Table 2.
Advantages and disadvantages of commonly used composite meshes
| Mesh | Abdominal wall side/visceral side | Advantages | Disadvantages |
| Composite meshes[24] | Permanent mesh/anti-adhesion barrier | Permanent mesh for inflammation, fibrosis, and abdominal wall ingrowth and strength | No level I evidence of the superiority of one mesh over another. Some differences have been noted in animal models, although adhesion prevention is similar for most[28]. A multi-center, human study is underway to better determine the characteristics of these composite meshes (NCT01355939)[29] |
| Visceral side designed to prevent adhesion related complications | |||
| Dualmesh[25] | Micropore ePTFE/Macropore ePTFE | Minimal inflammatory reaction[22] | PTFE has higher rates of bacterial adherence and less resistant to colonization[31,32] |
| Adhesions less tenacious than all other meshes[24,30] | Higher risk of explantation in open cases (14.2%), but not laparoscopic cases (4.6%)[32] | ||
| Less adhesiolysis time/mesh surface area compared to composix[24] | Limited fibrous tissue ingrowth and incorporation[22] | ||
| Composix™[25] | PP/ePTFE | PP thought to promote better ingrowth and inflammation | Adhesions predominately found due to mesh eversion at periphery[24] |
| Possible increased infection risk (8% in one series)[33] | |||
| Parietex[30] | PET/type I collagen, polyethylene glycol, and glycerol | United States evaluation showed adhesions in 18% of patients, vs 77% when uncoated PE was used | Collagen film absorbed quickly (20 d)[34] |
| Proceed[30] | PP encapsulated by PDS/oxidized regenerated cellulose | Lightweight, macro-porous mesh[34] | Incomplete peritoneal mesothelialization over graft |
| Induced dense adhesions in rabbit models[35] | |||
| C-QUR[30] | PP/omega 3 fatty acid gel | Less contracture in rabbit model[30] | Poor incorporation strength in rat model[28] |
| Sepramesh[25] | PP/sodium haluronate and carboxy - methylcellulose | Low adhesion coverage and good incorporation[28] | Inflammation induces breakdown of the coating, resulting in delayed adhesion formation[28] |
ePTFE: Expanded polytetrafluoroethylene; PDS: Polydioxanone; PE: Polyester; PET: Polyethylene terephthalate; PP: Polypropylene.