Lightweight Polypropylene Mesh Research Articles

Outcomes of Lightweight Mesh Sacrocolpopexy for Pelvic Organ Prolapse Repair

Objective: The research objective is to present and evaluate 3 years of experience in sacrospinal fixation using polypropylene mesh in the surgical treatment of genital prolapse in women. Methods: This retrospective study evaluated perioperative and mid-term outcomes in 68 women who underwent transvaginal sacroscopic cervicocolpopexy with lightweight polypropylene mesh for stage II-IV prolapse with apical involvement. Anatomical outcomes, complications, and symptoms were assessed using POP-Q staging and validated questionnaires preoperatively and at 12 and 36 months postoperatively. Results: No intraoperative complications were observed. In the long-term postoperative period, the following were observed: vaginal wall erosion in transvaginal Mesh-systems placement along the postoperative suture line at 2.9 % (2/68), and chronic pelvic pain at 2.9 % (2/68). The percentage of anatomical success in restoring the position of the apical vaginal segment was 98.5 % (67/68) 12 months after surgery and remained unchanged after 36 months of follow-up.

Comparison of Open Lichtenstein Repair and Laparoscopic Transabdominal Preperitoneal of Inguinal Hernia: A Pragmatic RCT in Bangladesh

Background: Laparoscopic inguinal hernia repair has emerged as an effective alternative to open Lichtenstein mesh repair for inguinal hernias. Objective: The purpose of the present study was to compare the surgical outcomes of laparoscopic trans-abdominal pre-peritoneal (TAPP) and open Lichtenstein mesh repair for the treatment of inguinal hernia. Methodology: This single centered, pragmatic randomized controlled trial was conducted in the Department of Surgery at 300 bed hospital, Narayanganj, Bangladesh from January 2018 to June 2020 for a period of two and half year. Patients who were presented with reducible, primary/recurrent, complete/incomplete inguinal hernias among male and female in more than or equal to 18 years of age were selected as study population. Lichtenstein mesh repair was performed which was compared with the laparoscopy group. Open Lichtenstein repair was done under spinal anesthesia with lightweight poly propylene mesh. Laparoscopy was performed by trans-abdominal pre-peritoneal (TAPP) technique under general anesthesia and heavy weight mesh was used. The hospital stay, operating time, post-operative complications like superficial wound infection, seroma formation, scrotal swelling as well as early recurrence and chronic groin pain were compared among these group. Results: A total number of 90 patients presented with inguinal hernia were recruited for this study of which TAPP was performed in 25 cases and 65 cases were undergone Lichtenstein repair. The mean age of laparoscopy and open group of patients were 49.28±9.9 years and 55.05±14.4 years respectively (p-0.03). The mean operation time was 85±10.31 minutes and 52.1±15.36 minutes in laparoscopy and open group respectively (p-0.000). The mean post-operative hospital stay was 2.9±0.78 days and 2.9±0.71 days in laparoscopy and open group respectively (p-0.94). In this study 21 (23.3%) patients developed 25 different early and late post-operative complications, out of which 15 (23.1%) in open group and 06 (23.3%) in laparoscopy group (p-0.52). One early recurrence was reported after 6 months follow up in laparoscopy group. Chronic groin pain was reported in 7 cases of which 5 (7.7%) cases in open group and only 2 (8.0%) cases in laparoscopy group (p-0.002). Conclusion: In conclusion the surgical outcomes of laparoscopic TAPP performed by a young surgeon in Bangladesh has given a clinically better result than open Lichtenstein repair considering hospital stay, seroma formation, wound infection, scrotal swelling and chronic groin pain. Journal of Current and Advance Medical Research, January 2023;10(1):35-40

OC-110 LAPAROSCOPIC RETROMUSCULAR INGUINAL HERNIA (LRMIHR) REPAIR USING PHASIX TM AND POLYPROPYLENE MESH: 5 YEARS OUTCOME

Abstract Background and objective Inguinal hernia routinely repaired with synthetic non-absorbable mesh. However, chronic pain may affect the success of flow recurrence. In contrast, using absorbable mesh and keeping its integrity for nine months as Phasix TM may be a suitable replacement for the synthetic non-absorbable mesh. This work assesses the results and cost of TAPP repair using Phasix TM & lightweight Polypropylene mesh. Methods Laparoscopic retromuscular inguinal hernia repair (LRMIHR) was performed from January 2015 to January 2023 with Institutional review board approval for 58 patients, 1 female and 57 males. The average age is 55.8, with a 27.5 mean BMI. The study was done in the hospital by one surgeon. Studying post-operative pain, reaction, mesh sensation discomfort, recurrence, and cost. Results In 5 years follow-up, the outcome is comparable without the non-significant advantage of absorbable mesh. Moreover, the cost of absorbable mesh (Phasix ST) is higher. Conclusion No clinical advantage of absorbable mesh in repairing the inguinal hernia. However, using phasix TM may have a place in repairing female and sports hernias. Further work is needed to evaluate phasix in hernia inguinal in a prospective multicenter trial.

V-023 ETEP REPAIR OF AN M2-3 W2 INCISIONAL HERNIA WITH AN ASSOCIATED SPIEGEL HERNIA. A CASE REPORT

Abstract Aim To describe a case of an extended-view totally extraperitoneal approach for both an M2-3 W2 incisional hernia with an associated right Spiegel hernia. Material & Methods A 68a female with a previous medical history of a midline laparotomy after diffuse peritonitis presented with a midline bulge in the upper third of the previous surgical wound. Preoperative CT scan showed a midline hernia of 4cm and found a right-sided Spiegel hernia of 3cm. Endoscopic treatment of both defects was offered and accepted. Results Patient was placed in supine position. Retromuscular space was created using blunt dissection with a balloon, which helped with direct visualization. Two 5mm trocars were placed in the left pararectal region. Dissection was performed and crossover from left to right was achieved following standard eTEP procedure. Reduction of preperitoneal fat was performed, and midline defects identified. Dissection was continued to the Retzius space and Cooper's ligaments. Identification and reduction of the Spiegel hernia followed. After completing the dissection of the retro rectus and preperitoneal space, primary closure was performed. A lightweight polypropylene mesh was deployed. No complications ocurred and discharge was on the 2nd day. Conclusions Treatment of incisional hernias is in evolution, as minimally invasive techniques have developed greatly since their description and now have a more widespread use among surgeons. eTEP is a novel approach that can be used for the treatment of midline incisional and some primary hernias, as shown in the case, with satisfactory short-term results and similar long-term outcomes to other techniques.

P-011 OPEN PREPERITONEAL APPROACH IN AN INCARCERATED ABSCESSIFIED GARENGEOT HERNIA

Abstract Aim The Garengeot hernia is a a rare entity (incidence 0.15–5%) that appears more frequently in elderly women and contents the vermiform appendix. Different surgical approaches are available but the most appropriate one is unknown. Association or conversion to laparotomy may be needed in complicated cases entailing higher morbimortality. Results 82-year-old female with hypertension, dyslipidemia and left inguinal hernioplasty. She presented acute right inguinal pain with a 1 month of evolution mass associated extended to the limb. Blood tests were normal but CT scan was performed reporting a right incarcerated inguinal hernia with acute perforated and abscessified appendicitis. Besides antibiotics, an open preperitoneal approach was performed. An incarcerated crural hernia was found: the sac was opened, the perforated appendix was reduced and the abscess was debrided. Appendicectomy was performed and after aseptic measures and critical view, a 15×15cm gentamicin impregnated large-pore light-weight polypropylene mesh was placed in the preperitoneal space covering the myopectineal orifice. Patient was successfully discharged 4 days after surgery with no complications after two years of follow-up. Conclusion The treatment of a complicated crural hernia in a septic environment in the emergency room represents a challenge. In an incarcerated and abscessified Garangeot hernia, an open preperitoneal approach (modified Nyhus technique) can be safely performed to confront both pathologies. Not only it allows access to the abdominal cavity through a small incision, avoiding the need for a laparotomy, but also favours an optimal exploration and repair of the myopectineal orifice.

Transvaginal surgical treatment of stage III-IV cystocele using a light prolene mesh: Safety of use and 5-year follow-up results.

The relevance of the article is due to the spread of the problem of genital prolapse in women. In order to solve this, the purpose of the presented work is to present and evaluate the 5-year experience of using light-weight polypropylene mesh, which is used in the transvaginal surgical treatment of stage III-IV cystocele. A retrospective cohort study was conducted at the Dnipro State Medical University at the Department of Obstetrics and Gynecology in the period from 2010 to 2020. A total of 612 patients with an average age of 64.8 ± 8.2 years (range 47-79) were included in it. Long-term analysis of operative treatment in 374 patients (76.0%) after 60 months showed a high level of satisfaction with the results of the operation 99.2% (371/374). A significant level of elimination of pathological symptoms in the functioning of the pelvic organs and improvement of the quality of life was established, which were assessed using questionnaires: PFDI-20 (76.4-4.3 (p < 0.05)), PFIQ-7 (41-8.4 (p < 0.05)), before the operation and at the final stage of the study. In total, 12 months after the operation, 2.6% (12/467) of the patients were re-operated on due to erosion of the vaginal wall at the site of placement of the MESH-system. The proposed technique for restoring the front wall of the vagina in case of an isolated cystocele of the III-IV degree, without signs of incomplete or complete prolapse of the uterus, showed a recurrence-free result in the indicated segment of the vagina.

P-015 POLY-4-HYDROXYBUTYRATE ABSORBABLE BARRIER COMPOSITE MESH AND POLY-PROLINE MESH: DUAL REPAIR FOR HUGE INCISIONAL HERNIA

Abstract Introduction A giant incisional hernia is a serious challenge. Along with loss of domain, the ideal surgical management is difficult to identify, with various surgical techniques and meshes. Obesity and comorbidities in patients with diabetes add to difficulties in repairing incisional hernias with loss of domain. Herein, we present a case in which a double-mesh technique was performed for surgical repair of huge incisional hernias. Presentation of Case An 80-year-old male patient with multiple comorbidities presented to the clinic with multiple incisional hernias secondary to a missile injury. The huge incisional hernias affected the patient's daily life and limited his activities. Abdominal computed tomography showed multiple central and lateral incisional hernias. Through a midline laparotomy, a 30 × 35-cm poly-4-hydroxybutyrate/absorbable barrier composite (P4HB/ABC) mesh was sutured to the abdominal wall intraperitoneally, and then a 20 × 25-cm lightweight polypropylene (LWPP) mesh was sutured to the edge of the muscular defect. Discussion This report described the case of a patient with multiple huge abdominal hernias, which were repaired using the double-mesh technique. The patient had an uneventful postoperative recovery. However, the patient had a seroma during follow-up, which was managed conservatively. Conclusion This report described the usefulness and challenges of using the double-mesh technique for successful repair of multiple central and lateral incisional hernias. We used two types of meshes, P4HB/ABC and LWPP meshes, which yielded good outcomes and no hernia recurrence occurred in a 3-year follow-up.

Evaluation of the quality of life after implantation of light or standard polypropylene hernia meshes.

Abstract.

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.

Alginate-assistant nanofiber integrated with polypropylene hernia mesh for efficient anti-adhesion effects and enhanced tissue compatibility

Polypropylene (PP) mesh has been one of the most frequently selected materials for abdominal wall hernia (AWH) repair in the past decades. However, the repair effectiveness is often compromised by the high incidence of adverse events. Improvements are highly desirable to reduce unwanted visceral adhesion and increase tissue integration. Herein, we developed a PP-based composite mesh combined with alginate-assistant nanofiber membrane (NFM) by assembling a large-pore lightweight PP mesh, a NFM barrier consisting of poly (lactic-co-glycolic acid) (PLGA) and polycaprolactone (PCL), and an alginate hydrogel (AH). In vitro studies revealed that the resulting meshes had excellent structural stability, mechanical properties, and biocompatibility. The NFM barriers were firmly attached to the PP substrates, with AH effectively eliminating the delamination without unwanted damage to the nanofiber barrier. In vivo experiments showed that incorporating AH-assistant NFM into PP prostheses could prevent visceral adhesion in an effective manner and promote mesh integration into surrounding tissues from the abdominal wall. These results prove a novel facile and successful strategy to endow prosthetic meshes with superior anti-adhesion capability and tissue compatibility for repairing AWH.

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.

O19 5-YEAR OUTCOMES OF A RANDOMIZED CLINICAL TRIAL OF MESH FIXATION WITH CYANOACRYLATE OR SUTURES FOR LICHTENSTEIN HERNIA REPAIR: RECURRENCE, CHRONIC PAIN AND QUALITY OF LIFE

Abstract Aim To assess the 5-year outcomes of mesh fixation with cyanoacrylate or sutures for Lichtenstein hernioplasty (recurrence rate, chronic pain, and patient’s quality of life (QoL). Methods 370 patients who underwent Lichtenstein hernia repair were randomized to receive either cyanoacrylate or non-absorbable sutures for lightweight polypropylene mesh fixation. Postoperative outcomes were evaluated by an independent blinded observer. QoL was assessed using the EuraHS-QoL questionnaire (European Registry for Abdominal Wall Hernias). Results Initially 188 patients received Glue and 182 Suture. Mean follow-up: 72.6±7.8 months. 78.1% patients (Glue:147,Suture:142) completed 5-years follow-up. No significant differences were observed in terms of chronic pain. VAS score≥3: 8.1% vs 9.1%, Glue vs. Suture, respectively (P = 0.836). 8 patients (2.7%) (4 in each group) reported pain at rest, reaching 10.7% when analyzing pain during activity. QoL was unaffected (EHS-QoL score=0) in the majority of patients: 131 (89.2%) vs. 127 (89.5%) for Glue or Suture respectively (p = 0.930). QoL-score greater than 20/90 points: 2 patients (Glue) vs. 6 (Suture) (p = 0.099). The Suture group QoL-score was higher in all domains but without statistical significance. Foreign body sensation was slightly higher in Suture group (7.5% vs. 9.3%) but without reaching statistical significance (p = 0.534). There were no differences in the recurrence rate (2.6% vs. 3.8% for Glue and Suture respectively) (p = 0533). Conclusions Chronic discomfort rate after Lichtenstein hernioplasty is not negligible. Atraumatic mesh fixation with glue was quicker and resulted in less acute postoperative pain than sutures for Lichtenstein hernia repair, but with no statistical differences in terms of chronic pain nor the long-term patients’ QoL.

Comparative study on nanofiber containing polypropylene-based composite mesh for abdominal wall hernia repair

Electrospun nanofibrous membranes (NFM) can serve as a physical barrier, employed to confer polypropylene (PP) mesh with anti-adhesion capability for repairing abdominal wall hernias. Still, the feasibility of NFM combined with different PP meshes was poorly researched. In this study, nanofiber containing composite meshes with three PP substrates were produced by integrating the NFM barrier compositing poly (lactic-co-glycolic acid) and polycaprolactone (PLGA/PCL) into each PP mesh. Tensile mechanical test results revealed that the PP component played a dominant role in the mechanical support, and this structure has not deteriorated in any case during the process. In vitro cell studies showed that the PP mesh with a higher density was significantly beneficial for cell proliferation within 3 days of seeding, while the one with lower density exhibited notable cell proliferation after a culture of 5 days. All the meshes had excellent biocompatibility. Moreover, an intraperitoneal implantation rabbit model was used to assess the anti-adhesion effects and tissue compatibility. The results revealed that the NFM barrier could be incorporated into the lightweight PP mesh to yield the composite mesh with superior anti-adhesion property and tissue compatibility.

Prospective Comparative Study of Laparoscopic Totally Extra-Peritoneal Repair for Inguinal Hernia with Light Weight Polypropylene Mesh V/S 3D Anatomically Shaped Large Pore Polypropylene Mesh

Prospective Comparative Study of Laparoscopic Totally Extra-Peritoneal Repair for Inguinal Hernia with Light Weight Polypropylene Mesh V/S 3D Anatomically Shaped Large Pore Polypropylene Mesh

Antibacterial Biopolymer Gel Coating on Meshes Used for Abdominal Hernia Repair Promotes Effective Wound Repair in the Presence of Infection.

Prosthetic mesh infection is a devastating complication of abdominal hernia repair which impairs natural healing in the implant area, leading to increased rates of patient morbidity, mortality, and prolonged hospitalization. This preclinical study was designed to assess the effects on abdominal wall tissue repair of coating meshes with a chlorhexidine or rifampicin-carboxymethylcellulose biopolymer gel in a Staphylococcus aureus (S. aureus) infection model. Partial abdominal wall defects were created in New Zealand white rabbits (n = 20). Four study groups were established according to whether the meshes were coated or not with each of the antibacterial gels. Three groups were inoculated with S. aureus and finally repaired with lightweight polypropylene mesh. Fourteen days after surgery, implanted meshes were recovered for analysis of the gene and protein expression of collagens, macrophage phenotypes, and mRNA expression of vascular endothelial growth factor (VEGF) and matrix metalloproteinases (MMPs). Compared to uncoated meshes, those coated with either biopolymer gel showed higher collagen 1/3 messenger RNA and collagen I protein expression, relatively increased VEGF mRNA expression, a significantly reduced macrophage response, and lower relative amounts of MMPs mRNAs. Our findings suggest that following mesh implant these coatings may help improving abdominal wall tissue repair in the presence of infection.

Evaluation of the histological and biomechanical properties of poly-4-hydroxybutyrate scaffold for pelvic organ prolapse, compared with polypropylene mesh in a rabbit model.

Poly-4-hydroxybutyrate (P4HB) is a biopolymer produced by Escherichia coli K12 bacteria. P4HB is fully resorbed in vivo by 18-24months post-implantation. The aim of this study is to evaluate P4HB in the rabbit abdomen and vagina to determine that the biomechanical and histological properties are similar to the standard polypropylene mesh. Our hypothesis is that the histological and biomechanical properties of a fully absorbable graft will be similar to a lightweight polypropylene (PP) mesh when implanted in rabbit vagina and abdomen. Sixteen (n = 16) female New Zealand White (retired breeder) rabbits were equally divided between two time points (3 and 9months). A total of 17 rabbits were used owing to one death secondary to suspected cardiomyopathy. P4HB scaffold and PP mesh were subcutaneously and peri-vaginally implanted into the rabbit abdomen and vagina respectively. All rabbits had both posterior and anterior vaginal implants, and half of the rabbits had four abdominal implants in addition to the vaginal implants. The abdominal implants were 4.5cm long × 1.5cm wide whereas the vaginal implants were 1.5cm long × 0.5cm wide. At 3 and 9months, gross necropsy was performed and samples were obtained, sectioned, stained and evaluated via histological analysis. Specimens were assessed for host inflammatory response, neovascularization, elastin content, and collagen deposition/maturation. Specimens were also biomechanically evaluated via uniaxial tensile test to determine the stiffness, ultimate tensile strength and load at ultimate tensile strength of the device/tissue composite. No abdominal mesh exposures were noted. A comparable number of asymptomatic partial vaginal exposures were observed at 3months (P4HB: n = 3; PP: n = 2) and 9months (P4HB: n = 3; PP: n = 2) respectively. Histological analysis of specimens showed comparable results in the P4HB and PP groups at 3 and 9months post-implantation. Although no acute inflammation was seen, chronic inflammation was demonstrated in all specimens. Elastic fibers were present in the 3-month vaginal PP and P4HB specimens, but were not seen again. There was an increase in type I/III collagen noted over time. Biomechanical evaluation of the vaginal mesh tissue complex showed ultimate tensile strength was not significantly different between P4HB and PP groups at 3 (P = 0.625) and 9months (P = 0.250) respectively. P4HB scaffold may represent a fully absorbable alternative to permanent mesh for pelvic organ prolapse (POP) repair.

A soft elastomer alternative to polypropylene for pelvic organ prolapse repair: a preliminary study.

We compared the impact of a mesh manufactured from the soft elastomer polydimethylsiloxane (PDMS) to that of a widely used lightweight polypropylene (PP) mesh. To achieve a similar overall device stiffness between meshes, the PDMS mesh was made with more material and therefore was heavier and less porous. We hypothesized that the soft polymer PDMS mesh, despite having more material, would have a similar impact on the vagina as the PP mesh. PDMS and PP meshes were implanted onto the vaginas of 20 rabbits via colpopexy. Ten rabbits served as sham. At 12weeks, mesh-vagina complexes were explanted and assessed for contractile function, histomorphology, total collagen, and glycosaminoglycan content. Outcome measures were compared using one-way ANOVA and Kruskal-Wallis testing with appropriate post-hoc testing. Relative to sham, vaginal contractility was reduced following the implantation of PP (p = 0.035) but not the softer PDMS (p = 0.495). PP had an overall greater negative impact on total collagen and glycosaminoglycan content, decreasing by 53% (p < 0.001) and 54% (p < 0.001) compared to reductions of 35% (p = 0.004 and p < 0.001) with PDMS. However, there were no significant differences in the contractility, collagen fiber thickness, total collagen, and glycosaminoglycan content between the two meshes. Despite having a substantially higher weight, PDMS had a similar impact on the vagina compared to a low-weight PP mesh, implicating soft polymers as potential alternatives to PP. The notion that heavyweight meshes are associated with a worse host response is not applicable when comparing across materials.

Polycarbonate Urethane Mesh: A New Material for Pelvic Reconstruction.

Polycarbonate urethane (PCU) is a new biomaterial, and its mechanical properties can be tailored to match that of vaginal tissue. We aimed to determine whether vaginal host immune and extracellular matrix responses differ after PCU versus lightweight polypropylene (PP) mesh implantation. Hysterectomy and ovariectomy were performed on 24 Sprague-Dawley rats. Animals were divided into 3 groups: (1) PCU vaginal mesh, (2) PP vaginal mesh, and (3) sham controls. Vagina-mesh complexes or vaginas (controls) were excised 90 days after surgery. We quantified responses by comparing: (1) histomorphologic scoring of hematoxylin and eosin- and Masson trichrome-stained slides, (2) macrophage subsets (immunolabeling), (3) pro-inflammatory and anti-inflammatory cytokines (Luminex panel), (4) matrix metalloproteinase (MMP)-2 and -9 using an enzyme-linked immunosorbent assay, and (5) type I/III collagen using picrosirius red staining. There was no difference in histomorphologic score between PCU and PP (P = 0.211). Although the histomorphologic response was low surrounding all mesh fibers, groups with PCU and PP mesh had a higher histomorphologic score than the control group (P < 0.005 and P < 0.002, respectively). There were no differences between groups in terms of macrophage subsets, pro-inflammatory cytokines, anti-inflammatory cytokines, MMP-2 and MMP-9, or collagen ratio. Polycarbonate urethane, an elastomer with material properties similar to those of vaginal tissue, elicits minimal host inflammatory responses in a rat model. Because its implantation does not elicit more inflammation than currently used lightweight PP, using PCU for prolapse mesh warrants further investigation with larger animal models.

Evaluation of Host Immune Cellular and Extracellular Matrix Responses to Prolapse Mesh With and Without Tension in a Rat Model.

We sought to determine whether vaginal host immune cellular and extracellular matrix responses are altered in a rat sacrocolpopexy model when lightweight polypropylene mesh is attached on tension versus without tension. We performed hysterectomy and ovariectomy in 32 Sprague-Dawley rats. Animals were assigned to 4 groups (n = 8/group): (1) controls with sham operation only (control), (2) mesh sutured only on the vagina (vaginal mesh), (3) sacrocolpopexy without tension, and (4) sacrocolpopexy with tension. Ninety days later, we excised vagina-mesh complexes. A histomorphologic scoring system of hematoxylin/eosin and Masson trichrome stained slides was used to assess host inflammatory responses. The cellular inflammatory response was further quantified using (1) identification of M1 and M2 macrophage subsets and (2) quantification of proinflammatory and anti-inflammatory cytokines. The extracellular matrix response was evaluated by measuring (1) matrix metalloproteinase-2 and matrix metalloproteinase-9 levels and (2) type I/III collagen. Histomorphological tissue responses were greater in all groups with mesh compared with sham controls. Both sacrocolpopexy groups had similar scores, but each group scored significantly higher than the vaginal mesh group. Among the 4 groups, there were no statistically significant differences in M1 or M2 macrophage subsets, proinflammatory or anti-inflammatory cytokines, or extracellular matrix remodeling responses. Attachment of prolapse mesh resulted in an increased histologic inflammatory response independent of tension. Other markers of cellular inflammation and extracellular matrix remodeling showed no differences among experimental groups. Tension on lightweight polypropylene mesh did not significantly alter the host response in this rat sacrocolpopexy model.

Self-gripping mesh versus polypropylene mesh in ventral hernia repair: an observational study

Background: To compare clinical outcomes following sutureless Parietex ProGrip™ mesh in ventral hernia repair to traditional lightweight polypropylene mesh secured with sutures.Methods: This was a study conducted at the Department of General Surgery in Velammal medical college from August 2019 to February 2020. This prospective observational study involved, 60 patients, 30 each undergoing ventral hernia repair with polypropylene mesh with suture fixation and Parietex ProGrip™ precut mesh (P group) without fixation. The primary outcome measure was postoperative pain using the visual analog scale were assessed prior to surgery and up to 3 months postoperatively (VAS, 0-150 mm); other outcomes (duration of surgery, wound infection and recurrence of hernia) were assessed up to 3 months postoperatively.Results: Compared to baseline (preoperative), pain score below four on the visual analogue scale was higher in the test group at discharge (76.7%) and 24 hours (96.7%), while the pain was more in the study group at discharge (43.3%) and seven days (70%). The difference between groups was significant at both time points. In the test group, patients without fixation suffered less pain compared to those with single-suture fixation (48 hours: 100% versus 86.6%, p=0.038; 3 months: 100% versus 100%, p≤0.001). Surgery duration was significantly shorter in the test group (&lt;60 minutes) (66.7% versus 40%; p&lt;0.038). No recurrence was observed at three months in both groups.Conclusions: A self-gripping mesh for ventral hernia repair may result in less pain in the early postoperative phase. Recurrence rates reduce as well as the patient’s quality of life improves.