Selecting Surgical Implants
Currently there are a wide variety of prosthetic implants available today. Choices include permanent synthetic meshes, biologic meshes (considered to be absorbable), hybrid meshes (with permanent and absorbable components) and other options that populate the shelves of our supply closets. In the future, we anticipate implants with coatings including antibiotics, growth factors and/or anesthetics.
In fact, some current products have coatings that offer multiple benefits, such as the Omega 3 fatty acid coating on some mesh products. (Atrium Medical) The coating, originally designed to be an adhesion barrier, offers the benefits of inflammatory down-regulation and increased type I collagen deposition.
Consideration for the most appropriate implant must account for patient characteristics, wound environment, presence or absence of infection, as well whether any concomitant procedures are being performed. One must assess the patient’s past surgical history, need for future procedures or operations. The potential impact that prosthetic implantation may have on future level of activity; frequency of strenuous activities must be taken into account, as well. Patient comorbidities, such as NIDDM, malignancy, history of radiation therapy or malignancy, smoking history are important. Prior infection at the operative site (remote or recent) as well as the presence or absence of ongoing infection, are critical concerns.
Also important is the current procedure, with respect to the presence or absence of bowel entry (with or without spillage), and whether this was intentional or accidental. The surgeon must consider all of these factors in the choice of prosthetic as well as the choice of operative technique; the use of an improper implant can lead to increased risk of infection, hernia recurrence, and the need for further operative procedures.