Foreign body reaction to meshes used for the repair of abdominal wall hernias

Eur J Surg. 1999 Jul;165(7):665-73. doi: 10.1080/11024159950189726.


Objective: To investigate the local tissue reactions to meshes that had been removed from humans.

Design: Open study

Setting: Surgical department of the technical University, Aachen, Germany.

Material: Samples of 17 non-absorbable meshes (1 polyester, 10 polypropylene, 2 reduced polypropylene, and 4 polytetrafluorethylene, PTFE) and 1 absorbable mesh (polyglactin 910) that had been implanted for repair of abdominal wall defects.

Interventions: Light and transmission electron microscopy, immunohistochemistry, and histological examination.

Main outcome measures: Signs of inflammatory response.

Results: Light microscopy showed chronic inflammatory tissue reaction, even after years, with pronounced differences among materials. Partial volume of inflammatory cells (%) varied from 32 in polypropylene, to 12 in expanded PTFE, 8 in polyester, and 7 in reduced polypropylene. Formation of connective tissue correlated significantly with the extent of the inflammatory reaction (p<0.01). In meshes implanted for long periods there were still numerous macrophages at the interface between tissue and polypropylene (45%), polyester (45%), expanded PTFE (25%), and reduced polypropylene (22%). There was no difference in time dependent tissue reactions (p = 0.19).

Conclusion: Inflammation around alloplastic materials used to repair defects in the abdominal wall persists for many years. There was evidence of long term wound complications as a result of persistent foreign body reactions. Further studies are required to evaluate the long term tissue response to these materials.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abdominal Muscles / metabolism
  • Abdominal Muscles / surgery*
  • Abdominal Muscles / ultrastructure
  • Adult
  • Aged
  • Female
  • Foreign-Body Reaction / etiology*
  • Foreign-Body Reaction / metabolism
  • Foreign-Body Reaction / pathology
  • Hernia, Ventral / complications*
  • Hernia, Ventral / metabolism
  • Hernia, Ventral / pathology
  • Hernia, Ventral / surgery
  • Humans
  • Immunohistochemistry
  • Male
  • Microscopy, Electron
  • Middle Aged
  • Reoperation
  • Surgical Mesh / adverse effects*
  • Surgical Mesh / statistics & numerical data