Introduction of synthetic meshes in the second half of the twentieth century revolutionised methods of hernia management and completely changed prognoses after such procedures. The evolution of surgical techniques, accompanied by a progress in the material science, allowed to use implants of unique properties, actually working together with the human body. The evolution in the approach to the implant itself is a history that would take a book to tell, the book that would enthral a reader with sudden plot twists, changes in paradigms, or unexpected falls of the largest players.
In the initial phase, implants’ evolution was driven by the approach focusing on their strength. Strong, thick weaves of polypropylene or polyester were supposed to act as a mechanical reinforcement of injured tissues and structures of the abdominal wall. At the peak of this approach, implants weight reached 300g/m2. At the beginning of the twenty first century, that tendency started to reverse. It was found that there was no need to create meshes that were so thick and heavy. Around 2005, the mesh weighted only 30-35g/m2. However, it was reinforced with an additional layer of dissolvable mesh, which left only a light structure of the permanent polymer after it was absorbed. The name “light meshes” reflects this approach.
A little bit later, due to pain and a so-called “feeling of a foreign body”, a concept of mesh elasticity emerged. It was noted that the initial elasticity did not correspond to the mesh elasticity after its placement in the body. Its overgrowing with the tissue led to formation of an unaesthetic scar. Macropore meshes were developed, an a term of “effective macroporosity” was introduced, measured after overgrowth with the tissue.
Following introduction of laparoscopic techniques (TAPP, TEP) it was found that the groin area is not flat. Corporations manufacture meshes of shapes adopted to these anatomical conditions. However, finding a balance between mesh macroporosity and weight, and its ability to maintain the shape is difficult. Additionally, such lightweight macroporous meshes do not maintain the shape memory. Thus corporations either give up macroporosity, or surround formed meshes with a ring maintaining their shape. However, in such cases the mesh is characterised by a certain rigidity. As it is manufactured on a basis of a certain compromise - adjusted to the anatomy of an average person, it cannot completely suit everybody. Actually, it does not suit anybody; its averaged anatomy only matches more or less the actual conditions of the patient. Women, men, obese, slim, older, younger, tall and short, all those people differ from each other.
Therefore, we need (or such is our mental projection) light and macroporous implants shaped according to patients’ needs. Today, we already have personalised prosthetics. Bone prosthetics or vascular prostheses are manufactured for a specific patient. However, in the surgery of the anterior abdominal wall we do not have permanent and rigid structures. The anterior abdominal wall is a functional conglomerate of many muscles and fasciae that is not supported by bones. Works describing such structures, based on mathematical modelling, have been conducted in centres all over the world for several years. Also in Poland. This way, foundations for individual implants, manufactured and suiting an individual patient, have been established.
The implant designed by us and a unique process of its manufacturing represent a next step in development of hernia management. A tomograph collects anatomical data and processes files for industrial machines manufacturing the implant on a basis of concepts derived from maths, physics, and strength. At the beginning, it will be expensive, time-consuming, and in opposition to the main corporate stream. But this is the future. An individualised macroporous anatomical implant meets all assumptions for everything that nowadays is considered important and modern. The road starts to open.