The Unfulfilled Potential of Synthetic and Biological Hydrogel Membranes in the Treatment of Abdominal Hernias

Abstract

Hydrogel membranes can offer a cutting-edge solution for abdominal hernia treatment. By combining favorable mechanical parameters, tissue integration, and the potential for targeted drug delivery, hydrogels are a promising alternative therapeutic option. The current review examines the application of hydrogel materials composed of synthetic and biological polymers, such as polyethylene glycol (PEG), polyvinyl alcohol (PVA), gelatine, and silk fibroin, in the context of hernia repair. Overall, this review highlights the current issues and prospects of hydrogel membranes as viable alternatives to the conventional hernia meshes. The emphasis is placed on the applicability of these hydrogels as components of bilayer systems and standalone materials. According to our research, hydrogel membranes exhibit several advantageous features relevant to hernia repair, such as a controlled inflammatory reaction, tissue integration, anti-adhesive-, and even thermoresponsive properties. Nevertheless, despite significant advancements in material science, the potential of hydrogel membranes seems neglected. Bilayer constructs have not transitioned to clinical trials, whereas standalone membranes seem unreliable due to the lack of comprehensive mechanical characterization and long-term in vivo experiments.

Keywords: bilayer membranes; in vivo studies; mechanical studies; surgical meshes; tissue engineering.

Figure 3

Examples of synthetic meshes. (a) Bard Mesh, (b) Vypro, (c) Prolene V R, (d) Bard V R Soft Mesh, (e) Trelex V, (f) Optilene V R, (g) SurgiPro V R, (h) Parietene V R, (i) Mersilene, and (j) Dynamesh V R IPOM. Used with kind permission from Elsevier [20].

Figure 7

Examples of bilayer constructs utilizing poly(N-isopropylacrylamide) hyaluronan derivative (left, (a–d) [63] and cellulose (right, (A–C) uncoated meshes/(D–F) bacterial cellulose-coated meshes) [84].

Figure 8

Evaluation methods for mechanical biocompatibility of surgical meshes: (a) uniaxial tensile, (b) biaxial tensile test, (c,d) ball bursting and deformation of mesh in ball burst testing, (e) suture retention, and (f) tear test [83].

Figure 1

The current literature review PRISMA 2020 flowchart [3].

Figure 2

An umbilical hernia and its treatment options. (Used with permission from the Hernia Center of Southern Carolina, USA).

Figure 4

An example of a biological mesh: an Acellular Dermal Matrix (Allomend by Allosource, https://hcp.alloderm.com/, accessed on 10 November 2024).

Figure 5

Advantages and disadvantages of synthetic and biological meshes.

Figure 6

Examples of cross-linking tactics [45,46].

Figure 9

Chemically (GDA) cross-linked (left) and physically (freeze-thawed) (right) PVA hydrogel implantation in Wistar rats (a,b) and Swine (c,d) models. Note, surgery on swine models was performed laparoscopically. Adapted from Dorkhani et al. and Fehér et al. [35,91].