A biomechanical analysis of different meshes for reconstructions of the pelvic floor in the porcine model

Kilian Wegmann,Alina Katharina Jansen,Christian Eichler,Julia Radosa,Leonidas Karapanos,Wolfram Malter,Axel Sauerwald,Sebastian Ludwig,Nadja Trageser

doi:10.1007/s00404-021-06344-9

Abstract

PurposeMany different surgical approaches have been established for the repair of a pelvic organ prolapse. Especially in laparoscopic surgery, it is important to generate easy surgical techniques with similar stability. This study shall simplify the choice of mesh by evaluating three polypropylene meshes regarding their biomechanical properties.MethodsBiomechanical testing was performed in the porcine model. The meshes are fixated on porcine fresh cadaver cervices after subtotal hysterectomy. The apical part of the mesh is fixated with parallel screw clamps at the testing frame. Forty-one trials were performed overall, subdivided into four subgroups. The groups differ in mesh type and fixation method. Maximum load, displacement at failure and stiffness parameters were evaluated with an Instron 5565® test frame.ResultsSERATEX® E11 PA (E11) showed the highest values for maximum load (199 ± 29N), failure displacement (71 ± 12 mm) and stiffness (3.93 ± 0.59 N/mm). There was no significant difference in all three evaluated parameters between SERATEX® B3 PA (B3) and SERATEX® SlimSling® with bilateral fixation (SSB). SERATEX® SlimSling® with unilateral fixation (SSU) had the lowest stiffness (0.91 ± 0.19 N/mm) and maximum load (30 ± 2 N) but no significant difference in displacement at failure.ConclusionAll meshes achieved a good tensile strength, but the results of maximum load show that the E11 is superior to the other meshes. Through a bilateral fixation of SERATEX® SlimSling®, a simple operating method is generated without a loss of stability.

Highlights

Pelvic organ prolapse is a frequent problem which occurs in nearly 50% of parous women [1]
All partial results are registered in Table 1. p values of the intergroup ANOVA analysis are recorded in Figs. 4 and 5
Since the mesh in vivo will be supported. This is the first biomechanical comparison between SlimSling® with unilateral fixation (SSU), SlimSling® with bilateral fixation (SSB), E11 and B3 used in sacrocervicopexy in a cadaver testing worldwide

Summary

Introduction

Pelvic organ prolapse is a frequent problem which occurs in nearly 50% of parous women [1]. According to DeLancey, the most frequent causal circumstances are failures of connective tissue and muscles of the pelvic floor [2], what can result in sensation of pressure on the vagina, sexual dysfunction or the impairment of the normal function of the urinary tract. In part, these symptoms can be alleviated by conservative methods like pelvic muscle exercises or a vaginal pessary.

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Results

Discussion

Conclusion