Acute inflammation triggered by two lightweight hernia meshes: a comparative in vitro and retrospective cohort study

Hernia. 2025 Jun 17;29(1):205. doi: 10.1007/s10029-025-03391-y.

Abstract

Purpose: Retro-muscular mesh augmentation is standard for repairing abdominal incisional or larger primary hernia. A wide variety of meshes with diverse properties are available. The knowledge on the immune-modulating effects of meshes is, however, insufficient. This study investigates the impact of two widely used lightweight meshes, ULTRAPRO® and ProGrip™, on macrophage activation (in vitro), systemic inflammation (in vivo), patient perioperative and long-term outcomes.

Methods: Human THP-1 cell-derived macrophages were cultured in absence and presence of ULTRAPRO® or ProGrip™ meshes. The release of pro-inflammatory cytokines, interleukin (IL)-1β and IL-6, was measured following inflammasome activation. In a retrospective study, systemic inflammation and postoperative outcomes after retro-muscular hernia repair using ULTRAPRO® (321 patients) or ProGrip™ (161 patients) meshes were analyzed.

Results: In the presence of ULTRAPRO®, IL-1β and IL-6 release by macrophages was increased, whereas ProGrip™ tended to reduce cytokine levels (p ≤ 0.05; n = 7). Baseline characteristics were comparable between both groups; systemic C-reactive protein levels were likewise higher in patients receiving ULTRAPRO® compared to ProGrip™ (mean difference: 26.9 ± 7.5 mg/dl; p < 0.0001). No relevant differences were observed in perioperative morbidity or short-term outcomes, including complications and hospitalization after hernia repair, but hernia recurrence rates tended to be higher within three-year follow-up after ProGrip™ implantation compared to ULTRAPRO® (p = 0.0630).

Conclusion: Meshes exhibit distinct immune-modulating effects on macrophages, leading to differential activation that may influence foreign-body reaction and systemic inflammation. These immune responses potentially impact clinical outcomes and recurrence after hernia repair. This study underscores the need for comparative prospective, randomized-controlled trials to further evaluate the clinical relevance of mesh-specific immunological effects.

Keywords: Abdominal wall; Hernia repair; Inflammation; Lightweight mesh; Retro-rectus; Sublay.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • C-Reactive Protein / metabolism
  • Female
  • Herniorrhaphy* / adverse effects
  • Herniorrhaphy* / instrumentation
  • Humans
  • Inflammation* / etiology
  • Inflammation* / immunology
  • Interleukin-1beta / metabolism
  • Interleukin-6 / metabolism
  • Macrophage Activation
  • Macrophages / immunology
  • Macrophages / metabolism
  • Male
  • Middle Aged
  • Postoperative Complications / etiology
  • Retrospective Studies
  • Surgical Mesh* / adverse effects
  • THP-1 Cells

Substances

  • Interleukin-1beta
  • Interleukin-6
  • C-Reactive Protein