A Meta Analysis of Polyester versus Polypropylene Mesh Ventral Hernia Repairs

Author(s):
Crystal Totten, University of Kentucky; Patrice Becker, Medtronic; Mathilde Lourd, Medtronic; John Roth, University of Kentucky

Background:

Tremendous controversy exists regarding the differences in outcomes following ventral hernia repair with either polypropylene (PP) or polyester mesh (PET). Both meshes are non absorbable and easily incorporate; however, the reported potential for mesh infections has long plagued the use of polyester mesh due to its multifilamentous nature. A multitude of studies have evaluated the risk of infection using polyester mesh, with a wide range of results. Alternatively, polypropylene mesh is a monofilament, with reports of decreased mesh explantation in the setting of infection and its use has been supported in the literature. This study represents a systematic review and meta-analysis of ventral hernia repair outcomes with PP and PET mesh.

Hypothesis:

Ventral hernia repairs with polyester and polypropylene mesh have similar infection and recurrence rates.

Methods:

A comprehensive literature search was performed using the Ovid search platform. Studies that met the search criteria regarding ventral hernia mesh repair using polyethylene terephthalate (PET) or polypropylene (PP) mesh were considered for meta-analysis. Criteria included ventral hernia repair papers with either polypropylene or polyester with a minimum follow up duration of one year. Included studies were subject to data extraction including mesh position, weight, recurrence rates, infection and complications. Random effect meta-analysis was run to provide pooled event rate and 95% CI.

Results:

Eighty-one articles including a total of 10,022 patients satisfied all criteria and were included in the final analysis. The analysis showed no significant differences in overall recurrence rate is 4.8% [3.5% – 6.5%] for PET and is 4.7% [3.7% – 6.0%] for PP. Additionally, the overall infection rate for PET mesh (3.5% [2.5% – 4.9%]) was comparable to that of PP mesh (5 % [3.9% – 6.3%]). Ventral hernia repairs performed laparoscopically had an infection rate of 1.6% compared to 5.2% with open procedures. There was no difference in recurrence and infection rates between laparoscopic repairs with PP and PET mesh.

Conclusions:

Ventral hernia repair can be safely performed with both polypropylene and polyester mesh. The risk of mesh infection and hernia recurrence is comparable between mesh materials. Surgical route appeared to be a driver with a decreased infection rate following laparoscopic repair independent of mesh type.