The hernia mesh litigation will continue until the ideal mesh is designed that limits the adverse effects of chronic inflammation and provides the necessary soft tissue support while overtime is replaced completely by the native tissue of the patient with no loss in terms of long-term support.
Complications from synthetic mesh used in the treatment of abdominal wall defects including inguinal hernias are the direct response of soft tissue injuries caused by the chronic immunologic response of the body to polypropylene and other synthetic mesh devices. The soft tissue injures will always be a source of ongoing litigation because they cause infections, bowel obstruction, fistulae, seromas, nerve damage and chronic pain, and other serious morbidity, and death.
The most perfected device to date is P4HB, which is a biological material, not synthetic and is a natural polymer derived from E coli that was genetically engineered, that can be woven into a mesh that is completely resorbed by the body over 12 to 18 months.[1]
A scoping review of P4HB reveals that P4HB mesh provides long term strength at the repair site, acceptable rates of recurrence, and performs favorably in contaminated settings compared with synthetics with a lower risk of infection.[2]
Injuries caused by synthetic hernia mesh used in abdominal wall reconstruction and inguinal hernia repair include: 1) Reoccurrence of hernia, 2) Intra-abdominal infection or abdominal wall infection, 3) Fistulae, 4) Nerve damage and chronic pain, 5) Seromas, 6) Malnutrition, and 7) Death.
Experts Include:
[1] Le Meur, et al. Poly(4-hydroxybutyrate) (P4HB) production in recombinant Escherichia coli: P4HB synthehesis is uncoupled with cell growth. Microb Cell Fact, 2013 Dec 11;12: 123; Deeken, et al. Fully resorbable poly-4-hydroxbutyrate (P4HB) mesh for soft tissue repair and reconstruction: A scoping review. Front Surg. 2023 Apr 12; 10:1157661.
[2] Deeken, et al. Fully resorbable poly-4-hydroxbutyrate (P4HB) mesh for soft tissue repair and reconstruction: A scoping review. Front Surg. 2023 Apr 12; 10:1157661.
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