Lightweight Mesh Research Articles

OC-090 MESH FIXATION IN LAPAROENDSOCOPIC REPAIR OF LARGE M3 INGUINAL HERNIAS – MULTICENTER, DOUBLE-BLINDED, RANDOMIZED TRIAL -> MEFI TRIAL

Abstract Introduction Guidelines of groin hernia treatment strongly recommends to fixate the mesh in large M3 medial defects during TAPP / TEP. In 2022 team consisting of hernia surgeons and scientists from universities of technology conducted an experimental study with the use of 3d groin model to verify the hypothesis that fixation is not necessary in above cases. Experiment showed that rigid and anatomically shaped meshes are able to maintain its position in groin without fixation. To confirm experimental results we decided to conduct RCT. Study Hypothesis Non-fixation of spatial, standard polypropylene meshes is non-inferior as compared to fixation of flat, polypropylene lightweight meshes in m3 hernias. Materials and Methods 11 large surgery centres in poland were recruited for this study. recurrence in 12-month follow-up was set as a primary endpoint. pain sensation (vas scale) was made secondary endpoint. minimal sample sizes were established 82–103 in each arm. first arm (control): patients repaired with the use of flat, macroporous mesh with fixation. second arm (experimental): patients repaired with the use of anatomically shaped, standard mesh without fixation. after dissection of preperitoneal space, surgeon will find out the technique he will have to perform. patients won't be aware of the method. pain and reccurence will be measured during the hospital stay and then up to 12-months after surgery. Predicted Outcomes Based on experimental study and own experience, we believe that recurrence rate in both groups (control and experimental) would be on the same level givingba strong argument for amending the guidelines.

Cytomorphological Effects of Lightweight and Heavyweight Polypropylene Mesh on the Ilioinguinal Nerve: An Experimental Study.

Objective This study aimed to investigate the cytomorphological effects of heavyweight and lightweight mesh on the ilioinguinal nerve in an experimental animal model. Methods Sixteen New Zealand male rabbits were included in the study. The left inguinal regions of the first six animals were assigned as controls and the right inguinal regions were assigned as the sham group. The left inguinal regions of the remaining 10 animals were assigned as the lightweight mesh group and the right inguinal regions were assigned as the heavyweight mesh group. No intervention was performed in the control group. In the sham group, only ilioinguinal nerve exploration was performed.In mesh groups, ilioinguinal nerve exploration was performed and the mesh was implanted on the ilioinguinal nerve. After three months, ilioinguinal nerve specimens were excised from both sides for cytomorphological examination. Results Myelin sheath thickening, separation of the myelin layers, and myelin vacuolization were more pronounced in the heavyweight mesh group compared to the lightweight mesh group. The G-ratio was moderately increased in the heavyweight mesh group when compared to other groups. The ratio of fibers with ≤4 µm diameter was higher in the lightweight mesh group compared toother groups, and the ratio of fibers with ≥9 µm diameter was higher in the heavyweight mesh group than in the other groups (p<0.05). Conclusion Both of the meshes induce cytomorphological alterations on the adjacent nerve tissues caused byforeign body reaction and compression. Ilioinguinal nerve degeneration was more pronounced in the heavyweight mesh than in the lightweight mesh. Histological alterations on the ilioinguinal nerves caused by different meshes may be related to chronic pain after hernia surgery. We believe our study will serve as a guide for future studies on the topic.

LIGHT WEIGHT VERSUS MEDIUM WEIGHT MESH IN LAPAROSCOPIC INGUINAL HERNIA MESH REPAIR

Hernia is repaired by laparoscopic or open approach. Laparoscopic inguinal hernia repairs performed are trans-abdominal preperitoneal repair (TAPP) and totally extra-peritoneal repair (TEP). This study aimed to update the previous reviews and to compare Light Weight versus Medium Weight Mesh in LIHR. Previous studies have shown benets of LWM compared to MWM in terms of decreased pain, discomfort, and early return to normal activity. Method: 50 patients operated for Laparoscopic Inguinal Hernia Mesh Repair were evaluated from Inpatient department of Sahyadri Speciality Hospital, Deccan, Pune between January 2020 to May 2021. 30 patients were operated using Anatomical 3D Light weight Mesh and 20 were operated using Paritene Flat Sheet Medium Weight Mesh; allocation done by simple randomization. It is a prospective, observational study. Aim was to evaluate the post-operative outcome and return to normal activities in LWM versus MWM in LIHR. Result: Mean duration of hospital stay, mean duration of days taken to resume daily activities, intensity of pain by VAS and NRS, foreign body sensation, incidence of seroma formation and inuence on male sexual life and fertility did not differ between patients of both groups. No signicant difference in post-operative pain and foreign body sensation between use of LWM and MWM.

OC-023 USING FIBROBLAST MEDIATED MATRIX CONTRACTION TO TEST MESH SHRINKAGE - A PROTOTYPE FOR IN VITRO MESH TESTING

Abstract Background/Aim Measuring how hernia meshes shrink after implantation is a commonly used parameter in in vivo mesh testing. We aim to use fibroblast populated collagen matrices (FPCMs) and their contraction to assess how different meshes shrink. Methods/Materials 1 millilitre circular FPCMs were formed in 24 well plates. Different hernia meshes were placed halfway through the FPCMs so that they were embedded. Matrices were seeded with immortalised human fibroblasts, allowed to set and then separated form the well plate using a sterile needle. Gels were cultured in fibroblast media at 37 degrees 5% CO2 for seven days and were allowed to contract naturally. Each day, photographs were taken and the area of the collagen and the mesh were calculated. Results When comparing collagen contraction with/without hernia mesh, It was noted that significantly greater contraction was observed without mesh - which hampered collagen contraction. When comparing meshes, It was noted that a lightweight mesh with larger pores lead to greater collagen contraction (54% Vs 45%) and greater mesh shrinkage (55% Vs 20%) compared to heavyweight mesh with smaller pores. Conclusion We present a cheap, standardised and unique technique for measuring mesh contraction in vitro.

BJS-03 DO WE NEED FIXATION OF THE MESH IN LAPAROENDOSCOPIC TECHNIQUES FOR M3 INGUINAL DEFECTS? AN EXPERIMENTAL STUDY

Abstract Background Hernia societies strongly recommend fixing the mesh in case of large M3 defects in laparoendoscopic repairs. The purpose is to reduce recurrence, which is alarmingly high for this defect. The authors conducted a research experiment to verify the hypothesis that it is possible to preserve the mesh in the operating field in large direct hernias (M3) without the need to use fixing materials. Method Authors conducted an experiment with scientists from Universities of Technology in a model that reflects the conditions in the groin area. By simulating conditions of the highest possible intra-abdominal pressure, they examined the mesh behavior within the groin and its ability to dislocate under the forces generated by this pressure. The experiment involved six spatial implants and one flat macroporous mesh. Results Heavyweight spatial meshes and lightweight spatial individualized mesh showed no tendency to dislocate or move directly to the gate, which was considered a rapid hernia recurrence. Lightweight Meshes, both spatial and flat, underwent significant migration and shifting towards the hernial gates. Conclusion Based on the results, we believe that mesh fixation is not the only alternative to preventing recurrence in complex defects. Similar effects can be achieved by using a larger, more rigid and anatomically fitted implant. The type of implant (rather than its fixation) seems to be a key factor from the point of view of mechanics and biophysics. Clinical trials confirming the results in vivo, will allow to supplement or amend the guidelines for the treatment of large inguinal hernias.

Is mesh fixation necessary in laparoendoscopic techniques for M3 inguinal defects? An experimental study.

Although international guidelines recommend not fixing the mesh in almost all cases of laparoendoscopic repairs, in case of large direct hernias (M3) mesh fixation is recommended to reduce recurrence risk. Despite lack of high-quality evidence, the recommendation was upgraded to strong by expert panel. The authors conducted a research experiment to verify the hypothesis that it is possible to preserve the mesh in the operating field in large direct hernias (M3) without the need to use fixing materials. The authors conducted an experiment with scientists from Universities of Technology in a model that reflects the conditions in the groin area. By simulating conditions of the highest possible intra-abdominal pressure, they examined the mesh behavior within the groin and its ability to dislocate under the forces generated by this pressure. The experiment involved six spatial implants and one flat macroporous mesh. Heavyweight spatial meshes and lightweight spatial-individualized meshes showed no tendency to dislocate or move directly to the orifice, which was considered a rapid hernia recurrence. Lightweight meshes, both spatial and flat, underwent significant migration and shifting toward the hernial orifices. Based on the results, we believe that mesh fixation is not the only alternative to preventing recurrence in complex defects. Similar effects can be achieved using a larger, more rigid, and anatomically fitted implant. The type of implant (rather than its fixation) seems to be a key factor from the point of view of mechanics and biophysics. Clinical trials confirming the results in vivo will allow to supplement or amend the guidelines for the treatment of large inguinal hernias.

OC-031 INCIDENCE AND RISK FACTORS FOR RECURRENCE OF RIVES-STOPPA REPAIR FOR INCISIONAL HERNIAS. TWENTY-YEAR RETROSPECTIVE ANALYSIS OF LONG-TERM OUTCOMES OF DIFFERENT MESH REPAIRS

Abstract Objective the aim of this study was to determine the long-term recurrence and complication rates following Rives-Stoppa repair of midline incisional hernias with different types of synthetic materials. Patients and Methods medical files of 1628 patients with midline incisional hernias who underwent abdominal wall reconstruction using Rives-Stoppa repair between January 1999 and December 2019 were reviewed. All patients followed up after 1 month, 6 months, and 1year later and after that yearly. Results until 2007, 674 patients were operated on with available meshes for that time (mosquito net – 135, polyester mesh – 322, and polypropylene mesh – 217). After 2007, polypropylene meshes were used in 1054 patients (heavyweight in 428 patients and lightweight meshes in 626). The global recurrence rate after a mean follow-up of 96.5 months in the first group of patients was 13.3% and in the second group was 7.13% (mean follow-up of 108.4 months). The infection rate was 16.8% versus 9.2% with an increased incidence at 30 days (84 vs 62 patients). The hematoma rate was equally distributed. Seroma formation was almost 2.5-fold increased in the first group of patients (21.3% vs 8.7%). Increased rate of seroma formation were associated with mosquito net (OR = 1.7; 95% CI = 0.5–1.3; p=o.o2), heavyweight type type (OR = 0.9; 95 CI = 0.07–0.4; p=o.o31). Infection was associated with the usage of mosquito net, heavyweight type, and polyester mesh. Conclusions the lightweight mesh offers a safe method for abdominal wall reconstruction.

Comparison of mean Postoperative Inguinodynia in patients undergoing open Inguinal Hernia Surgery with use of standard Polypropylene Heavy Weight Mesh v/s Ultra Pro light Weight Mesh

Background: Various types of meshes for inguinal hernias have been discovered to combat with chronic groin pain related problems. The data regarding these findings was variable due to difference in the cut off values used in the past in different studies to label inguinodynia and local data was scarce where HWM is still highly practiced. Aim: To compare the mean postoperative inguinodynia in patients undergoing open inguinal hernia surgery with use of standard polypropylene heavy weight mesh (HWM) v/s Ultra Pro lightweight mesh (LWM). Methodology: This is a prospective randomized controlled trail conducted at department of surgery, Services Institute of Medical Sciences, from July 2019 to June 2020. Cases were divided in two groups by using radio opaque sealed envelopes labeled as A and B. Group-A underwent Lichtenstein mesh repair by Ultra Pro LWM and group B had polypropylene heavy weight mesh (HWM). Lichtenstein mesh repair was done under spinal or general anesthesia by the experienced surgeon. Duration of surgery was also calculated (from incision to closure). Patient was followed in outpatient department at 3 months where the outcome was seen and inguinodynia was assessed. Results: The mean age was in group A was 40.66±10.52 years and 40.53 ±12.56 years in group B. The mean pain Score in group A was 2.024±0.88 and in Group-B it was 2.97 ±0.85. Conclusion: Ultra Pro LWM is more effective in terms of less postoperative pain as compared to standard polypropylene heavy weight mesh in patients undergoing open inguinal hernia surgery Keywords: Postoperative, Inguinodynia, Inguinal hernia, Standard, Polypropylene heavy weight mesh, Ultra Pro light

Mesh complications after total vs supracervical laparoscopic hysterectomy at time of minimally invasive sacrocolpopexy.

Our objective was to compare mesh exposure rates (4 months and 1 year) after total (TLH) vs supracervical (SLH) laparoscopic hysterectomy at time of minimally invasive sacrocolpopexy (SCP). Secondary outcomes included 30-day complications and midurethral mesh exposure rates. This a retrospective cohort study at a tertiary care referral center from 2011 to 2018. Subjects were identified using Current Procedural Terminology codes. Demographics, operative characteristics, and perioperative complications were abstracted from medical records. Four hundred three women met the inclusion criteria: 91 SLH+SCP and 312 TLH+SCP. Median follow-up was 52 weeks with an overall mesh exposure rate of 1.5%. Follow-up was available for 90% of patients at 4 months and 51% at 1 year. Half of patients had lightweight mesh (n = 203), and half had ultralightweight mesh (n = 200). Vaginal mesh fixation was performed with permanent suture in 86% (n = 344) and delayed absorbable suture in 14% (n = 56) of patients. At 4 months, vaginal mesh exposure rates did not differ between groups (0% SLH vs 1% TLH, p = 1.00). All mesh exposures in the study period occurred with lightweight mesh in the TLH arm. No differences were noted in 1-year mesh exposure rates, 30-day perioperative complications (p = 0.57), or midurethral mesh exposure rates at 4 months (p = 0.35) and 1 year (p = 1.00) between groups. Short-term mesh exposure following SCP with ultralightweight and lightweight polypropylene mesh is rare regardless of type of hysterectomy and much lower than reported in earlier studies with heavier weight mesh. These data suggest TLH at the time of SCP is a safe option in appropriately counseled patients.

Cost Effectiveness of the Use of Prophylactic Mesh To Prevent Parastomal Hernia After Urinary Diversion with an Ileal Conduit

BackgroundProphylactic lightweight mesh in the sublay position reduced the cumulative incidence of parastomal hernia (PSH) after cystectomy with ileal conduit diversion in a randomised controlled trial. ObjectiveTo investigate whether the use of prophylactic mesh is cost-effective in comparison to no mesh from the health care provider perspective. Design, setting, and participantsData on health care resource utilisation (outpatient care and inpatient care) were obtained for 159 patients included in a randomised trial. The patients underwent surgery at Skåne University Hospital or Helsingborg County Hospital (80 with a prophylactic mesh and 79 without) and information about care was ascertained from the regional health care register. The patients underwent surgery between 2012 and 2017 and were followed until death or August 2020. Outcome measurements and statistical analysesThe primary outcome measure was the clinical incidence of PSH. Costs are reported in Euro in 2020 prices (€1 = 10.486 Swedish Krona) and presented as the incremental cost-effectiveness ratios (ICERs) with confidence intervals (CIs) calculated using a nonparametric bootstrap procedure. Sensitivity analyses and subgroup analyses were performed to capture the uncertainty for ICERs. Results and limitationsThe mean difference in total costs between the mesh and no-mesh groups was −€2047 (95% CI −€16 441 to €12 348). Seventeen patients (21.5%) in the no-mesh group developed clinical PSH versus six patients (7.5%) in the mesh group (p = 0.001). This indicates that mesh is less costly and more effective compared to no mesh from the health care provider perspective. Subgroup analyses showed that results were more advantageous for women and for patients younger than 71 yr and with less comorbidity than for their counterparts. ConclusionsThe use of prophylactic mesh during ileal conduit reconstruction to prevent PSH is cost-effective from the health care provider perspective. Patient summaryIn patients having their bladder surgically removed, a mesh implant can be inserted when a portion of the intestine is used to create an opening to drain urine from the body. Our results show that mesh use to prevent development of a hernia at the opening where urine exits the body is cost-effective from the perspective of health care providers.

Outcomes following sacrocolpopexy using ultralight and lightweight mesh.

Introduction and hypothesisThis study reports the long-term anatomic and subjective outcomes following sacrocolpopexy based on mesh weight and provides device-specific data.MethodsThis cohort study compared ultra-lightweight (≤ 20 g/m2) with lightweight mesh (≥ 25 g/m2). The primary outcome was composite failure defined as at least one of ≥ stage 2 apical prolapse, anterior or posterior vaginal wall beyond hymen, complaint of bulge or retreatment. Effect measure estimates were calculated as the incidence rate ratio of composite failure comparing the use of ultra-light with lightweight mesh. Crude and adjusted incidence rate ratios (IRRs) were obtained using uni- and multivariable Poisson regression models.ResultsOf 358 women who met inclusion criteria, 220 (61%) agreed to attend for review; 95 (43%) had ultra-lightweight mesh and 125 (57%) had lightweight mesh including UpsylonTM. Median follow-up for ultra-light and lightweight mesh was 36 (IQR 22–42) and 63 (IQR 48–87) months, respectively (p < 0.001). Accounting for differences in follow-up time, there was no significant difference in composite failure between ultra-light and lightweight mesh groups (IRR 1.47, 95% CI 0.83–2.52, p = 0.15). This persisted after adjustment for age, body mass index, parity, smoking and presence of advanced prolapse prior to surgery (IRR 1.52, 95% CI 0.94–2.47, p = 0.087). Mesh exposure for both groups was mostly asymptomatic, and the rate was 7% for the ultra-light group and 8% in the lightweight group. Overall, repeat surgery for recurrent apical prolapse and mesh exposure occurred in 4% and 2%, respectively.ConclusionsUltra-lightweight mesh appears to have similar incidence rate of failure compared to lightweight mesh. UpsylonTM mesh has a similar low rate of recurrent apical prolapse and mesh exposure.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00192-022-05182-w.

Predictive factors of recurrence for laparoscopic repair of primary and incisional ventral hernias with single mesh from a multicenter study

Laparoscopic ventral hernia repair (LVHR) is a widely practiced treatment for primary (PH) and incisional (IH) hernias, with acceptable outcomes. Prevention of recurrence is crucial and still highly debated. Purpose of this study was to evaluate predictive factors of recurrence following LVHR with intraperitoneal onlay mesh with a single type of mesh for both PH and IH. A retrospective, multicentre study of data collected from patients who underwent LVHR for PH and IH with an intraperitoneal monofilament polypropylene mesh from January 2014 to December 2018 at 8 referral centers was conducted, and statistical analysis for risk factors of recurrence and post-operative outcomes was performed. A total of 1018 patients were collected, with 665 cases of IH (65.3%) and 353 of PH (34.7%). IH patients were older (p < 0.001), less frequently obese (p = 0.031), at higher ASA class (p < 0.001) and presented more frequently with large, swiss cheese type and border site defects (p < 0.001), compared to PH patients. Operative time and hospital stay were longer for IH (p < 0.001), but intraoperative and early post-operative complications and reinterventions were comparable. IH group presented at major risk of recurrence than PH (6.7% vs 0.9%, p < 0.001) and application of absorbable tacks resulted a significative predictive factor for recurrence increasing the risk by 2.94 (95% CI 1.18–7.31). LVHR with a light-weight polypropylene mesh has low intra- and post-operative complications and is appropriate for both IH and PH. Non absorbable tacks and mixed fixation system seem to be preferable to absorbable tacks alone.

Randomised controlled trial: standard lightweight mesh vs self-gripping mesh in Lichtenstein procedure

&lt;b&gt; Introduction:&lt;/b&gt; Lichtenstein hernioplasty has been a gold standard of hernioplasty for 30 years now. However, the procedure may be followed by an unacceptably high rate of chronic pain, numbness and discomfort. &lt;/br&gt;&lt;/br&gt; &lt;b&gt;Aim:&lt;/b&gt; To compare outcomes of Lichtenstein repair using a Parietene ProGrip self-fixing mesh versus the standard lightweight macroporous mesh. &lt;/br&gt;&lt;/br&gt; &lt;b&gt;Material and methods:&lt;/b&gt; As many as 141 patients with unilateral primary inguinal hernia participated in this single-centre, randomised, prospective, single-blind (patient-blinded) study. Randomisation yielded two treatment groups: control group of 88 patients treated with Lichtenstein method using lightweight standard mesh (LS) and study group of 53 patients receiving treatment with self-fixing mesh (PG). Patients were followed up for 6 months. Primary outcome was the presence and severity of postoperative pain at discharge, at 30 days and 6 months post-procedure. Other study parameters were: duration of the procedure, duration of hospitalisation, presence of early and late complications, time needed to return to full activity and patient satisfaction. &lt;/br&gt;&lt;/br&gt; &lt;b&gt;Results:&lt;/b&gt; No statistically significant differences in pain severity were demonstrated at discharge or at long-term follow-up. In the first 30 days post-procedure the patients in the PG group complained of pain of greater severity on the NRS (2.0 vs 1.4) (P = 0.0466). The duration of the procedure in the PG group was 9.4 minutes shorter than in the LS group (P = 0.0027). No statistically significant differences between the groups were found in other studied parameters. &lt;/br&gt;&lt;/br&gt;&lt;b&gt;Conclusions:&lt;/b&gt; Self-fixing mesh can be safely used in inguinal canal repair procedures. It significantly shortened the duration of the procedure but at the same time did not reduce the severity of pain, including the rate of chronic postoperative inguinal pain.

Recurrence of prolapse after total vs supracervical laparoscopic hysterectomy at time of minimally invasive sacrocolpopexy

To determine if type of hysterectomy, total laparoscopic hysterectomy (TLH) vs supracervical laparoscopic hysterectomy (SLH), at the time of sacrocolpopexy (SCP) impacts prolapse outcomes at 1 year. The primary outcome was prolapse recurrence as defined as prolapse of greater than or equal to stage II in any compartment. The secondary outcome was a composite surgical success, with success defined as no mesh exposure and no prolapse at or beyond the hymen noted by exam. This is a retrospective study comparing prolapse recurrence rates in patients undergoing TLH or SLH with SCP at a tertiary care referral center from 2011 to 2018. Subjects were identified using Current Procedural Terminology codes for TLH, SLH, and SCP. Patient demographics, operative characteristics, and perioperative complications were abstracted from medical records. Primary outcome was prolapse recurrence at 1-year. Group comparisons were performed using student’s t-test, chi square Fisher’s exact test, and Mann Whitney tests as appropriate. A p value of <.05 was considered significant. We performed a multivariate logistic regression model to see if type of hysterectomy remained associated with prolapse recurrence at 1 year while controlling for potential confounding factors. 403 women undergoing SCP met inclusion criteria; 91 SLH and 312 TLH. No clinically significant differences in demographic characteristics were noted between groups. Median follow-up was 52 weeks (IQR 17-52 weeks). Half of patients had lightweight mesh (n=203), while the other half had ultralightweight mesh (n=200). Vaginal mesh fixation was done with permanent suture in 86% (n=344) and with delayed absorbable suture in 14% (n=56) of patients. Follow up data for prolapse recurrence was available for 90% (n=361) of patients at 4 months and 48% (n=193) of patients at 1 year. At 4 months, women undergoing SLH were more likely to have recurrent prolapse ≥ stage II at any compartment (35% SLH vs 17% TLH, p=.002). At 1 year, there was no difference in prolapse recurrence by route of laparoscopic hysterectomy (34% SLH vs 29% TLH, p=0.57). There was no difference in composite surgical success between groups at 1 year (86% SLH vs 84% TLH, p=0.82). Recurrence most commonly involved the posterior compartment (80% Ap, Bp points), followed by both anterior and posterior (11% Aa, Ba, Ap, Bp points), anterior (7%, Aa, Ba points), and apical (2% C point). On multivariate logistic regression controlling for pre-operative POP-Q stage, mesh type, and higher BMI, type of hysterectomy was not associated with an increased likelihood of prolapse recurrence. Prolapse outcomes at 1-year following SLH and TLH at time of SCP are similar. Surgeons should decide when to perform a SLH vs TLH based on individualized assessment of patient factors and shared decision-making.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Totally extraperitoneal inguinal hernia repair versus Lichtenstein repair: a one-year follow-up study

The inguinal hernia has an incidence of 27 — 43 % in males. Surgical repair is the most accepted treatment to prevent the development of complications. Laparoscopic inguinal hernia repair has become popular worldwide and includes the use of a laparoscopic technique for mesh placement behind the defect. Objective — to assess whether totally extraperitoneal (TEP) inguinal hernia repair shows benefits over Lichtenstein repair in intraoperative and one‑year follow‑up postoperative outcomes for male patients with primary unilateral inguinal hernia. Materials and methods. 53 males were randomly allocated to two groups. Group 1 included 27 patients who underwent totally extraperitoneal hernia repair using self‑gripping lightweight mesh, and group 2 included 26 patients who were treated surgically with Lichtenstein repair using lightweight mesh. Results. Both groups were comparable in mean age, type of hernia, body mass index and patient’s distribution according to the European hernia society classification. TEP repair takes on average a little less time as compared to Lichtenstein repair, and this difference is not statistically significant. The mean of visual analogue scale for pain scoring in the first 24 hours after surgery as well as in the next 24 hours is statistically significantly smaller in group 1 compared to group 2. The mean time taken to return to work was 2.15 times longer in group 2 than in group 1, and the difference was statistically significant. Conclusions. Totally extraperitoneal hernia repair shows potential benefits over Lichtenstein repair for primary unilateral inguinal hernias as it causes less pain in the postoperative period and ensures early return to work.

그물형 안테나의 고어 개수에 따른 Radio Frequency (RF) 특성 분석

This research discusses the change in radio frequency (RF) characteristics according to the number of Gores on the deployable mesh antennas for potential micro-satellite applications. The deployable type of lightweight mesh antenna can be used for various space missions such as communication/SAR/ SIGINT. In order to implement an ideal curvature of antenna surface, sufficient number of antenna rib structures are required. However, the increase in antenna ribs affects various design factors of the antenna system, especially total system mass, complexity of deployable mechanism and reliability. In this paper, the proper number of ribs for the mesh antenna were derived by comparison of electro-magnetic (EM) simulation results of example of antenna model in accordance with the various number of ribs.

EP.TH.652Use of the Proceed Ventral Patch (PVP) Mesh for Small to Medium sized defects in Ventral Hernia Repair over 10 years – Simple, Safe and Secure

Abstract Aims The Proceed Ventral Patch (PVP) has been in use since the late 2000s and is a self-expanding lightweight mesh patch comprised of multiple layers of absorbable and non-absorbable materials including polypropylene and polydioxanone. It is intended for use in all ventral hernias. We report our single-centre experience of using the mesh with primary outcomes being recurrence and reoperation for recurrence, readmission within 21 days for post-operative complications and discharge as day-case. Methods Retrospective review of case notes from 54 patients who were operated between October 2010 and November 2020 was undertaken. Patient characteristics were of a 2.1: 1 Male:Female ratio with a median age of 56 years old. 3 epigastric hernias and 51 paraumbilical hernias were repaired using either a 4.3cm or 6.4cm Proceed Ventral Patch. The size of the hernia defect ranged from 0.5cm to 4cm with a median defect size of 2cm for the 54 patients. Results There were no intraoperative complications. Two patients (0.04%) underwent laparoscopic reoperation for recurrence. Only one (0.02%) patient was readmitted within 21 days for a wound abscess which was drained and treated with a VAC dressing with satisfactory healing. The operations were split between nine different surgeons of varying expertise from ST5 level to Consultant level. Conclusions Ventral hernia repair with PVP is intuitive to learn and has low recurrence/complication rates.

Combined Robotic Ventral Rectopexy and Sacrocolpopexy- a Single Institution Approach

<h3>Study Objective</h3> To describe the multidisciplinary workup of pelvic organ prolapse and rectal prolapse or intussusception and to describe our technique of robotic ventral rectopexy and sacrocolpopexy. <h3>Design</h3> N/A. <h3>Setting</h3> N/A. <h3>Patients or Participants</h3> This is a patient with multi-compartment pelvic organ prolapse and rectal intussusception. <h3>Interventions</h3> The surgery is begun with the sacral dissection. The peritoneum is then opened in continuation along the right side of the rectum. Once the peritoneal reflection has been opened, it is carried down and further dissected from the posterior vagina. The deep pelvic dissection is then performed in the rectovaginal septum to the levator ani muscles, about five to six centimeters deep. Once the levator muscles are exposed, a ruler is introduced into the pelvis and the rectal width is measured. The anterior bladder dissection is then performed. A single sheet of flat, large pore, polypropylene mesh is then introduced and first secured to the levators bilaterally. Next the mesh is secured to the anterior rectum, sewing distal to proximal. This single sheet of mesh is then also used for the entire sacrocolpopexy by next securing the mesh to the posterior vagina. The mesh is then folded over the vaginal apex to the anterior vagina and before it is secured, the sacral tail is created by using the midportion of the mesh pulled out over the apex. The remaining steps of the procedure are completed in the same fashion as a standard sacrocolpopexy. <h3>Measurements and Main Results</h3> The patient had excellent anterior, apical, and posterior support with the use of a single flat sheet of lightweight mesh. The surgery had no complications with a minimal EBL. <h3>Conclusion</h3> Multidisciplinary treatment of concomitant pelvic organ and rectal prolapse by urogynecology and colorectal surgery allows for a safe and effective treatment of both conditions concurrently via a robotic ventral rectopexy and sacrocolpopexy with a single lightweight flat mesh sheet.

V07-07 CORPORAL RECONSTRUCTION USING LIGHTWEIGHT MESH DURING PENILE PROSTHETIC SURGERY

You have accessJournal of UrologySexual Dysfunction & Transgender (V07)1 Sep 2021V07-07 CORPORAL RECONSTRUCTION USING LIGHTWEIGHT MESH DURING PENILE PROSTHETIC SURGERY Wai Gin Lee, Luca Venturino, and David Ralph Wai Gin LeeWai Gin Lee More articles by this author , Luca VenturinoLuca Venturino More articles by this author , and David RalphDavid Ralph More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002034.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Options for reconstruction of the corpora cavernosa are limited. Synthetic grafts like Dacron™ (Maquet, Sweden) and GORE-TEX™ (Gore Medical, USA) are used but have high infection rates. Lightweight macroporous mesh is a promising alternative due to better integration and surrounding tissue ingrowth. This video illustrates the technique for corporal reconstruction using a lightweight mesh following erosion and septal crossover of an inflatable penile prosthesis. METHODS: The patient is a 41-year-old insulin dependent diabetic with erectile dysfunction and a 90° dorsal curvature from a large ossified plaque. He had an inflatable penile prosthesis inserted with concomitant plaque excision and grafting. He represented with a penile deformity 15 months following surgery and was found to have distal erosion of both prosthesis cylinders and septal crossover of the left sided cylinder. Via a penoscrotal incision, the cylinders were retrieved, and two tubed mesh grafts were fashioned to reinforce the tunical defect. A macroporous lightweight composite mesh (Ultrapro®; Ethicon) made of polypropylene (Prolene®; Ethicon) and poliglecaprone-25 (Monocryl®; Ethicon) was chosen. The mesh is partially absorbable and therefore minimises the amount of residual foreign material and may reduce the risk of post-operative infection. The device was kept partially inflated for a week and the patient was asked to refrain from sexual intercourse for 6 weeks post-surgery. RESULTS: Post-operative course was uneventful. The patient is sexually active and remains satisfied after 8 months of follow-up. CONCLUSIONS: This video demonstrates that a lightweight macroporous mesh may be an alternative synthetic graft for corporal reconstruction. The polypropylene/poliglecaprone-25 mesh has several advantages because it is partially absorbable and easy to handle while providing a strong scaffold to prevent further device erosion. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e552-e553 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Wai Gin Lee More articles by this author Luca Venturino More articles by this author David Ralph More articles by this author Expand All Advertisement Loading ...

PD32-05 COMPARISON OF HEAVY WEIGHT VERSUS LIGHT WEIGHT WIDE PORE POLYPROPYLENE MESH FOR ROBOTIC SACROCOLPOPEXY USING FOUR MESHES AND 351 CASES

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Pelvic Prolapse (PD32)1 Sep 2021PD32-05 COMPARISON OF HEAVY WEIGHT VERSUS LIGHT WEIGHT WIDE PORE POLYPROPYLENE MESH FOR ROBOTIC SACROCOLPOPEXY USING FOUR MESHES AND 351 CASES Cassandra Schuster, Maximilian Carey, and Robert Carey Cassandra SchusterCassandra Schuster More articles by this author , Maximilian CareyMaximilian Carey More articles by this author , and Robert CareyRobert Carey More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002033.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: All FDA approved wide pore polypropylene Y-mesh grafts available for robotic sacrocolpopexy have variance in the mesh weight, pore size, thickness, surface area ratio and suture pull out strengths. In this study we evaluated results observed for robotic sacrocolpopexy performed with four separate wide pore polypropylene Y meshes that differ markedly in their physical properties. METHODS: Data is collected from an IRB approved prospectively maintained retrospective database of robotic sacrocolpopexy cases performed at an 836 bed tertiary care hospital by a single surgeon. Using analysis matched for covariates of BMI, prolapse stage and previous attempts at repair, We evaluated whether the weight of the Y-mesh influenced the anatomic outcome and rate of de novo SUI at mean 46 month follow-up. RESULTS: Between 2011 and 2020, a total of 351 patients underwent robotic sacrocolpopexy for POP-Q Stage IV VVP. The cases were divided between 4 different mesh materials (n=50, 50, 100, and 151) in patients undergoing repair. The mesh material varied from the heaviest mesh weight (52 g/m2, 527 microns thick, and a suture pull out strength of 18.3 N) to the lightest weight mesh (25 g/m2, 200 microns thick, and suture pull out strength of 23.3 N). At mean 46 month follow-up, anatomic success for apical prolapse was 100% and there was no difference in the rates of Grade 2 or less anterior or posterior prolase in each group (4%). De novo SUI was found in 10% patients in the heaviest mesh group and in 8% of patients in the lighter mesh groups. All de novo SUI patients did not have a mid urethral sling, MUS, placed at the time of the procedure. There was one mesh erosion in the light weight mesh group in a salvage patient that underwent concomitant pre-existing mesh removal at the time of surgery. CONCLUSIONS: Although the two Y-meshes are markedly different in their weight, surface area, thickness and suture pullout strength, there was no observed significant difference in the anatomic success of repair, the rate of de novo stress urinary incontinence or mesh erosion. The rates of de novo SUI seen in this study, have led us to perform a MUS procedure at the time of sacrocolpopexy for all Grade IV prolapse patients. Source of Funding: none © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e546-e546 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Cassandra Schuster More articles by this author Maximilian Carey More articles by this author Robert Carey More articles by this author Expand All Advertisement Loading ...