Mesh

The use of surgical meshes has become the standard practice for abdominal wall hernia repair due to its efficacy in reducing long-term recurrence rates. Since the introduction of synthetic materials in the 1950s and the popularization of the Lichtenstein technique in 1989, a wide variety of prosthetic materials have been developed, including non-absorbable synthetics, absorbable synthetics, and biological matrices. This chapter explores the critical factors influencing mesh-tissue interaction, such as material composition, porosity, grammage, and filament structure, which determine the processes of incorporation, encapsulation, or resorption. Detailed comparisons are provided between common polymers like polypropylene, polyester, expanded polytetrafluoroethylene (ePTFE), and polyvinylidene fluoride (PVDF), alongside an analysis of composite meshes designed to prevent intra-abdominal adhesions. Furthermore, the text evaluates the clinical application of absorbable and biological meshes, particularly in complex or contaminated surgical fields. While biological meshes are often recommended for infected sites, the chapter highlights the ongoing debate regarding their high cost and recurrence rates compared to modern synthetic alternatives.