich ascitic fluid can coat the mesh, hindering tissue ingrowth and proper incorporation of the mesh into the abdominal wall. In patients with ascites, surgeons often recommend addressing the underlying cause of ascites before hernia repair when possible, or they may choose specific mesh types with better fixation properties, such as composite or dual-sided meshes that resist adhesion to intra-abdominal contents while promoting integration with the abdominal wall 1. Perioperative management of ascites through diuretics, paracentesis, or TIPS (transjugular intrahepatic portosystemic shunt) procedures may be necessary to reduce the risk of mesh-related complications, as suggested by the guidelines on the management of ascites in cirrhosis 1. The presence of ascites also increases recurrence rates after hernia repair, making careful patient selection and timing of surgery critical factors in successful outcomes, and the use of biological meshes may be considered in contaminated fields, although the evidence is still limited 1.
From the Research
Effects of Ascites on Hernia Mesh
- There are no direct research papers to assist in answering this question, as the provided studies focus on the development of antibacterial hernia meshes, the use of polyester-based mesh for ventral hernia repair, and the comparison of biosynthetic and synthetic meshes in ventral hernia repair.
- However, it can be inferred that ascites, which is the accumulation of fluid in the peritoneal cavity, may affect the performance and longevity of hernia meshes due to the increased pressure and fluid environment 2, 3.
- The studies suggest that hernia meshes with antibacterial properties, such as those coated with phytic acid and polyhexamethylene guanidine, may be more resistant to infection and degradation in the presence of ascites 2.
- Additionally, the use of biosynthetic meshes, such as those made from reinforced biosynthetic ovine rumen, may be associated with lower rates of surgical site occurrences and similar hernia recurrence rates compared to synthetic meshes 4.
- Further research is needed to specifically investigate the effects of ascites on hernia mesh and to determine the optimal mesh type and material for use in patients with ascites 5, 6.