Dual-function Bioactive Coating for Surgical Mesh: A Sequential Anti-inflammatory and Pro-regenerative Strategy to Minimise Hernia Recurrence

Abstract Background: Surgical meshes used in hernia repair face long-term challenges, particularly postoperative complications such as chronic inflammation and poor tissue integration leading to much more complications such as hernia recurrence. Objective: This study proposes a mesh with dual-function bioactive coating which is a mesh that modulated in a way to suppress acute immune response to improve healing outcomes and reduce recurrence rates. Methods: The mesh designed to have two functional layers. The first layer uses leverages poly (lactic-co-glycolic acid) as a degradable carrier for dexamethasone, providing early-stage inflammation control followed by a layer of chitosan-hyaluronic acid hydrogel that releasing vascular endothelial growth factor and transforming growth factor-beta 3 to guide constructive remodelling. In addition, surface nano-structuring via layer-by-layer assembly enhances mechanical stability and cellular interactions. Results: In vivo evaluations in a rat ventral hernia model were used to evaluate long-term mesh showing a significant improvement in tissue integration; the coated meshes demonstrated a 67% reduction in fibrotic capsule thickness and also it lowered the level of inflammatory-induced cytokines. In addition, the trial shows the availability of coating mesh to polarise macrophages toward the regenerative M2 phenotype, which is a key predictor of reduced fibrosis. In vivo studies give the coated mesh an advantage in enhancing vascularisation and collagen deposition compared to uncoated controls. Conclusion: This study addresses the critical limitations of conventional meshes. The proposed strategy offers a clinically translatable solution to improve surgical outcomes, particularly in hernia repair, where mesh rejection and fibrosis remain major challenges.