Surgical mesh issues

Surgeons repairing ventral (abdominal) hernias and abdominal wall defects use synthetic, natural (tissue-based) and hybrid mesh reinforcements to bridge, reinforce and stabilize the hernia repairs.

But surgical mesh issues add risks such as foreign body rejection and mesh degradation.

Though permanent synthetic mesh is durable, the immune system can reject the foreign body material. Symptoms can include organ perforation, bowel obstruction and chronic pain.

In addition, the surgeon may have to remove the mesh and resection the surrounding tissues in response to complications. The resections can diminish the remaining abdominal wall.

Natural mesh products aren’t perfect either. While the biologic (tissue-based) reinforcements meet the demands that immune responses place on foreign bodies, these mesh technologies are not durable.

Resorbable synthetic mesh is another choice for hernia repairs. Resorbable synthetics use polymers that offer reinforcement, then resorb over time, leaving no trace of the foreign bodies. But the dissipating materials reduce the reinforcement.

OviTex provides a hybrid solution

TELA Bio sought to drop the weaknesses of earlier surgical mesh products with its OviTex line of mesh reinforcements.

The TELA Bio OviTex Reinforced Tissue Matrix (RTM) mesh products offer a unique hybrid using synthetics and biologics. The product comprises layers of ovine rumen (sheep forestomach). According to Paul Talmo, principal of strategy at TELA Bio, OviTex is ideal for hernia and stomach wall applications because of its handling, stability and biomimetic characteristics.

OviTex binds the ovine rumen with a polymer suture interwoven through the layers for strength and durability, Talmo says. The OviTex material embroiders the ovine rumen using polymer sutures, which make up only 5% of the reinforcement device’s weight.

According to Talmo, the ovine tissue buffers the body against localized inflammation and foreign body responses to the minimal polymers while the sutures offer durability. In addition, OviTex comes with permanent or resorbable sutures, so the surgeon and the patient have options for the procedure.

What OviTex does for patients and physicians

Paul Szotek, M.D., is medical director of the Indiana Hernia Center. Office visits for Szotek’s patients include pre-surgical counseling with shared decisions on hernial procedures and the opportunity to use OviTex mesh reinforcements.

Before OviTex, Szotek used a biologic mesh material. He sought a mesh reinforcement product with durability, infection resistance, and a low residual foreign body material when he found TELA Bio’s OviTex.

Szotek offers patients a choice of traditional mesh repair or a Reinforced Biologic Repair (ReBAR) using a mix of tissue repair and OviTex reinforced biologic.

“Once they decide to have surgery and decide they want the ReBAR repair, we either implant OviTex using the DaVinci robot (>60% of cases) or with an open incision based on the technical aspects and the type of hernia,” says Szotek.

According to Szotek, OviTex is durable and clears any resulting infections.

Physician wish list

Among Szotek’s wish list of future enhancements to OviTex is a gripping technology on the mesh to enhance lateral friction to prevent sliding. He prefers a range of LPR mesh sizes for laparoscopic and robotic surgeries.

According to Talmo, TELA Bio plans to provide more products tailored to specific soft-tissue applications. Its OviTex LPR, intended to improve the mesh product’s handling abilities in less invasive laparoscopic and robotic hernia procedures, is an example of a tailored surgical mesh reinforcement solution.

Where to find

Look for TELA Bio surgical mesh products at telabio.com.