ABSTRACT
An acute inflammatory response is initially predominated by neutrophils and then gradually replaced by monocytes. Monocytes then differentiate into macrophages which play a crucial role in the acceptance or rejection of the implant. Macrophages will interact with host cells to induce production of proteins and fibroblasts. Because of the activation of these mediators, the acute inflammatory response can continue for years. Fibroblasts will ultimately produce collagen, predominated by type 3 collagen initially, and matrix proteins which begin the process of remodeling. While the inflammatory response is necessary for incorporation of implants, complications including implant shrinkage, erosion, and adhesions can occur. Properties of the implant greatly influence the amount of inflammation, and therefore the choice of implant for the augmentation of prolapse repair will greatly impact the success of the surgery. Additionally, host immunologic factors may play a role in the success of implants. In a cohort of women undergoing suburethral slings with synthetic mesh, assays of various immunologic factors were collected preoperatively. The study concluded that women with elevated levels of interferon (IFN)-gamma were more likely to have erosion of the polypropylene mesh compared to controls without erosion of their mesh ( 2 ). Studies are currently underway to attempt to predict patients who are more likely to reject meshes based upon cytokine profiles. Despite efforts to develop biologically inert implants, the host will respond to any foreign body with an inevitable inflammatory response that can be influenced by the choice of implant.
