Are Biologic Meshes Better?
Biologic Mesh refers to a very diverse group of products designed to reenforce soft tissue repairs. They are used in many areas of surgery like Plastic Surgery,Neurosurgery and General Surgery. Some are basically sterilized tissue harvested from animals and human cadavers, while others have literally been created in the lab with living microorganisms.
The very nature of how these products are produced means they are expensive. Therefore we have an obligation to use them only when we think there is an advantage for the patient. In general surgery they are occasionally used to help close the defects in complex abdominal wall reconstruction. Particularly when there is a wound contamination or active infection. These products are either reabsorbed by the body or naturally breakdown over a variable period of time. This is why they may be safer to use in complex wounds where permanent meshes create a higher chance of chronic wound infection. Unfortunately because they do “go away” they may only be a very temporary solution for some patients.
We do not use absorbable or biologic mesh products in this practice to repair abdominal or inguinal hernias as a primary repair because the recurrence rates are too high. We do use theses types of products to reenforce our hiatal and paraesopahgeal hernia repairs because there has been data to suggest that doing so may reduce recurrences in this area versus a primary or “non-mesh” repair. Although permanent “non-biologic” mesh has been used successfully in this area there is a valid concern that a permanent mesh in this location could create damage or an erosion into the esophagus.
In short, biologic meshes are not “better” but they do have advantages when appropriately utilized.