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Coated / Hybrid Mesh

Hybrid mesh describes a construction, not a single material or clinical indication. A device may combine permanent PP with an absorbable polymer, reinforce an extracellular matrix with permanent or resorbable fibers, or combine multiple degradable components. Coating, partial absorption and complete absorption are not interchangeable.[1][2][3]

The aims include easier handling, altered tissue interaction and appropriate load transfer. Permanent PP provides lasting reinforcement but sustains a foreign-body response, while biologic and fully absorbable scaffolds integrate well and lack durable strength. Hybrid constructs are designed so that a biologic or absorbable component offsets the negative attributes of the permanent prosthetic, which keeps the mechanical strength.[1]

Partially Absorbable Constructs​

Partially absorbable meshes combine a permanent, lower-weight PP knit with absorbable fibers that degrade over weeks to months.

  • Vypro and Vypro II (Ethicon) add polyglactin 910 multifilaments to a low-weight PP knit. The absorbable component stiffens the mesh for handling. In a rat abdominal-wall model, the polyglactin multifilaments reduced macrophages and granulocytes and limited scar to the perifilamentary region.[5] A meta-analysis of 10 randomized inguinal-hernia trials (2,027 patients) found no significant difference from PP in recurrence, pain, urinary tract infection or seroma; in the four trials (1,305 patients) reporting foreign-body sensation, the pooled OR favored Vypro II (0.58, 95% CI 0.42 to 0.80).[11]
  • A lightweight PP with a poliglecaprone component (Ultrapro type) was the mesh in the lightweight arm of the sacrocolpopexy study below.[4]

In the rat model, coating the PP with polyglactin favored a connective-tissue capsule around the whole mesh and appeared to hinder incorporation, while adding polyglactin filaments appeared favorable.[5]

Know What Remains Implanted​

ConstructionExample and distinction
Permanent plus absorbable syntheticPP/polyglactin or PP/poliglecaprone constructs leave permanent PP after the absorbable component is lost. A lighter residual implant still has permanent-mesh risks.[1][4]
Biologic matrix plus permanent polymerOviTex LPR's July 2024 IFU describes ovine extracellular matrix with monofilament PP. Its soft-tissue indications include hernia and abdominal-wall defects.[2]
Biologic matrix plus resorbable polymerOviTex PRS Short-Term Resorbable contains ovine matrix and PGA. Its March 2022 IFU excludes high-load applications such as bridging hernias.[3]
Coated / tissue-engineered scaffoldSurface layers may alter handling, adhesion or biologic response; experimental scaffolds may contain no permanent backbone. Clinical benefit and safe tissue contact require evidence for the exact construction.

Both cited OviTex IFUs contraindicate use with known sensitivity to sheep-derived material. The LPR document also advises against use with known PP sensitivity.[2][3] Complications can include infection, pain, adhesions, fistula, recurrence and wound failure.[2][3]

A coating is not automatically an improvement. In an older rat abdominal-wall experiment, adding polyglactin fibers and coating the entire PP surface produced different tissue responses; the coating promoted encapsulation.[5]

Partially Absorbable Mesh in Vaginal POP Repair​

Two retrospective series and one randomized trial associate partially absorbable mesh with less exposure at some time points. The randomized comparison with native tissue found no significant anatomical or composite benefit, and none of the studies shows a consistent reduction in exposure or a superior replacement for native tissue.

StudyDesign and useful findingLimitation
Farthmann 2013Randomized 200 women to conventional PP or partially absorbable mesh. Exposure with PP versus partially absorbable mesh was 11.3% vs 3.2% at 3 months (P = 0.0492), 6.6% vs 6.3% at 12 months and 7.5% vs 3.4% at 36 months. The authors described a trend favoring the partially absorbable product. Recurrent prolapse was more frequent with the partially absorbable mesh (P > 0.05).[6]The 12- and 36-month comparisons did not establish a safety advantage.
Lensen 2013Retrospective analysis of prospectively collected data on 569 women (347 non-absorbable, 222 partially absorbable mesh), compared two trocar-guided kits. At 12 months, exposure was 12% vs 5%, and reoperation in untreated compartments was 5% vs 1%. Failure rates were similar.[12]Two different kits and a nonrandom comparison, so mesh type is confounded with the kit.
Quemener 2014Retrospective series of 250 women with partially absorbable mesh, median follow-up 20 months. Reintervention 8% (mesh exposure 2%, recurrent prolapse 1.2%, urinary complications including de novo SUI 4.8%).[13]The authors concluded that partially absorbable mesh did not appear to give an advantage in reintervention rates over non-absorbable mesh.
Cho 2018Retrospective single-center cohort, non-absorbable vs partially absorbable mesh for anterior and apical prolapse. Objective outcomes were better with partially absorbable mesh at 1 and 2 years, and exposure was similar in the two groups. Recurrence was higher with partially absorbable mesh (not significant).[14]—
Steures 2019Randomized 163 women to partially absorbable mesh or native-tissue repair. At 24 months, anatomical success was 32/71 versus 22/69 (RR 1.4, 95% CI 0.92–2.2) and composite success among women with complete endpoint data was 49/56 (88%) versus 43/59 (73%); no significant anatomical or composite benefit was shown. Four exposures were reported among 71 assessed mesh-group women (6%).[7]Treatment crossover occurred.
Page 2023: abdominal sacrocolpopexyTwo consecutive single-center cohorts (median follow-up about 8 years) compared heavier-weight PP (more than 44 g/m², n = 101) with lightweight PP (28 g/m²) containing a resorbable poliglecaprone component (n = 238). Graft-related complications occurred in 7.3% (13/178 assessed lightweight recipients) versus 22.8% (23/101) (HR 3.3, 95% CI 1.6 to 7.1), and reintervention for them in 2.1% (5/238) versus 18.8% (19/101). Patient-reported improvement (PGIC 4 or higher) and anatomical failure did not differ.[4]Weight and the absorbable component differ together.Ethicon supported the audit.

FDA's transvaginal POP restrictions are not bypassed by describing a device as hybrid or biologic. Keep this indication separate from abdominal prolapse repair and SUI slings.[8]

Reinforced Tissue Matrices​

Reinforced tissue matrices embed a polymer in decellularized extracellular matrix. The matrix is intended to recruit host cells and attenuate the foreign-body response while the polymer offloads abdominal pressure. OviTex (TELA Bio) is the best-known example, and the LPR version combines ovine matrix with monofilament PP.[2] The published data are from hernia and abdominal-wall repair, including a review by authors affiliated with the manufacturer, and pelvic-floor outcome data are lacking.[15] No head-to-head trials against standard synthetic mesh exist in urogynecologic indications.

Tissue-Engineered Constructs​

Nanofiber coatings, drug-eluting layers and cell-seeded scaffolds remain active research areas. All of the following are preclinical unless stated.

  • PLCL and fibrinogen co-electrospun mesh. In a canine abdominal-defect model, the mesh had similar host responses to PP with better early vascularization and tissue organization. In a retrospective, patient-selected human comparison (38 women; 35 followed to 6 months), the abstract reports greater Aa-point improvement with PLCL/fibrinogen, but the paper's tables show the opposite: mean Aa moved from 1.20 to −0.50 cm with PLCL/fibrinogen and from 1.52 to −3 cm with PP (6-month difference P = 0.017).[16]
  • Polyurethane and gelatin nanofiber-coated PP. No mesh exposure was observed in the treated rat prolapse model, with higher collagen content and fewer macrophages. Exposure in women was not assessed in this rat model.[9]
  • PCL mesh with PLGA nanofibers. 3D-printed PCL mesh had strength comparable to commercial PP meshes and survived 10,000 fatigue cycles. Metronidazole, lidocaine and estradiol released for 4, 25 and 30 days in vitro, and CTGF for more than 30 days. The mesh lost mechanical strength over time in animals as the polymer degraded.[17]
  • Polystyrene and gelatin core-sheath nanofibers. The gelatin sheath provides a hydrophilic surface over a non-degradable core, and the implant switched to an accommodation immune phenotype by 2 weeks in vivo.[18]
  • PCL mesh with CTGF, PEG-fibrinogen and mesenchymal stem cells. In elderly rats at about 53 weeks, the mesh showed support, biocompatibility and no mesh-related complications in an abdominal repair model.[19]
  • Chitosan, PLA and chitosan trilayer for urethral reconstruction. In vitro, the scaffold had higher elastic modulus and tensile strength than PLA or acellular dermis, with smooth muscle cell growth and greater angiogenic potential in a chicken embryo assay. It has not been used in clinical urethral reconstruction.[10]
  • Collagen and PLAC hybrid for bladder regeneration. Human bladder smooth muscle and urothelial cells proliferated on the hybrid in vitro, and the hybrid produced less inflammation than PLAC mesh alone after subcutaneous implantation in nude mice.[20]

Reviews describe drug-eluting layers, 3D-printed patient-specific scaffolds and cell-seeded constructs as directions for development.[21][22]

Current Use​

  • Midurethral slings. Hybrid slings are not in widespread clinical use. See Polypropylene Mesh for sling material.
  • Sacrocolpopexy. Lightweight PP is the usual material. Hybrid constructs have not been widely adopted.
  • Transvaginal POP repair. Mesh products for vaginal POP have been withdrawn in many countries.[8][23]
  • Urologic reconstruction. Tissue-engineered hybrid scaffolds with biologic components or cells are the most active research area, and all remain investigational.

Practical Use​

Before choosing a hybrid device, identify its exact components, indication and jurisdiction; determine whether reinforcement remains permanent; and check tissue-contact, load, allergy and handling restrictions in that version's IFU.

See also: Polypropylene Mesh, Absorbable Synthetic Mesh, Prolapse Repair.

References​

1. Reid CM, Jacobsen GR. A Current Review of Hybrid Meshes in Abdominal Wall Reconstruction. Plastic and Reconstructive Surgery. 2018;142(3 Suppl):92S-96S. doi:10.1097/PRS.0000000000004860

2. TELA Bio. OviTex LPR Permanent Polymer Instructions for Use, PI.9123.05. July 2024; English section.

3. TELA Bio. OviTex PRS Short-Term Resorbable Polymer Instructions for Use, PI.9149.04. March 2022.

4. Page AS, Cattani L, Pacquée S, et al. Long-Term Data on Graft-Related Complications After Sacrocolpopexy With Lightweight Compared With Heavier-Weight Mesh. Obstetrics and Gynecology. 2023;141(1):189-198. doi:10.1097/AOG.0000000000005021

5. Klinge U, Klosterhalfen B, Müller M, et al. Influence of Polyglactin-Coating on Functional and Morphological Parameters of Polypropylene-Mesh Modifications for Abdominal Wall Repair. Biomaterials. 1999;20(7):613-623. doi:10.1016/s0142-9612(98)00211-7

6. Farthmann J, Watermann D, Niesel A, et al. Lower Exposure Rates of Partially Absorbable Mesh Compared to Nonabsorbable Mesh for Cystocele Treatment: 3-Year Follow-Up of a Prospective Randomized Trial. International Urogynecology Journal. 2013;24(5):749-758. doi:10.1007/s00192-012-1929-2

7. Steures P, Milani AL, van Rumpt-van de Geest DA, Kluivers KB, Withagen MIJ. Partially Absorbable Mesh or Native Tissue Repair for Pelvic Organ Prolapse: A Randomized Controlled Trial. International Urogynecology Journal. 2019;30(4):565-573. doi:10.1007/s00192-018-3757-5

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

9. Guo T, Hu X, Du Z, et al. Modification of Transvaginal Polypropylene Mesh With Co-Axis Electrospun Nanofibrous Membrane to Alleviate Complications Following Surgical Implantation. Journal of Nanobiotechnology. 2024;22(1):598. doi:10.1186/s12951-024-02872-z

10. Abbas TO, Parangusan H, Yalcin HC, et al. Trilayer Composite Scaffold for Urethral Reconstruction: In Vitro Evaluation of Mechanical, Biological, and Angiogenic Properties. Biomedical Materials. 2024. doi:10.1088/1748-605X/ad1c9c

11. Gao M, Han J, Tian J, Yang K. Vypro II mesh for inguinal hernia repair: a meta-analysis of randomized controlled trials. Ann Surg. 2010;251(5):838–842. doi:10.1097/SLA.0b013e3181cc989b

12. Lensen EJ, Withagen MI, Kluivers KB, Milani AL, Vierhout ME. Comparison of two trocar-guided trans-vaginal mesh systems for repair of pelvic organ prolapse: a retrospective cohort study. Int Urogynecol J. 2013;24(10):1723–1731. doi:10.1007/s00192-013-2098-7

13. Quemener J, Joutel N, Lucot JP, et al. Rate of re-interventions after transvaginal pelvic organ prolapse repair using partially absorbable mesh: 20 months median follow-up outcomes. Eur J Obstet Gynecol Reprod Biol. 2014;175:194–198. doi:10.1016/j.ejogrb.2013.12.031

14. Cho MK, Moon JH, Kim CH. Non-absorbable and partially-absorbable mesh during pelvic organ prolapse repair: a comparison of clinical outcomes. Int J Surg. 2018;55:5–8. doi:10.1016/j.ijsu.2018.05.011

15. Sawyer M, Ferzoco S, DeNoto G 3rd. A polymer-biologic hybrid hernia construct: review of data and early experiences. Polymers (Basel). 2021;13(12):1928. doi:10.3390/polym13121928

16. Wu X, Wang Y, Zhu C, et al. Preclinical animal study and human clinical trial data of co-electrospun poly(L-lactide-co-caprolactone) and fibrinogen mesh for anterior pelvic floor reconstruction. Int J Nanomedicine. 2016;11:389–397. doi:10.2147/IJN.S88803

17. Chen YP, Lo TS, Lin YT, et al. Fabrication of drug-eluting polycaprolactone/poly(lactic-co-glycolic acid) prolapse mats using solution-extrusion 3D printing and coaxial electrospinning techniques. Polymers (Basel). 2021;13(14):2295. doi:10.3390/polym13142295

18. Ge L, Li Q, Jiang J, et al. Integration of nondegradable polystyrene and degradable gelatin in a core-sheath nanofibrous patch for pelvic reconstruction. Int J Nanomedicine. 2015;10:3193–3201. doi:10.2147/IJN.S75802

19. Laursen SH, Hansen SG, Taskin MB, et al. Electrospun nanofiber mesh with connective tissue growth factor and mesenchymal stem cells for pelvic floor repair: long-term study. J Biomed Mater Res B Appl Biomater. 2023;111(2):392–401. doi:10.1002/jbm.b.35158

20. Engelhardt EM, Micol LA, Houis S, et al. A collagen-poly(lactic acid-co-ɛ-caprolactone) hybrid scaffold for bladder tissue regeneration. Biomaterials. 2011;32(16):3969–3976. doi:10.1016/j.biomaterials.2011.02.012

21. Farmer ZL, Domínguez-Robles J, Mancinelli C, Larrañeta E, Lamprou DA. Urogynecological surgical mesh implants: new trends in materials, manufacturing and therapeutic approaches. Int J Pharm. 2020;585:119512. doi:10.1016/j.ijpharm.2020.119512

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

23. Tailor V, Digesu A, Swift SE. Update in transvaginal grafts: the role of lightweight meshes, biologics, and hybrid grafts in pelvic organ prolapse surgery. Obstet Gynecol Clin North Am. 2021;48(3):515–533. doi:10.1016/j.ogc.2021.05.006