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Absorbable Synthetic Mesh

Absorbable synthetic meshes are polymers that degrade by hydrolysis in vivo. They provide temporary reinforcement while host tissue infiltrates and remodels, with the aim of leaving no permanent foreign body and so avoiding long-term erosion, chronic pain and late infection.[15] Polymer loss, declining mesh strength and the strength of the repaired tissue are different measurements.[1][2]

Fully absorbable mesh should not be substituted for a permanent sling or prolapse implant.

Materials and Support Duration​

Material / exampleWhat the evidence or product information establishes
Polyglactin 910 / rapidly absorbable polymersProvide short-lived reinforcement. Polyglactin 910 (Vicryl) was described as losing 50% of its mechanical stability within 3 weeks. In the rat abdominal-wall model, it produced a pronounced early inflammatory reaction and more connective tissue, followed by loss of stability and dilatation of the repair after 3 weeks. The authors linked this to the frequent incisional hernias with short-term absorbable meshes.[3]
Polylactide (PLA)The long-term absorbable polylactide mesh was described as preserving more than 50% of its mechanical stability for over 1 year. In the same rat abdominal-wall model, observed through 180 days, it retained mechanical stability, with less inflammation and connective tissue than polyglactin.[3]
P4HB / PhasixFully resorbable monofilament mesh; manufacturer information describes degradation over approximately 12–18 months.[1]
PGA:TMC / GORE BIO-AA scaffold containing 67% polyglycolic acid and 33% trimethylene carbonate, with an approximately 6–7-month resorption period. It is not intended where permanent mesh support is required.[2]
TIGR Matrix and other dual-fiber constructsA review of preclinical abdominal-wall studies reported only partial remodeling with a persistent foreign-body reaction after 1 year for TIGR Matrix, and good remodeling of GORE BIO-A at 6 to 12 months. Chemistry and architecture differ substantially.[14]
Partially absorbable PP constructsThe absorbable component disappears but PP remains permanently. See Coated / Hybrid Mesh.

The desired gradual transfer of load to healing tissue is a design goal. Rat and rabbit comparisons of Phasix and BIO-A measured inflammation, repair thickness, strength and bacterial colonization under experimental conditions. In rats, BIO-A resorbed faster, with a greater inflammatory response at 4 weeks and a thinner repair site than Phasix at 16 and 24 weeks. In rabbits inoculated with MRSA, Phasix had lower abscess scores and bacterial colonization and greater strength than BIO-A. The Phasix manufacturer funded the study; three authors were consultants and two were its employees. The authors attributed the results to monofilament macroporous versus multifilament microporous construction.[4]

Product Safety Boundaries​

Check the exact product and jurisdiction

Phasix should not be used where permanent wound or organ support from mesh is required. Its US safety information prohibits direct contact with bowel or viscera, advises avoidance with known tetracycline or kanamycin allergy, and notes that unresolved infection may require removal. The manufacturer's CE-marked safety summary contraindicates Phasix for pelvic organ prolapse repair and for SUI treatment; another manufacturer safety summary words the prolapse restriction as transvaginal repair.[1][17]

GORE BIO-A is indicated for reinforcement of soft tissue, including hernia-related applications; its product information contraindicates use requiring permanent support and reconstruction of cardiovascular defects.[2]

FDA's 2019 transvaginal POP order was not limited to permanent PP: the affected products included Xenform, a biologic matrix.[5]

Pelvic Organ Prolapse Evidence​

The 2024 Cochrane review did not establish a benefit of absorbable mesh over native-tissue vaginal repair. Evidence for individual outcomes came from a small trial (54–66 assessed women) with wide confidence intervals.[6]

A 2024 sheep study implanted a prototype P4HB scaffold or PP mesh in the posterior vaginal wall. Exposures at 12 months occurred in 3/8 P4HB and 4/8 PP explants; at 24 months they occurred in 0/8 and 4/8, respectively. P4HB had fully resorbed with maintained explant stiffness at the later endpoint, and P4HB explants had higher collagen content and less myofibroblast differentiation than PP at 24 months. The study was funded in part by the P4HB manufacturer.[7]

Urinary Exposure: Keep Materials and Models Separate​

Urine can alter material performance, but findings depend on the polymer, construction, pH, organism and test conditions. A suture immersion experiment found that PDS lost all strength after 3 days in sterile urine, and PGA lost 64% after 10 days.[8] In Proteus-infected urine, both lost all strength after 1 day. Catgut kept its strength.[8] A different experiment using polyglactin 910 mesh found that at day 21 breaking strength was below 10% of control in serum and culture media and 12% to 24% of control in urine, and below 5% in all solutions by day 38.[9] Degradation was prolonged in low-pH and infected urine, and minimal at 38 days in infected urine at pH 5.0.[9] The first study tested sutures and the second tested mesh, so neither justifies a universal claim that every absorbable mesh or PDS suture loses all strength after three days in any urinary reconstruction. The findings do mean that the mechanical window of a short-term absorbable in urine is unpredictable, and a short-term absorbable should not be the sole load-bearing element in genitourinary reconstruction.

Do not prescribe urinary acidification, alkalinization or tolerated infection to manipulate mesh degradation on the basis of these bench findings. For an anastomosis, choose a clinically appropriate suture and technique; for an implant exposed to urine, establish product-specific compatibility and the reconstructive plan.

Investigational GU Reconstruction​

Cell-seeded polymer scaffolds for bladder reconstruction and bioengineered urethral replacements remain research approaches.

  • Bladder augmentation scaffolds. In a canine augmentation cystoplasty model, a PLGA mesh seeded with autologous urothelial and smooth muscle cells restored baseline urodynamics as early as 4 months, and the unseeded scaffold did not return to baseline by 9 months. The difference was associated with cell seeding.[10]
  • PLGA composites. PLGA mesh coated with fibrin or collagen was compatible with differentiated adipose-derived stem cells in vitro, and PLGA-fibrin gave better leak and porosity properties. Tensile properties were measured on the bench only.[11]
  • Renal hemostasis. In a rabbit partial nephrectomy model, PGA mesh stopped bleeding immediately. The fibers were digested between 2 weeks and 2 months and the mesh was completely resorbed by 3 months, leaving a new fibrous capsule with no renal reaction and no difference from an omental fat graft.[12]
  • Biodegradable urologic stents. Self-reinforced 80L/20G PLGA stents degraded faster in artificial urine than in phosphate buffer, and the in vitro degradation rate coincided with a clinical test in the authors' report.[13]

When mesh avoidance is a priority, discuss established native-tissue operations or autologous fascia as appropriate to the indication. Material innovation should be evaluated against meaningful symptom, recurrence, reoperation and long-term safety outcomes.

Advantages and Limitations​

The theoretical advantages are no permanent foreign body and organized collagen remodeling rather than dense scar, particularly with P4HB in the sheep model.[7] Monofilament macroporous designs showed lower bacterial colonization in the rabbit model.[4]

The limitations are these:

  • Recurrence risk if tissue regeneration lags resorption. Short-term absorbable meshes used as an abdominal inlay have been reported to result in large incisional hernias in almost all cases, which the authors of the rat study linked to the loss of stability at 2 to 3 weeks.[3]
  • Unpredictable degradation in urine.[8][9]
  • No support for transvaginal POP repair in the 2024 Cochrane review.[6]
  • Clinical evidence in pelvic floor surgery is limited, and no human study cited here compares fully absorbable mesh with permanent synthetic mesh in these indications.[6][7] The P4HB-versus-PP comparison above used separate sheep explant groups.[7]

Current Use​

In pelvic floor reconstruction, absorbable mesh has largely been supplanted by native-tissue repair when mesh avoidance is the goal, by permanent PP mesh where augmentation is indicated and approved, and by autologous rectus fascia when permanent biologic support is preferred. P4HB scaffolds and partially absorbable constructs are candidates for a future clinical role, and cell-seeded PLGA constructs are the main investigational route for bladder regeneration. A separate P4HB device, the TephaFlex retropubic sling, was evaluated in a prospective noncomparative cohort of 17 women with moderate to severe SUI. Objective cure was reported in 76% at 12 months and 47% at 24 months; three women underwent a second midurethral sling procedure, one received urethral bulking for failed cure, and one had exposed mesh with part of the device sheath left behind.[16]

See also: Polypropylene Mesh, Coated / Hybrid Mesh.

References​

1. BD. Phasix Mesh: US product safety information; US and CE-marked safety summaries in BD-135707, August 2024. Resorption interval is not a fixed strength-retention interval.

2. Gore Medical. GORE BIO-A Tissue Reinforcement: product description, indications and contraindications. Accessed September 2026.

3. Klinge U, Schumpelick V, Klosterhalfen B. Functional Assessment and Tissue Response of Short- and Long-Term Absorbable Surgical Meshes. Biomaterials. 2001;22(11):1415-1424. doi:10.1016/s0142-9612(00)00299-4

4. Stoikes NFN, Scott JR, Badhwar A, Deeken CR, Voeller GR. Characterization of Host Response, Resorption, and Strength Properties, and Performance in the Presence of Bacteria for Fully Absorbable Biomaterials for Soft Tissue Repair. Hernia. 2017;21(5):771-782. doi:10.1007/s10029-017-1638-3

5. US Food and Drug Administration. FDA Activities: Urogynecologic Surgical Mesh. Includes April 2024 SUI mini-sling review and 2019 POP order.

6. Yeung E, Baessler K, Christmann-Schmid C, et al. Transvaginal Mesh or Grafts or Native Tissue Repair for Vaginal Prolapse. Cochrane Database of Systematic Reviews. 2024;3:CD012079. doi:10.1002/14651858.CD012079.pub2

7. Guler Z, Kaestner LA, Vodegel E, et al. Two-Year Preclinical Evaluation of Long-Term Absorbable Poly-4-Hydroxybutyrate Scaffold for Surgical Correction of Pelvic Organ Prolapse. International Urogynecology Journal. 2024;35(3):713-722. doi:10.1007/s00192-023-05720-0

8. el-Mahrouky A, McElhaney J, Bartone FF, King L. In Vitro Comparison of the Properties of Polydioxanone, Polyglycolic Acid and Catgut Sutures in Sterile and Infected Urine. The Journal of Urology. 1987;138(4):913-915. doi:10.1016/s0022-5347(17)43415-x

9. Best CD, Lowe R, Shu J, Terris MK. Comparison of the Breaking Strength of Polyglactin Mesh in Urine, Serum, and Cell Culture Media. Urology. 1999;53(6):1239-1244. doi:10.1016/s0090-4295(99)00056-4

10. Jayo MJ, Jain D, Wagner BJ, Bertram TA. Early Cellular and Stromal Responses in Regeneration Versus Repair of a Mammalian Bladder Using Autologous Cell and Biodegradable Scaffold Technologies. The Journal of Urology. 2008;180(1):392-397. doi:10.1016/j.juro.2008.02.039

11. Salem SA, Hwei NM, Bin Saim A, et al. Polylactic-co-glycolic acid mesh coated with fibrin or collagen and biological adhesive substance as a prefabricated, degradable, biocompatible, and functional scaffold for regeneration of the urinary bladder wall. Journal of Biomedical Materials Research Part A. 2013;101(8):2237-2247. doi:10.1002/jbm.a.34518

12. Mounzer AM, McAninch JW, Schmidt RA. Polyglycolic acid mesh in repair of renal injury. Urology. 1986;28(2):127-130. doi:10.1016/0090-4295(86)90103-2

13. Välimaa T, Laaksovirta S. Degradation behaviour of self-reinforced 80L/20G PLGA devices in vitro. Biomaterials. 2004;25(7-8):1225-1232. doi:10.1016/j.biomaterials.2003.08.072

14. Miserez M, Jairam AP, Boersema GSA, et al. Resorbable synthetic meshes for abdominal wall defects in preclinical setting: a literature review. Journal of Surgical Research. 2019;237:67-75. doi:10.1016/j.jss.2018.11.054

15. Shiroud Heidari B, Dodda JM, El-Khordagui LK, et al. Emerging materials and technologies for advancing bioresorbable surgical meshes. Acta Biomaterialia. 2024;184:1-21. doi:10.1016/j.actbio.2024.06.012

16. van Rest KLC, Kastelein AW, Brouard KJ, Ras L, Jeffery ST, Roovers JPWR. "Safety and Efficacy Report for the Use of Poly-4-Hydroxybutyrate as a Retropubic Mid-Urethral Sling (MUS) for Stress Urinary Incontinence: A Prospective 24 Months Follow-Up of New Poly-4-Hydroxybutyrate TephaFlex SUI Bioresorbable MUS." J Minim Invasive Gynecol. 2024;31(2):131-137. doi:10.1016/j.jmig.2023.11.013

17. BD. Phasix Mesh: CE-marked product safety summary BD-135701. August 2024.