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Purpose <p>Retro-muscular mesh augmentation is standard for repairing abdominal incisional or larger primary hernia. A wide variety of meshes with diverse properties are available. The knowledge on the immune-modulating effects of meshes is, however, insufficient. This study investigates the impact of two widely used lightweight meshes, ULTRAPRO<sup>®</sup> and ProGrip™, on macrophage activation (in vitro), systemic inflammation (in vivo), patient perioperative and long-term outcomes.</p> Methods <p>Human THP-1 cell-derived macrophages were cultured in absence and presence of ULTRAPRO<sup>®</sup> or ProGrip™ meshes. The release of pro-inflammatory cytokines, interleukin (IL)-1β and IL-6, was measured following inflammasome activation. In a retrospective study, systemic inflammation and postoperative outcomes after retro-muscular hernia repair using ULTRAPRO<sup>®</sup> (321 patients) or ProGrip™ (161 patients) meshes were analyzed.</p> Results <p>In the presence of ULTRAPRO<sup>®</sup>, IL-1β and IL-6 release by macrophages was increased, whereas ProGrip™ tended to reduce cytokine levels (<i>p</i> ≤ 0.05; <i>n</i> = 7). Baseline characteristics were comparable between both groups; systemic C-reactive protein levels were likewise higher in patients receiving ULTRAPRO<sup>®</sup> compared to ProGrip™ (mean difference: 26.9 ± 7.5&#xa0;mg/dl; <i>p</i> &lt; 0.0001). No relevant differences were observed in perioperative morbidity or short-term outcomes, including complications and hospitalization after hernia repair, but hernia recurrence rates tended to be higher within three-year follow-up after ProGrip™ implantation compared to ULTRAPRO<sup>®</sup> (<i>p</i> = 0.0630).</p> Conclusion <p>Meshes exhibit distinct immune-modulating effects on macrophages, leading to differential activation that may influence foreign-body reaction and systemic inflammation. These immune responses potentially impact clinical outcomes and recurrence after hernia repair. This study underscores the need for comparative prospective, randomized-controlled trials to further evaluate the clinical relevance of mesh-specific immunological effects.</p>

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Acute inflammation triggered by two lightweight hernia meshes: a comparative in vitro and retrospective cohort study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年6月17日

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  • Martin Reichert,
  • Bernadet Massambo,
  • Anca-Laura Amati,
  • Veronika Grau,
  • Katrin Richter,
  • Andreas Hecker

摘要

Purpose

Retro-muscular mesh augmentation is standard for repairing abdominal incisional or larger primary hernia. A wide variety of meshes with diverse properties are available. The knowledge on the immune-modulating effects of meshes is, however, insufficient. This study investigates the impact of two widely used lightweight meshes, ULTRAPRO® and ProGrip™, on macrophage activation (in vitro), systemic inflammation (in vivo), patient perioperative and long-term outcomes.

Methods

Human THP-1 cell-derived macrophages were cultured in absence and presence of ULTRAPRO® or ProGrip™ meshes. The release of pro-inflammatory cytokines, interleukin (IL)-1β and IL-6, was measured following inflammasome activation. In a retrospective study, systemic inflammation and postoperative outcomes after retro-muscular hernia repair using ULTRAPRO® (321 patients) or ProGrip™ (161 patients) meshes were analyzed.

Results

In the presence of ULTRAPRO®, IL-1β and IL-6 release by macrophages was increased, whereas ProGrip™ tended to reduce cytokine levels (p ≤ 0.05; n = 7). Baseline characteristics were comparable between both groups; systemic C-reactive protein levels were likewise higher in patients receiving ULTRAPRO® compared to ProGrip™ (mean difference: 26.9 ± 7.5 mg/dl; p < 0.0001). No relevant differences were observed in perioperative morbidity or short-term outcomes, including complications and hospitalization after hernia repair, but hernia recurrence rates tended to be higher within three-year follow-up after ProGrip™ implantation compared to ULTRAPRO® (p = 0.0630).

Conclusion

Meshes exhibit distinct immune-modulating effects on macrophages, leading to differential activation that may influence foreign-body reaction and systemic inflammation. These immune responses potentially impact clinical outcomes and recurrence after hernia repair. This study underscores the need for comparative prospective, randomized-controlled trials to further evaluate the clinical relevance of mesh-specific immunological effects.