Polypropylene mesh and systemic side effects in inguinal hernia repair: current evidence

Introduction Increasing awareness and regulatory body attention is directed towards the insertion of synthetic material for a variety of surgical procedures. This review aims to assess current evidence regarding systemic and auto-immune effects of polypropylene mesh insertion in hernia repair. Methods The electronic literature on systemic and auto-immune effects associated with mesh insertion was examined. Results Foreign body reaction following mesh implantation initiates an acute inflammatory cellular response. Involved markers such as IL-1, IL-6, IL-10 and fibrinogen are increased in circulation in the presence of mesh but return to normal at 7 days post operatively. Oxidative degradation of implanted mesh is likely, but no evidence exists to support systemic absorption or resulting disease effects. Variable cytokine production in healthy hosts leading to unpredictable or overwhelming response to implanted biomaterial warrants further investigation. Clinical studies show no associated long-term systemic effects with mesh. Conclusion To date, there remains no evidence to link polypropylene mesh and systemic or auto-immune symptoms. Based on current evidence, the use of polypropylene mesh is supported.