Synthetic vs biological meshes: can in vitro cellular responses predict the outcome in patients? Literature review, experimental study and clinical experience in Day Surgery and inpatients related to the improvement of quality of life

Abdominal wall hernia surgical repair is a common procedure (1) (2). Over time, hernia repair has evolved from predominantly primary suture repairs to tension-free repairs with synthetic mesh. About one million prostheses are used worldwide for abdominal wall repair each year (6), but despite a substantial decrease in the recurrence rate after tension-free repair, the use of mesh is not without its own complications. In the attempt to reduce the possibility of complications related to synthetic mesh use, biological meshes in abdominal wall hernia repair were introduced. Biological meshes are derived from humans and animals and become incorporated into the wound, acting as a scaffold for tissue repair, leading to a strong, well-healed, vascularised wound (17). Due to the nature of biologics, the adhesions associated with synthetic mesh should not occur and neovascularization should soon allow delivery of immune cells and antibiotics Although biological meshes are gaining popularity, the exact molecular mechanism leading to host reaction and biological graft integration remains unclear and poorly understood by the surgical community. In the first part of this thesis a review of all data available now about biological grafts and their interaction with tissue is presented. In the second part our laboratory results concerning interaction between different matrices (synthetic and biological) used in abdominal wall repair surgery and primary fibroblast cultures are reported. Finally, in the third part, our clinical experience with biological meshes is described.