In vitro study of synthetic prosthetic meshes for inguinal hernia repair
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Inguinal hernia is a protrusion of part of viscera through the abdominal wall. The prosthetic mesh is widely used in inguinal hernia repair, where it is implanted in place to make up the hernia defects and further repair is enhanced by host tissue ingrowth into the mesh. Due to the significance of the implant for successful hernia repair, there is increasing need for understanding the roles of mesh materials and constructions in order to design ideal prosthetic mesh. This study used an in vitro model by growing NRK-49F cells on synthetic prosthetic meshes, which differed in types of materials (polypropylene (PP), polyester (PET), polytetrafluoroethylene (PTFE)) and weights (lightweight, heavyweight), to compare the difference in biological and mechanical responses of these meshes after implantation. Cell morphology and cell proliferation on the meshes were investigated to predict the biological response in the recipient. PP and PET meshes induced acute initial foreign body reaction, implying better cell/tissue incorporation than PTFE mesh. Weight reduction could weaken the foreign body reaction, leading to well organized cellular layer wrapping the prosthetic materials. The mechanical response was studied by performing of tensile testing and dynamic mechanical simulation on the vital/avital composite meshes. The results demonstrated that cell incorporation significantly increased the stiffness of heavyweight PP and PET meshes; however, lightweight PP mesh could inhibit this increase and reduce the complication of ‘stiff abdomen’ in the long-term. Additionally, the cell incorporation also contributed to mechanical reinforcement of the meshes after implantation and it could ensure the mechanical integrity of the implants in the long-term.