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

Abstract

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

Supplementary materials

Table S1 Full list of study data sets

Acknowledgments

Medical writing and editorial support was provided by Nicholas Paquette, PhD of Medtronic based on content and conclusions determined by the authors. The abstract of this paper was presented at the American Hernia Society 2016 and 36th Annual Meeting of the Surgical Infection Society conferences as poster presentations. The posters’ abstracts were published in the 18th Annual Hernia Repair and Program and Abstracts 36th Annual Meeting of the Surgical Infection Society Palm Beach, Florida, May 18-21, 2016.

Disclosure

PB and ML are both employed by Medtronic (Trevoux, France; formerly Covidien). PB also reports being a medtronic employee. This literature review is comparing mesh materials, medtronic like other manufacturers is selling Polypropylene and polyester meshes. Dr Scott Roth reports grants, personal fees from Bard, personal fees from Allergan, stock options from Miromatrix, during the conduct of the study; grants, personal fees from Bard, personal fees from Allergan, stock options from Miromatrix, outside the submitted work. The authors report no other conflicts of interest in this work.