Treating hernias with titanised mesh implants - information for healthcare professionals

The TiMESH titanised mesh implant has been in use unchanged since 2002. It sets the standard for gerneral and visceral surgery in terms of benefits, quality and handling.¹ In addition to TiMESH, which can be applied universally for the intraperitoneal and extraperitoneal treatment of all types of hernias, there are also other titanised mesh implants that are specially designed for specific types of hernias.

Proven benefits
The titanised surface of the mesh provides proven benefits for patients. Numerous studies document the advantages of titanised polypropylene meshes compared to conventional polypropylene meshes. TiMESH demonstrably enables better quality of life for patients.²

Safe, tried and tested
Users from around the world trust in the tried and tested top quality: more than 500,000 patients have been treated with TiMESH to date.

Quality made in Germany
The titanised meshes are developed and produced at the pfmmedical site in Nuremberg. That is your guarantee of “Quality made in Germany”.
 

• Easy handling³
  The hydrophilic property of the titanised surface allows the mesh to stick to the abdominal wall, making it excellent to model and easy to handle during the procedure.
• Very good visibility
  Once the mesh has adhered to the abdominal wall, the structures behind the mesh remain visible. It is easier to cover the hernia, and the risk of injury to nerves or vessels is minimised. 
• Smooth trocar insertion
  Rolled-up titanised meshes can simply be inserted into the trocar (down to 3 mm trocar with TiMESH extralight 16 g/m²). The excellent plasticity makes the unrolling equally trouble-free. 
• Universal application
  TiMESH is ideal for all surgical techniques including IPOM. This reduces the amount of storage space required in the operating theatre, as fewer articles are needed.
•  Very good ingrowth
  The titanised, hydrophilic surface of the mesh implant enables better cell growth⁴ and reduces the risk of inflammation⁵, which in turn means less scarring and thus decreased risk of mesh shrinkage^6,7. 

• Better tolerance
  The titanisation means fewer postoperative seromas.²
• Less postoperative pain
  Patients experience less pain, so there is less need for analgesics.⁸
• Shorter recovery time
  After the implantation of titanised meshes, patients can return to symptom-free everyday life earlier.^8,9
• Decreased foreign body sensation
  The titanisation minimises the inflammatory response, which in turn reduces scarring and mesh shrinkage^5,6,7,10,11. The excellent ingrowth means that patients experience less foreign body sensation.²

The titanised mesh implant TiMESH is designed for universal application in all intraperitoneal and extraperitoneal types of hernias, regardless of the surgical technique. The surgeon simply selects the appropriate mesh size or the appropriate mesh blank and can then use it for any surgical technique, including IPOM. Individual mesh adaptation is possible at any time.

Thus all hernia types can be treated with the mesh implant:

• Inguinal hernias
• Femoral hernias
• Incisional hernias
• Umbilical hernias
• Epigastric hernias
• Parastomal hernias
• Hiatal hernias

• TiLENE® Blue Mesh is suitable for all hernias and surgical techniques, including intraperitoneal application (IPOM).
• TiLENE® Strip can be used to prevent incisional hernias.
• TiLENE® Guard is designed for the prevention and treatment of parastomal hernias.
• TiLENE® Inguinal was developed specifically for the treatment of inguinal hernias. 
• TiSURE® is used to treat diaphragm defects.

• Titanised type 1a polypropylene mesh
• Weight 16 g/m², 24 g/m², 35 g/m² or 65 g/m²
• Pore size: 1.0 mm or 3.0 mm
• Monofilament fabric
• Non-absorbable
• Atraumatic laser-cut edges
• EO-sterilised (ethylene oxide), pyrogen-free

Following mesh implantation, the immune system reacts to the foreign body. This means that the surface of the mesh thread becomes a reactive area. The relative reactive surface area is defined by the ratio of the reactive area to the total area of the mesh. The pore size of the mesh has a significant influence on this. Macroporous meshes have a smaller relative reactive surface area and reduced inflammatory responses.¹⁰ Biocompatible mesh materials with a surface coating have also proven beneficial.^5,6,10,11

Our meshes combine both of these properties: a small relative reactive surface area and a titanised mesh surface. Both have a beneficial effect on the body’s inflammatory response to the mesh, which enables increased ingrowth of soft tissue.

IPOM with TiMESH

With its universal application, excellent product characteristics and proven benefits, TiMESH is a leading product for general and visceral surgery. The International Endohernia Society (IEHS) included TiMESH in its guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias¹².

1. CE-labeling of the titanised hernia mesh TiMESH: 2002
2. Horstmann R., Hellwig M., Classen C., Röttgermann S., Palmes D., Impact of polypropylene amount on functional outcome and quality of life after inguinal hernia repair by the TAPP procedure using pure, mixed, and titanium-coated meshes. World J Surg, 2006, 30(9): 1742-1749
3. Wintermantel, E., S.-W.H., Medizintechnik Life Science Engineering. 5 ed. 2009, Berlin Heidelberg: Springer-Verlag
4. Lehle K., Lohn S., Verbesserung des Langzeitverhaltens von Implantaten und anderen Biomaterialien auf Kunststoffbasis durch plasmaaktivierte Gasphasenabscheidung (PACVD), Abschlussbericht Forschungsverbund “Biomaterialien (FORBIOMAT II)”. 2002, 149–173
5. Scheidbach H., Tamme C., Tannapfel A., Lippert H., Köckerling F., In vivo studies comparing the biocompatibility of various polypropylene meshes and their handling properties during endoscopic total extraperitoneal (TEP) patchplasty: an experimental study in pigs. Surg Endosc, 2004, 18(2): 211-220
6. Scheidbach H., Tannapfel A., Schmidt U., Lippert H., Köckerling F., Influence of titanium coating on the biocompatibility of a heavyweight polypropylene mesh. An animal experimental model. Eur Surg Res, 2004, 36(5): 313-317
7. Schug-Paß C., Tamme C., Tannapfel A., Köckerling F., A lightweight polypropylene mesh (TiMesh) for laparoscopic intraperitoneal repair of abdominal wall hernias: : comparison of biocompatibility with the DualMesh in an experimental study using the porcine model. Surg Endosc, 2006, 20(3): 402-409
8. Moreno-Egea A., Carrillo-Alcaraz A., Soria-Aledo V., Randomized clinical trial of laparoscopic hernia repair comparing titanium-coated lightweight mesh and medium-weight composite mesh. Surg Endosc, 2013, 27(1): 231-239
9. Koch A., Bringman S., Myrelid P., Smeds S., Kald A., Randomized clinical trial of groin hernia repair with titanium-coated lightweight mesh compared with standard polypropylene mesh. Br J Surg, 2008, 95(10): 1226-1231
10. Zhu L. M., Schuster P., Klinge U., Mesh implants: An overview of crucial mesh parameters. World J Gastrointest Surg, 2015, 7(10): 226-236
11. Wood A. J., Cozad M. J., Grant D.A., Ostdiek A. M., Bachman S. L., Grant S.A., Materials characterization and histological analysis of explanted polypropylene, PTFE, and PET hernia meshes from an individual patient. J Mater Sci Mater Med, 2013, 24(4): 1113-1122
12. Bittner R., Bingener-Casey J., Dietz U., Fabian M., Ferzli G., Fortelny R., Köckerling F., Kukleta J., LeBlanc K., Lomanto D., Misra M., Morales-Conde S., Ramshaw B., Reinpold W., Rim S., Rohr M., Schrittwieser R., Simon T., Smietanski M., Stechemesser B., Timoney M., Chowbey P., Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society [IEHS])-Part III. Surg Endosc, 2014, 28: 380-404