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Abstract: Prostethic mesh material such as nonabsorbable polypropylene used in open and laparoscopic hernia repair are characterized by controllable mechanical properties but may elicit undesirable physiological reactions due to the nonphysiological inert polymer material. We succeeded in developing a biocompatible coating for these meshes, based on a physiological inorganic polymer, polyphosphate (polyP) that is morphogenetically active and used as a metabolic energy source, and a collagen matrix. The polyP/collagen hydrogel material was prepared by a freeze‐extraction method, with amorphous Ca‐polyP microparticles. Electron microscopy (SEM and REM) studies revealed that the polyP/collagen coats are built up of ≈50 nm‐sized microparticles deposited onto the collagen matrix which forms a continuous layer around the polypropylene fibers that also spans the mesh pores. This bioresorbable inorganic/organic hybrid coat was found to be degraded during three days of incubation in medium/serum. The biomechanical properties of the coated meshes are comparable to those of the unmodified polypropylene meshes, with a higher toughness in longitudinal orientation and a more pronounced extensibility in the transverse orientation. The polyP/collagen coating improved cell attachment to the polypropylene meshes and strongly increase the growth of fibroblasts (MC3T3‐E1 cells). Furthermore, those mats upregulate the expression of the gene encoding the stromal cell‐derived factor‐1α (SDF‐1), a mesenchymal stem cells attracting chemokine in the fibroblasts. We conclude that coating of inert polymer meshes with a biocompatible, collagen‐inducing polyP/collagen inorganic/organic hybrid layer may improve tissue integration of the meshes and the outcome of surgical hernia repair and may redudce the foreign body reaction in contaminated field. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 2109–2121, 2018. [ABSTRACT FROM AUTHOR]

Introduction: Surgical approaches to flank hernias have been poorly standardised. The most demanding issues in intermuscular net insertion are the limited area in the dorsal direction and the difficulties in fixing the net to the costal arch or the iliac crest. This is why many different surgical procedures have been published., Patients/material and Methods: From August 2015 to October 2016, nine patients with a primary incisional lateral hernia received open retromuscular preperitoneal mesh repair. In intermuscular mesh placement, the mesh size must be smaller at smaller values of the CPA (costopelvic angle). On the dorsal side of the reference stretch RS of 10 cm between costal arch and iliac crest, fixations are necessary to achieve stability. Retroperitoneal preperitoneal net implantation is unrestricted by the patient's anatomy. The placement of the mesh is similar to the Stoppa procedure and almost any size can be used with little fixation. Remodeling of the abdominal wall can be comfortably achieved., Results: All 9 patients underwent retromuscular preperitoneal mesh repair. The hernia size was 92.85 cm 2 with a corresponding mesh size of 426.22 cm 2 . No adverse side effects or surgical complications were observed; the length of hospital stay was between 3 to 7 days; the follow up was 3 to 18 months, with a mean follow-up of 9.1 months. In a follow-up questionnaire, the patients reported a high satisfaction rate with a grade of 1,2 (school mark); there was no recurrence. The pain level decreased from VAS grade 4 preoperatively to 1.2 postoperatively. 7 patients had no pain at all., Summary: In conclusion, adequate overlap of the implanted mesh can be achieved in the preperitoneal retromuscular space even in large hernias. Fixation of the mesh to the costal arch or the iliac crest is not necessary and would only induce postoperative pain. Long-term stability depends on the size of the mesh. Remodeling of the abdominal wall with closure of the fascia above the mesh can be easily achieved., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (Georg Thieme Verlag KG Stuttgart · New York.)