Mesh Insertion Research Articles

P-021 DELAYED ENTEROCUTANEOUS FISTULA AND ENCAPSULATING MESH INFECTION AFTER COMPOSITE MESH REPAIR OF AN ABDOMINAL MIDLINE INCISIONAL HERNIA - COMPLICATIONS 12 YEARS LATER

Abstract Aim Mesh infection is a well-recognised complication of incisional hernia repair, however, is usually encountered within months after mesh insertion. Only a few cases have been published where an enterocutaneous fistula has presented many years after mesh repair of an incisional hernia. Here we describe a complicated case of enterocutaneous fistula and mesh infection 12 years after the primary surgery. Material & Methods A 44 year-old gentleman presented acutely with a worsening 4 month history of an umbilical discharging sinus with associated fever, intermittent abdominal pain and nausea. There was also an associated hard lump and skin erythema. He previously had a laparotomy, small bowel resection for tuberculosis and ileostomy formation 13 years ago, followed by ileostomy reversal and intraperitoneal incisional hernia repair with composite mesh 1 year later. Results Cross-sectional imaging showed a large volume of gas within the mesh with underlying small bowel and collection within anterior abdominal wall, suggesting an enterocutaneous fistula. The patient initially underwent ultrasound guided aspiration of the collection followed by nutritional optimisation prior to another laparotomy, mesh excision and small bowel resection. The mesh was found to have a thick biofilm initially thought to be encased in mycobacterium but further testing was negative for this. Conclusions Delayed mesh infection over more than a decade after mesh insertion is rare. It is likely that pre-existing risk factors such as previous TB and small bowel resection with adhesions increased the risk of enterocutaneous fistulation.

P-031 TREATMENT OF A VOLUMINOUS INGUINOSCROTAL HERNIA AFTER A PREOPERATIVE PNEUMOPERITONEUM PREPARATION

Abstract Voluminous inguinoscrotal hernias that have lost their “right of domain”, are usually hard to repair, and need preoperative preparations to reduce the risk of complications after the treatment, such as compartment syndrome, intestinal ischemia, and respiratory problems. In this e-poster, we present a case report of a patient who had a voluminous inguinoscrotal hernia containing most of the small intestine and the entire right colon, which we treated after a preoperative pneumoperitoneum preparation (PPP). The preparation was conducted 20 days before the surgery and the pneumoperitoneum was created through a percutaneous catheter that we inserted in the epigastric region after a radiologic control. We injected 1000 ml of air per day, and the dose was adapted to the clinical tolerance of the patient. We performed a reintegration of the hernia's volume, a resection of the hernial sac, and a reduction of the size othe profound inguinal ring via a Raphia, no intestinal resections were made, and the postoperative course was uneventful. We plan a second intervention that consists of a hernia repair by a mesh insertion and a resection of the extra skin developed as a result of the voluminous hernia. PPP is an interesting way to prepare the abdominal cavity to receive the component of a voluminous hernia after its reduction. The patient should be closely monitored during the preparation and after the surgery in order. Sometimes a second operation is necessary for definitive cure or aesthetic needs.

MP07-09 TRENDS IN IMPLANTATION AND EXPLANTATION OF MESH FOR PELVIC ORGAN PROLAPSE AMONG FPMRS AND GENERAL UROLOGISTS

You have accessJournal of UrologyCME1 Apr 2023MP07-09 TRENDS IN IMPLANTATION AND EXPLANTATION OF MESH FOR PELVIC ORGAN PROLAPSE AMONG FPMRS AND GENERAL UROLOGISTS Mitchell G. Goldenberg, Unwanaobong Nseyo, Madeleine Burg, Evgeniy Kreydin, and David A. Ginsberg Mitchell G. GoldenbergMitchell G. Goldenberg More articles by this author , Unwanaobong NseyoUnwanaobong Nseyo More articles by this author , Madeleine BurgMadeleine Burg More articles by this author , Evgeniy KreydinEvgeniy Kreydin More articles by this author , and David A. GinsbergDavid A. Ginsberg More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003222.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The use of synthetic mesh in the treatment of pelvic floor conditions has long been scrutinized. Statements from multiple professional societies recommend that mesh for pelvic organ prolapse (POP) be performed only by those properly trained in both implantation and management of complications. We used case logs from the American Board of Urology (ABU) to understand temporal changes in the use of pelvic mesh among subspecialty trained and general urologists. METHODS: Case logs submitted to the ABU for certification and recertification in 2013 and in 2020 were reviewed. Demographic data including surgeon age, fellowship training, certification cycle, and practice type and location was analyzed. We analyzed trends in mesh insertion (both for POP and SUI) and mesh revision/removal based using common procedural terminology (CPT) codes among FPMRS and general urologists. Statistical analysis was performed using chi-squared test, binary regression, and Cronbach’s alpha. RESULTS: Over the two study years, 1877 surgeons contributed 253,326 unique procedures. A total of 1910 (1.8% of total cases) mesh implantation procedures were performed in 2013 compared to 2245 (1.5%) in 2020. Among FPMRS providers (n=154, 8.2%), the use of vaginal mesh for POP decreased from 4.6% to 1.5% (p<.001) of their total procedure volume, while transabdominal mesh for POP increased from 3.1% to 5.3%, (p<.001, see Figure 1). Similar changes were seen among generalists, among whom the rate tripled (0.1% to 0.4%, p<.001, see Figure 1b). Mesh revision/removal rates were stable (2.9%, p=.224) among FPMRS providers, but significantly decreased among general urologists in 2020 (0.2% to 0.1% p<.001). On multivariable analysis, generalists more likely to perform mesh revisions/removals were non-academic, female, and practiced in areas with a population density ≥1 million. Generalists implanting mesh were also more likely to perform revision/removal (Cronbach’s alpha=0.343, p=.015). CONCLUSIONS: Mesh-augmented POP repairs continue to be used among FPMRS and general urologists. However, these data indicate that general urologists may be referring mesh complications onto FPMRS providers, indicating that societal and FDA recommendations are perhaps not being adhered to. Source of Funding: The Catherine and Joseph Aresty Department of Urology © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e87 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mitchell G. Goldenberg More articles by this author Unwanaobong Nseyo More articles by this author Madeleine Burg More articles by this author Evgeniy Kreydin More articles by this author David A. Ginsberg More articles by this author Expand All Advertisement PDF downloadLoading ...

Parastomal hernia prevention with permanent mesh in end colostomy: failure with late follow-up of cohorts in three randomized trials

PurposeShort-term results have been reported regarding parastomal hernia (PH) prevention with a permanent mesh. Long-term results are scarce. The objective was to assess the long-term PH occurrence after a prophylactic synthetic non-absorbable mesh.MethodsLong-term data of three randomized controlled trials (RCTs) were collected. The primary outcome was the detection of PH based exclusively on a radiological diagnosis by computed tomography (CT) performed during the long-term follow-up. The Kaplan–Meier method was used for the comparison of time to diagnosis of PH according to the presence of mesh vs. no-mesh and the technique of mesh insertion: open retromuscular, laparoscopic keyhole, and laparoscopic modified Sugarbaker.ResultsWe studied 121 patients (87 men, median age 70 years), 82 (67.8%) of which developed a PH. The median overall length of follow-up was 48.5 months [interquartile range (IQR) 14.4–104.9], with a median time until PH diagnosis of 17.7 months (IQR 9.3–49.0). The survival analysis did not show significant differences in the time to development of a PH according to the presence or absence of a prophylactic mesh neither in the overall study population (log-rank, P = 0.094) nor in the groups of each technique of mesh insertion, although according to the surgical technique, a higher reduction in the appearance of PH for the open retromuscular technique was found (log-rank, P = 0.001).ConclusionIn the long-term follow-up placement of a non-absorbable synthetic prophylactic mesh in the context of an elective end colostomy does not seem effective for preventing PH.

A prospective multicentre study evaluating the outcomes of the abdominal wall dehiscence repair using posterior component separation with transversus abdominis muscle release reinforced by a retro-muscular mesh: filling a step

BackgroundThis study aimed to evaluate the results of posterior component separation (CS) and transversus abdominis muscle release (TAR) with retro-muscular mesh reinforcement in patients with primary abdominal wall dehiscence (AWD). The secondary aims were to detect the incidence of postoperative surgical site occurrence and risk factors of incisional hernia (IH) development following AWD repair with posterior CS with TAR reinforced by retromuscular mesh.MethodsBetween June 2014 and April 2018, 202 patients with grade IA primary AWD (Björck's first classification) following midline laparotomies were treated using posterior CS with TAR release reinforced by a retro-muscular mesh in a prospective multicenter cohort study.ResultsThe mean age was 42 ± 10 years, with female predominance (59.9%). The mean time from index surgery (midline laparotomy) to primary AWD was 7 ± 3 days. The mean vertical length of primary AWD was 16 ± 2 cm. The median time from primary AWD occurrence to posterior CS + TAR surgery was 3 ± 1 days. The mean operative time of posterior CS + TAR was 95 ± 12 min. No recurrent AWD occurred. Surgical site infections (SSI), seroma, hematoma, IH, and infected mesh occurred in 7.9%, 12.4%, 2%, 8.9%, and 3%, respectively. Mortality was reported in 2.5%. Old age, male gender, smoking, albumin level < 3.5 gm%, time from AWD to posterior CS + TAR surgery, SSI, ileus, and infected mesh were significantly higher in IH. IH rate was 0.5% and 8.9% at two and three years, respectively. In multivariate logistic regression analyses, the predictors of IH were time from AWD till posterior CS + TAR surgical intervention, ileus, SSI, and infected mesh.ConclusionPosterior CS with TAR reinforced by retro-muscular mesh insertion resulted in no AWD recurrence, low IH rates, and low mortality of 2.5%.Trial registration Clinical trial: NCT05278117.

Open Inguinal Hernia Repair: Incidence of Mesh Infection

Introduction: Wound and mesh infections after inguinal hernia repair are very severe complications. Today it is an established fact to repair hernias with meshes in various ways to prevent or delay the recurrence of hernia, but knowledge regarding the incidence of mesh infection is rare. The aim of the study was to assess the incidence of mesh infection in Open Inguinal Hernia Repair. Methods: This retrospective study was conducted at the Department of Surgery, Sylhet M.A.G Osmani Medical College, Sylhet, Bangladesh during the period from January 2020 to December 2021. The study included 400 patients who underwent mesh repair for inguinal hernia repair during the 2 years period. Among the total 400 patients, 24 were diagnosed with mesh related infections. Mesh related infections influenced by type of mesh use; surgical techniques and underlying comorbidity were all recorded. Both medical and surgical management required for mesh infection were also recorded. Use of antimicrobial included coverage of staphylococcus. Laparoscopic hernia repair cases were excluded from the study. Result: The study found 24 mesh related infection in a total of 400 patients who underwent open inguinal hernia repair. The overall mesh related infection rate was 3%. The infection was established at a variable delay after mesh insertion, with 40% delayed onset after procedure and 60% diagnosed during the first post-operative month. Infection was cured in 6 patients after mesh removal. Conclusion: Mesh removal appears to be one of the appropriate treatments for this rare and serious complication. The most common pathogen was Staphylococcus aureus and E. Coli. The possibility of a mesh related infection remains active weeks or even years after initial hernia repair. If mesh infection develops it should be treated vigorously and mesh should be excised early if necessary.

Localized remeshing for polyhedral splines

Smooth spline surfaces can now be built with polyhedral control nets rather than just grid-like tensor-product control nets. However, irregularities such as T-junctions, multi-sided facets, and n-valent vertices need to be sufficiently separated. Automatically generated quad-dominant meshes, and meshes created by designers unaware of the requirements for spline surfaces often pack irregularities too tightly.Global refinement, e.g. via two steps of subdivision, can sufficiently separate irregularities. However, each refinement quadruples the number of polynomial pieces. Moreover, first-step artifacts can lead to oscillating and pinched highlight line distributions. We therefore investigate minimal, single edge insertion, re-connection and localized refinement of quad-dominant meshes to make them suitable for polyhedral splines.

Ten-year surgical complications and mesh erosion of transvaginal Elevate™ mesh for management of pelvic organ prolapse

This study aims to review the surgical complications and mesh erosion with a cohort of patients who underwent Elevate™ mesh repair. This was a single-centre, retrospective study of women undergoing Elevate™ mesh reconstruction between 2006 and 2016. Women who presented with symptomatic prolapse of stage II or above were enrolled. The study outcomes were intra-operative and peri-operative complications (including mesh complications) at six weeks, one year and five years reporting with a standardised communicable method—the International Urogynecological Association (IUGA)/International Continence Society (ICS) scale and the Clavien and Dindo Classification. A total number of 350 women had Elevate™ mesh insertion. The mesh exposure rate was 1.1% and the surgical complication rate in our series was low and self-limiting (2% were Dindo grade 3). With the low morbidity and mesh-related complications, Elevate™ mesh should be at least kept as an alternative treatment of pelvic organ prolapse. Impact statement What is already known on this subject? Transvaginal mesh repair surgery was popular to treat advanced pelvic organ prolapse 10 years ago. However, after announcement of the Food and Drug Administration (FDA) public notification regarding mesh-related complications, particularly mesh exposure, use of transvaginal mesh and its safety have been scrutinised. Despite the increasing challenging and difficult medico-legal climate, several studies on second generation mesh kits, such as Elevate™ have shown favourable outcomes with low complication rates including our group. What do the results of this study add? In this paper, the surgical complications and mesh erosion of Transvaginal mesh was reported in a quantified communicable method—the International Urogynecological Association (IUGA)/International Continence Society (ICS) scale and the Clavien and Dindo Classification. This is significant because it is the largest case studies from a single centre with 350 patients. What are the implications of these findings for clinical practice and/or further research? This study well demonstrated using a standardised way to classify mesh exposure and peri-operative complications which is lacking in the past, while majority studies only focus to discuss on surgical outcome instead of complications. This may make a spark for future research analysis.

Large left atrial thrombus resection in a patient in sinus rhythm without mitral valve disease: A case report.

IntroductionLeft atrial (LA) ball thrombi are often associated with atrial fibrillation (AF) and mitral valve disease (MVD). Differentiating between thrombi and LA tumors can be challenging.Presentation of a caseA 63-year-old man with a prior mesh insertion for abdominal incisional hernia was admitted with fever. He was diagnosed with an abdominal mesh-related infection requiring surgical debridement. Preoperative transthoracic echocardiography revealed a 39-mm smooth mass in the LA adherent to the atrial septum. The mass was suspected to be a cardiac tumor based on the morphology. The patient underwent mass resection. Pathophysiology revealed that the mass was a thrombus, necessitating anticoagulation therapy. No recurrence of thrombus formation was reported.DiscussionIn this case, a plausible factor causing the thrombus formation is the chronic mesh. Since LA thrombi can become free-floating or grow rapidly, early surgical intervention is essential to prevent thrombotic events or sudden death.ConclusionAn LA thrombus should be included in the differential diagnosis when an LA mass is detected. Prompt surgical resection prevents thrombotic events and improves patient outcomes.

Transversus Abdominis Release Versus Anterior Component Separation in Ventral Abdominal Hernia - A Prospective Comparative Study

Ventral abdominal hernia (VAH) repair is considered a surgical challenge especially hernias with large defect size and loss of domain (1-3). The incidence of recurrence after VAH repair ranges from 18.1% in primary VAH to 30.6% in secondary VAH (incisional hernia) (4). The principle of any hernia repair is to achieve a tension free repair with re-enforcement by mesh to decrease the incidence of recurrence (5). Many techniques had been studied and evaluated to address the problem of complex VAH with large defects and loss domain (1,6). In 1973, Rives et al. described their technique of retro rectus space dissection for incisional hernia (IH) repair allowing medial mobilization of myofascial flap and sub-lay mesh insertion (7, 8). But this technique has limitation in cases of large VAH as it doesn’t allow major myofascial advancement due to lateral limitation of linea semilunaris (LS) (9). In 1990, Ramirez et al. at described their technique of open anterior component separation (ACS) (10). In this technique, the external oblique aponeurosis is separated from internal oblique lateral to LS to achieve more medial mobilization of myofascial flap (9). ACS was successfully utilized in cases of large VAH, but the technique had its drawbacks. ACS was found to be associated with high rates of wound complications (seroma, wound infection, and flap necrosis) due to excess subcutaneous dissection with the possibility of lateral abdominal wall hernia at area of external oblique incision. The recurrence rate after ACS ranges from 9-18% (4). In 2012, Novitsky et al. were the first to describe the technique of posterior component separation and transversus abdominis release (PCS-TAR). The technique involved retro rectus space dissection reaching the LS, then an incision is made at posterior rectus sheath to access the space between internal oblique and transversus abdominis muscles. Dissection is carried on in this space until reaching psoas muscle laterally. This technique has the advantage of allowing maximum medial myofascial mobilization without major subcutaneous dissection. In addition, the technique allows for sub-lay mesh placement (11). All these different component separation techniques aim to reestablish a functional abdominal wall through autologous tissue repair by separating between myofascial layers of anterior abdominal wall (AAW). This allows medial mobilization of myofascial flap to obliterate large size defects (12-14). Due to the relative novelty of these techniques, a knowledge gap still persists regarding which CS technique is suitable to different types of VAH. The aim of our study is to compare the outcomes of TAR with ACS as regard short term postoperative complication and recurrence rate.

Acceptability and effectiveness of a multidisciplinary team approach involving counselling for mesh-removal patients

Patients with complications following mesh removal risk a variety of symptoms, and can view medical intervention negatively. This study explored the patient-acceptability of a Multidisciplinary Team (MDT), and whether the presence of a Counsellor would be accepted and effective. Twenty consecutively referred women, who had undergone mesh-removal but experienced complications were interviewed about their experiences, and completed the Queensland scale for pelvic floor symptoms, McGill Pain Questionnaire, and Hospital Anxiety and Depression Scales, before and after treatment. Patients had high levels of pelvic-floor symptoms, sensory and affective pain, anxiety, and depression. 70% reported a positive MDT experience; predicted by higher anxiety, and lower depression. 60% elected to receive Counselling, which commenced within one week of referral, typically lasted 1–4 sessions, and reduced pelvic-floor symptoms, affective pain, anxiety, and depression. Results suggest that the MDT approach is generally acceptable for this patient group, and that mesh-removal patients accept and benefit from input by a Counsellor. Impact statement What is already known on this subject? Concerns have been raised regarding the safety of mesh insertion. Multidisciplinary Teams (MDTs) are suggested to offer a strong approach to managing many women’s health conditions, but no studies have examined mesh-removal patients, making generalisation difficult to the current patient group. Furthermore, it is unknown whether an MDT approach, including a Counsellor, would be acceptable to mesh-removal patients. What do the results of this study add? Patients had high levels of pelvic-floor symptoms, pain, anxiety, and depression. 70% reported the MDT experience as positive, predicted by higher anxiety, and lower depression. 60% elected to receive Counselling, which reduced pelvic-floor symptoms, affective pain, anxiety, and depression. What are the implications of these findings for clinical practice and/or further research? The Counselling provided as part of the MDT approach was able to commence quickly, did not require many sessions, and reduced reported pelvic-floor symptoms, affective pain, anxiety, and depression. These findings suggest that an MDT approach involving Counselling is generally acceptable, and that mesh-removal patients accept and benefit from the input of a Counsellor, as part of their treatment.

DETERMINATION OF THE AVERAGE WALL TEMPERATURE OF THE PLATE IN A RECUPERATIVE HEAT EXCHANGER WITH A CORRUGATED MESH INSERT

This article discusses the issue of determining the value the average wall temperature of the plate of a recuperative heat exchanger type “air-to-air” with a corrugated mesh insert based on the results processing the data of a physical experiment to determine the thermohydraulic characteristics such heat exchange surfaces. It has been established that the temperature fi eld of heat exchange surfaces of this type is nonuniform, depends on the conditions of heat exchange and hydraulic regimes of air fl ow. Therefore, the adoption of the arithmetic means value of the measured surface temperatures as the calculated average temperature of the heat exchanger wall entails signifi cant errors in the subsequent processing of experimental data and fi nal the values of the heat transfer coeffi cients, the values the Nusselt criterion and the criterion equations of heat transfer. It is proposed to determine the average value the wall temperature of the heat exchanger based on the results of measurements the wall’s temperatures, the estimate of the coordinates the center of distribution the results of measurements the wall temperatures, the equations of heat balance and heat transfer.

P080 ROUTINE ELECTIVE ILIOHYPOGASTRIC NEURECTOMY IN LICHTENSTEIN INGUINAL HERNIA REPAIR

Abstract Aim Chronic postherniorraphy pain occurs in 8-25% of patients undergoing groin hernioplasty with mesh insertion. The most common cause for inguinodynia is neuropathy resulting from nerve damage or entrapment during mesh fixation. With wide mesh insertion there is often a conflict between upper prosthesis margin and an iliohypogastric nerve. The aim of this study is to present a routine elective iliohypogastric neurectomy in Lichtenstein groin hernia repair for prevention of chronic inguinodynia. Material and Methods Between 2018 and 2020, 398 patients were admitted for open inguinal hernia repair. 218 patients underwent a Lichtenstein repair with transection of iliohypogastric nerve before implantation of 10x14 polypropylene mesh (IH group). In the control group of 180 patients all nerves were spared (C group). Follow-up was conducted on 1 POD,1 month, and 1 year after surgery. Results 1 month after a surgery a pain was reported in 24 (11%) patients in IH group (2.9% severe; 8.1% moderate; 89% no pain), and 48 (26.7%) patients in C group (3.9% severe; 22.8% moderate; 73.3% no pain). 1 year after a surgery a persistent pain was reported in 1 (0.4%) patient in IH group, and in 5 (2.8%) patients in C group. An incidence of inguinodynia was significantly lower after iliohypogastric neurectomy (0.5% vs. 2.8%; p &amp;lt; 0.001). Conclusions Routine neurectomy of iliohypogastric nerve appears to be an effective technique in chronic inguinodynia after open mech repair for inguinal hernias. Iliohypogastric nerve resection allows to place a flat synthetic mesh with wide coverage of myopectineal orifice with no need for additional mesh trimming.

P001 IS PROPHYLACTIC MESH IS ROUTINELY REQUIRED FOR STOMA CONSTRUCTION? IDENTIFICATION OF THE ‘TARGET GROUP’

Abstract Background Evidence to support routine prophylactic mesh insertion during stoma construction is conflicting. The PREVENT randomised controlled trial (RCT) suggested lower incidence of parastomal hernia (PSH) with prophylactic mesh but with no quality of life or cost benefit. Another two RCTs has shown no prophylactic benefit (STOMAMESH &amp; STOMA-const). Although European Hernia guidelines recommends routine prophylactic mesh in end-colostomy, NICE guidelines suggest mesh on individual basis not routinely. Aim To identify the group with higher risk to develop a symptomatic PSH when prophylactic mesh should be considered Material and Methods A single center retrospective review of all stoma formed. Younger patient than 18 years and patients who had less than 6 months’ follow-up were excluded. Development of PSH was confirmed by radiological evidence or direct intra-operative visualization Results 194 patients between January 2015 till December 2019 were included with mean follow-up of 15.7±13.5 months where 91 patients developed PSH. On multivariate analysis, older age (&amp;gt;65) (OR 2.3, 95% CI 1.08 – 4.99, p 0.03) and Obesity (OR 5.8, 95% CI 2.53 – 13.57, p 0.00) were risk factors of developing PSH. Among the PSH group, 28 were symptomatic (31%). Symptomatic subgroup had higher ASA (ASA &amp;gt;2) than asymptomatic subgroup (50% Vs 27%, p 0.05) Conclusions Obese patients older than 65 years are at increased risk of PSH. IF their ASA &amp;gt;2 this PSH is likely to become symptomatic. This is the group who should benefit the most from prophylactic measures including mesh insertion and should be targeted for future trials

Transobturator Tape and Chronic Pelvic Pain: A Big "Mesh"

<h3>Study Objective</h3> This video describes the presentation of a patient with chronic pelvic pain following placement of transobturator tape sling, illustrates the mesh removal surgery and techniques, and discusses the mechanisms by which insertion of mesh may cause acute and chronic pain. <h3>Design</h3> N/A. <h3>Setting</h3> Academic teaching hospital. <h3>Patients or Participants</h3> N/A. <h3>Interventions</h3> Mesh placement for incontinence or pelvic organ prolapse may cause debilitating pelvic pain. This video highlights how these patients may presents, surgical technique to remove mesh, and various processes by which mesh induces pain. <h3>Measurements and Main Results</h3> N/A. <h3>Conclusion</h3> Mesh placement may lead to significant chronic pelvic pain through a variety of mechanisms which work independently and jointly, often requiring a multifaceted approach to treatment.

MRI Surveillance of Plastic Material Surgical Meshes: Experimental Model - Interim Results

The number of surgical procedures for abdominal wall defects is increasing, often requiring the insertion of plastic material meshes. Surveillance of patients with inserted plastic meshes requires an accurate determination of the position of the mesh. However, this is a difficult task, depending on the kind of mesh, magnetic resonance imaging (MRI) protocol or consistence of the surrounding tissue (fat, muscle, aponeurosis). The aim of our research was to develop an experimental model to test the ability of MRI to identify the exact position of surgical plastic meshes: polypropylene or polyester. To simulate the placement of a mesh in human body we developed a model built up from two pieces of tissue with dimensions of 40 cm x 20 cm, harvested from a pig with a weight of 120 kg. The meshes were situated for MRI evaluation between the two pieces: abdominal pig muscle respectively suprajacent abdominal pig wall subcutaneous fat, approximately 2 cm high. Five surgical meshes were scanned through six MRI sequences, in view of establishing an optimal MRI scanning protocol and best visible meshes. The MRI scans were evaluated by 5 radiologists with different degrees of training. Our results showed that the experimental model developed by us can be successfully used to test the ability of MRI to visualize different kind of plastic meshes. Also, our experiment has revealed that T1fl2D sequence is the best in highlighting meshes from surrounding tissue, and the best visualized Mesh was number 4, made of polyester. In conclusion, based on our experimental model, we should select a plastic mesh or MRI protocol which will allow an optimal post implantation monitoring. Modern technology of material�s fabrication can help to better identify the mesh itself using MRI scanning.

Efficacy of TnR Nasal Mesh for prevention of septal perforation during septoplasty

ObjectiveSeptoplasty has been reported as the most common cause of the septal perforation. The interposition of the graft materials between the flaps at the site of the tear may be helpful to decrease the likelihood of septal perforation. The purpose of this study was to investigate the efficacy of TnR Nasal Mesh on the prevention of septal perforation following septoplasty. MethodsAmong 46 patients had septal perforation after septoplasty, 35 patients were treated with TnR Nasal Mesh and 11 with autologous septal cartilage for bilateral mucosal tears at the corresponding area of the nasal septum. TnR Nasal Mesh or septal cartilage was placed between the injured mucoperichondrial flaps and confirmed in its original position at both sides under nasal endoscope. Objective endoscopic examination for septal mucosa status was evaluated between the patients who were treated with TnR Nasal Mesh or septal cartilage. ResultsTwenty patients (57.1%) showed complete bilateral mucosa healing and nine (25.7%) had unilateral healing after TnR Nasal Mesh insertion. However, complete bilateral and unilateral mucosa healing was observed in 4 (36.4%) and 1 patients (9.1%) treated with septal cartilage, respectively. Complete healing rate for septal perforation was significantly higher in TnR Nasal Mesh than in septal cartilage insertion (p=0.022). None of the patients showed complications or adverse reactions after TnR Nasal Mesh or septal cartilage treatment. ConclusionTnR Nasal Mesh insertion after bilateral septal mucosal tear during septoplasty reduces permanent septal perforation without an apparent adverse effect. Therefore, TnR Nasal Mesh may be a safe and effective graft material for the prevention of septal perforation following septoplasty.

Performance Augmentation of the Flat Plate Solar Thermal Collector: A Review

The need for hot water in residential buildings requires a significant energy potential. Therefore, an efficient water heating system is important to achieve the goal of saving high-grade energy. The most simple and cheapest solar water heater is a flat plate solar collector (FPSC), which can increase the thermal energy of fluid by absorbing solar radiation. The performance of FPSC is comparatively low due to the dilute nature of solar insolation. Therefore, advancement of FPSC is being undertaken to improve the performance and achieve size reduction. In past, several techniques have been exploited to improve the performance of FPSC, which are presented in the present paper. These techniques include surface modifications, use of nanofluids, solar selective coating, and applications of a mini/macro channel, heat pipe, and vacuum around absorber. Surface modification on the absorber/absorber tube techniques are exploited to transfer the maximum possible solar energy to working fluids by increasing the heat transfer rate. Insertion of wire mesh, coil, and twisted tapes in the flow has great potential to increase the Nusselt number by 460% at the expense of a large pressure drop. Selective coating of Cu0.44 Ti0.44 Mn0.84 helps to absorb up to 97.4% of the incident solar energy, which is more significant. Many nanofluids have been exploited as heat transfer fluids, as they not only increase the performance but also reduce the fluid inventory. So, these techniques play a very prominent role in the performance of FPSC, which are discussed in detail. Summaries of the results are presented and recommendations proposed.

Effect of single-layer metal wire mesh insertion on the burning behavior of laminar coflow propane/air diffusion flames

Wire mesh is a useful structural material for combustors, which has the thermal effect of quenching, holding or enhancing a flame. Previous researches mainly focused on the interaction between premixed flame and wire mesh in confined/semi-confined pipes, and the mesh, in addition to the thermal effect on flames, also induced a dynamic resistance to the flow in the pipes. This study aims to independently elucidate the thermal effect of a single-layer wire mesh insertion on the laminar coflow propane/air diffusion flames, wherein the dynamic effect of mesh is negligible. The wire mesh and flame properties were varied to investigate their effects on flame dynamics, including the mesh thermal conductivity, mesh porosity, mesh insertion positions above the burner, and fuel flow rates. The results show that flames could not pass through a mesh with high thermal conductivity, low porosity or low insertion position, and the mesh temperature, Tm, measured in such cases was low. This suggests that the flame behavior is closely related to Tm. The critical mesh temperature, Tm,crt, between flame passing and not passing through wire mesh in all tested cases was determined to be 965±15 K, i.e., flames can pass through a mesh only if Tm>Tm,crt. An empirical method was proposed to estimate Tm, which well matched the experimental data. Further, for all cases of flame passing through mesh, the flame height could be reduced using a mesh with high thermal conductivity or low porosity while maintaining the same flame speed, and a general formula was developed to describe the flame height. In summary, a single-layer wire mesh can function as a flame inhibitor or holder rather than an enhancer when “cutting” a buoyancy-driven diffusion flame.

Closing the gap: evidence-based surgical treatment of rectus diastasis associated with abdominal wall hernias.

Rectus diastasis (RD) associated with abdominal hernias present a surgical challenge associated with a paucity in treatment guidelines. The objective of this systematic review is to review surgical techniques and assess complication and recurrence rates of RD in patients with concurrent abdominal hernias. PubMed and EMBASE databases were systematically searched, and data extraction was performed on articles which met the inclusion criteria. Pooled analyses of complication and recurrence rates were performed to compare open vs. minimally invasive surgery. Student t tests were performed to compare differences in continuous outcomes. Twenty-eight studies were included in this review. RD can be surgically repaired by both open and laparoscopic approaches using both non-absorbable and absorbable sutures. The majority of the techniques reported included mesh insertion either above the aponeurosis, retromuscular, preperitoneal, or intraperitoneal. Open techniques, compared to laparoscopic approaches, were associated with a significantly higher rate of skin dehiscence (6.79% vs. 2.86%; p = 0.003) and hematoma formation (4.73% vs. 1.09%; p < 0.001) and a significantly lower rate of post-operative seroma formation (2.47% vs. 8.29%; p < 0.001). No significant difference in RD recurrence rates were observed between open and laparoscopic repair (0.22 vs. 0.63%, p = 0.17). Both open and laparoscopic surgery are safe and effective methods that can be used to repair RD in patients with RD and concurrent abdominal hernias as evident by the low recurrence and complication rates and almost negligible major complications post repair.