Table 1.

Summary of papers included in the review

First author	Year	Title of study	Aim of study	Study type	Patients and material	Methods	Outcomes
Clancy [1]	2019	Polypropylene mesh and systemic side effects in inguinal hernia repair: current evidence	To evaluate the systemic reaction to hernia mesh implantation	Systematic review	23 articles on polypropylene mesh and systemic reaction	Medline, National Library of Medicine, Embase and Cochrane Library	No evidence to link polypropylene mesh and systemic or auto-immune responses
Dias [3]	2012	Autoimmune [auto-inflammatory] syndrome induced by adjuvants (ASIA): Case report after inguinal hernia repair with mesh	Case report of ASIA after hernia mesh implantation	Case report	Patient with silicon breast implants and bilateral inguinal mesh hernioplasty	Clinical examination, mesh explanation and histology	Mesh removal in the case improved systemic symptoms
Teravaer [4]	2018	Autoinflammatory/autoimmunity syndrome induced by adjuvants (Shoenfeld’s syndrome) in patients after a polypropylene mesh implantation	Identify patients with ASIA after polypropylene mesh implantation and investigate changes in immune response	Prospective cohort	714 patients, 40 had symptoms of ASIA. 18 mesh hernioplasty and 22 vaginal mesh	Clinical, histology and laboratory investigations	Fatigue common symptoms of ASIA. Pre-existing allergic conditions a risk factor for ASIA. ASIA is associated with lower serum IgG
Kowalik [29]	2020	Are polypropylene mesh implants associated with systemic autoimmune inflammatory syndromes? A systematic review	Looking for correlation between polypropylene mesh implantation and autoimmune reaction	Systematic review	4 papers on topic	Medline, Embase, Web of Science, Scopus and Cochrane Library	No association between polypropylene mesh implantation and systemic autoimmune syndrome
Kotovic [30]	2017	Systemic inflammatory response after hernia repair: a systematic review	An overview of inflammatory response and serum markers following hernia repair – comparison of markers between mesh and non-mesh repairs	Systematic review	31 papers on systemic inflammatory response after hernia mesh repair	Medline, Embase and Scopus	Hernioplasty increased serum CRP, IL-6, leukocyte, neutrophil, IL-1, IL-10, fibrinogen and alpha1-antitrypsin, with a decrease in lymphocyte count and albumin at 24 h. Slightly higher responses in those with a mesh implant
Dievernich [10]	2012	Characterization of innate and adaptive immune cells involved in the foreign body reaction to polypropylene meshes in the human abdomen	Investigation of immune response, especially adaptive immune response, to foreign body implants in the human abdomen	Retrospective cohort	7 patients with polypropylene mesh ventral hernia repair	Histology with immunofluorescence analysis	Demonstrated both innate and adaptive immunity contributes to a foreign body reaction after mesh implantation
Chughtai [43]	2017	Hernia repair with polypropylene mesh is not associated with an increased risk of autoimmune disease in adult men	Comparison of patients with mesh implantation to control cohort (patients undergoing colonoscopy) and looking for development of ASIA in either group	Retrospective cohort	26,579 patients after mesh hernioplasty and 271 after colonoscopy	Patient database analysis	No association between polypropylene mesh implantation and autoimmune disease or ASIA