Are polypropylene mesh implants associated with systemic autoimmune inflammatory syndromes? A systematic review

C.R. Kowalik*, S.E. Zwolsman, A. Malekzadeh, R.M.H. Roumen, W.A.R. Zwaans, J.W.P.R. Roovers

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review

7 Citations (Web of Science)


Purpose The surgical implantation of polypropylene (PP) meshes has been linked to the occurrence of systemic autoimmune disorders. We performed a systematic review to determine whether PP implants for inguinal, ventral hernia or pelvic floor surgery are associated with the development of systemic autoimmune syndromes. Methods We searched Embase, Medline, Web of Science, Scopus, Cochrane library,, and WHO-ICTR platform. Last search was performed on November 24th 2021. All types of studies reporting systemic inflammatory/autoimmune response in patients having a PP implant for either pelvic floor surgery, ventral or inguinal hernia repair were included. Animal studies, case reports and articles without full text were excluded. We intended to perform a meta-analysis. The quality of evidence was assessed with the Newcastle-Ottawa Scale. This study was registered at Prospero (CRD42020220705). Results Of 2137 records identified, 4 were eligible. Two retrospective matched cohort studies focused on mesh surgery for vaginal prolapse or inguinal hernia compared to hysterectomy and colonoscopy, respectively. One cohort study compared the incidence of systemic conditions in women having urinary incontinence surgery with and without mesh. These reports had a low risk of bias. A meta-analysis showed no association when comparing systemic disease between mesh and control groups. Calculated risk ratio was 0.9 (95% CI 0.82-0.98). The fourth study was a case series with a high risk of bias, with a sample of 714 patients with systemic disease, 40 of whom had PP mesh implanted. Conclusion There is no evidence to suggest a causal relationship between being implanted with a PP mesh and the occurrence of autoimmune disorders.
Original languageEnglish
Pages (from-to)401-410
Number of pages10
Issue number2
Early online date12 Jan 2022
Publication statusPublished - Apr 2022


  • Pelvic organ prolapse
  • Polypropyleen
  • Mesh
  • Inguinal hernia
  • Systemic autoimmune disorders
  • Implant

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