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Polyester vs polypropylene, do mesh materials matter? A meta-analysis and systematic review

Authors Totten C, Becker P, Lourd M, Roth JS

Received 20 December 2018

Accepted for publication 5 April 2019

Published 12 September 2019 Volume 2019:12 Pages 369—378

DOI https://doi.org/10.2147/MDER.S198988

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Amy Norman

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser


Crystal Totten,1 Patrice Becker,2 Mathilde Lourd,2 J Scott Roth1

1Division of General Surgery, Department of Surgery, University of Kentucky, College of Medicine, Lexington, KY 40536-0298, USA; 2Medical Affairs, Medtronic, Sofradim Production, Trevoux 01600, France

Correspondence: J Scott Roth
Division of General Surgery, Department of Surgery, University of Kentucky Medical Center, 800 Rose Street, C-226 UKMC, Lexington, KY 40536, USA
Tel +1 859 323 6346
Fax +1 859 323 6840
Email s.roth@uky.edu

Purpose: Controversy exists regarding the outcomes following ventral hernia repair with polypropylene (PP) or polyester (PET) mesh. Monofilament PP less frequently requires extraction in the setting of contamination compared to multifilament PET mesh. The purpose of this systematic review and meta-analysis was to analyze the clinical outcomes of ventral hernia repair with PP and PET mesh.
Patients and methods: A comprehensive literature search was performed using the Ovid search platform. Criteria included ventral hernia repair publications using either PP or PET mesh 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: Ninety-seven studies including a total of 10,022 patients were included in the final analysis. Hernia recurrence rates are similar (4.8%, 95% CI [3.5–6.5] vs 4.7%, 95% CI [3.7–6.0]) as well as mesh infection rates (3.5%, 95% CI [2.5–4.9] vs 5.0%, 95% CI [3.9–6.3]) between PET and PP, respectively. Mesh infections occurred less frequently in laparoscopic repair compared to open (1.6%, 95% CI [0.9–2.6] vs 5.2%, 95% CI [4.3–6.3]).
Conclusion: This study suggests that mesh material does not affect recurrence or infection in ventral hernia repair and that surgery can be safely performed with both PP and PET mesh. A laparoscopic approach is associated with a decreased infection rate compared to open repair independent of mesh type.

Keywords: polyester, polypropylene, ventral hernia, recurrence, infection


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