Coatings on Absorbable Meshes Used for Hernia Repair: A Scoping Review

Introduction Permanent meshes are used to reduce recurrences in abdominal hernia repair, yet recurrence rates remain high, and permanent meshes may be associated with chronic pain. Absorbable meshes may reduce mesh-related complications but are associated with an increased recurrence risk. Mesh coatings may improve biocompatibility and outcomes. We aimed to provide an overview of coatings applied to absorbable meshes and to report beneficial and adverse effects. Methods All studies including humans or animals investigating non-commercially coated absorbable meshes in abdominal hernia repair were included. PubMed, Embase, Cochrane Central, LILACS, and CNKI were searched without language constraints. Results Of 3409 studies screened, 46 were included. All were conducted on animals (n = 1641) with surgically induced hernias. Median follow-up was 45 days (range 14–252). The 22 studied coatings were mesenchymal stem cells, platelet-rich plasma, different growth factors, fibroblasts, amniotic fluid, amniotic membrane, skeletal muscle cells, fibrinogen, zinc and citric acid, extracellular matrix, chitosan and/or ibuprofen, ibuprofen, dexamethasone, licorice extract, Royal Jelly honey, astragalus extract, silk fibroin, alginate, cyclic arginine-glycine-aspartic acid peptide, and CuSO 4 (copper). Mesenchymal stem cells and platelet-rich plasma were most studied. Mesenchymal stem cells and platelet-rich plasma increased cell ingrowth, collagen deposition, neovascularization, and increased tensile strength, while reducing inflammation; however, platelet-rich plasma showed variable effects on inflammation. In addition, platelet-rich plasma reduced recurrences. Conclusion We identified 22 different coatings used on absorbable meshes, with variable results. Mesenchymal stem cells and platelet-rich plasma were most studied, the latter with promising preclinical findings on recurrence reduction, requiring clinical confirmation.