Mesh Complications Research Articles

Outcomes of Abdominal Apical Suspension Using Mesh in a Tertiary Training Hospital: A Seven-year Retrospective Review.

Pelvic organ prolapse (POP) is an inconvenience that can affect a woman's well-being. Reconstructive pelvic floor surgery involves repairing defects in the endopelvic fascia and pelvic floor musculature as close to the physiologic and anatomic norm. The cornerstone of successful prolapse repair is a strong apical support. The aim of the study is to determine the outcomes of abdominal sacrocolpopexy (ASC) and abdominal sacrohysteropexy (ASH) in the Philippines. The study utilized a descriptive study design to compare the pre-operative and post-operative Pelvic Organ Prolapse Quantification Score (POP-Q Score), presence of mesh complications, and urinary/bowel symptoms in patients operated within 2010-2016 in a Philippine tertiary training hospital. Based on recovered charts and inclusion/exclusion criteria, this study sampled 34 of 50 patient records. Statistical measures of median and range were used to describe pre-operative and post-operative POP-Q scores in any two follow-ups within 6-, 12-, 18-, and 24-month interval. The objective success rate and incidence of urinary/bowel symptoms were described using frequencies and percentages. Presence of any mesh erosion was noted for each follow-up. McNemar's test was applied to assess the comparative occurrence of each symptom comparing between the pre-operative and first follow-up periods. ASC had a success rate of 73.7% at six months and 56.3% at 12 months post-surgery. ASH showed an 84.6% success rate at six months and 71.4% at 12 months. Apical support has a 97% success rate without affecting the anterior or posterior compartments. Out of 20 ASC patients, 5 (25%) exhibited anterior compartment descent, whereas two out of 14 ASH patients (14.2%) had the same condition. It is observed that the anterior vaginal wall has the higher tendency to descend after reconstructive surgery, independent of route or technique. In addition, not all patients with surgical prolapse beyond -1 experienced symptomatic vaginal bulges. Overall, a notable decrease in the occurrence of urine symptoms was seen after the surgery. No mesh erosion was seen within the initial two years of follow-up but there was a single reported instance of abdominal hernia, an uncommon consequence. This study demonstrated that ASC and ASH have good success rate in apical support; however, descent of the anterior or posterior compartment diminishes the overall success rate in terms of over-all objective POP-Q score. Both resulted to improvement in symptoms with minimal complications.

Dysregulated wound healing in the pathogenesis of urogynecologic mesh complications

To test the hypothesis that dysregulated wound healing is associated with Urogynecologic mesh complications, we collected vaginal cell secretions using vaginal swabs after polypropylene mesh implantation in patients with (N = 39) and without (N = 40) complication. A customized multiplex immunoassay measured markers of inflammation (MCP-1, IGFBP-1, IL-2, IL-10, IL-17, PDGF-BB, bFGF, IL-1b, IL-6, IL-12p70, TNF-α), neuroinflammation (IL-1RA, TGF-β, IL-15, IL-18, IL-3, M-CSF), angiogenesis (VEGF), and matrix proteins (fibronectin, tenasin c, thrombospondin-2, lumican) between groups. Patients with complications were younger, heavier, implanted with mesh longer, and more likely to be ever smokers. A 5 kg/m2 BMI increase and ever-smoking were associated with a 2.4-fold and sixfold increased risk of complication, respectively. Patients with the highest tertile of bFGF, fibronectin, thrombospondin-2, TNF-β, or VEGF had an odds ratio (OR) of 11.8 for having a mesh complication while ≥ 3 elevated had an OR of 237 while controlling for age, BMI, and smoking. The highest tertile of bFGF, thrombospondin-2, and fibronectin together perfectly indicated a complication (P < 0.0001). A receiver-operator curve for high bFGF, thrombospondin-2, and fibronectin showed excellent discrimination between complications and controls (AUC 0.87). These data provide evidence of dysregulated wound healing in mesh complications. Modifiable factors provide potential targets for patient counseling and interventions.

Five-Year Follow-Up of a Slowly Resorbable Biosynthetic P4HB Mesh (Phasix) in VHWG Grade 3 Incisional Hernia Repair.

To assess the 5-year recurrence rate of incisional hernia repair in Ventral Hernia Working Group (VHWG) 3 hernia with a slowly resorbable mesh. Incisional hernia recurs frequently after initial repair. In potentially contaminated hernia, recurrences rise to 40%. Recently, the biosynthetic Phasix mesh has been developed that is resorbed in 12-18 months. Resorbable meshes might be a solution for incisional hernia repair to decrease short- and long-term (mesh) complications. However, long-term outcomes after resorption are scarce. Patients with VHWG grade 3 incisional midline hernia, who participated in the Phasix trial (Clinilcaltrials.gov: NCT02720042) were included by means of physical examination and computed tomography (CT). Primary outcome was hernia recurrence; secondary outcomes comprised of long-term mesh complications, reoperations, and abdominal wall pain [visual analogue score (VAS): 0-10]. In total, 61/84 (72.6%) patients were seen. Median follow-up time was 60.0 [interquartile range (IQR): 55-64] months. CT scan was made in 39 patients (68.4%). A recurrence rate of 15.9% (95% confidence interval: 6.9-24.8) was calculated after 5 years. Four new recurrences (6.6%) were found between 2 and 5 years. Two were asymptomatic. In total, 13/84 recurrences were found. No long-term mesh complications and/or interventions occurred. VAS scores were 0 (IQR: 0-2). Hernia repair with Phasix mesh in high-risk patients (VHWG 3, body mass index >28) demonstrated a recurrence rate of 15.9%, low pain scores, no mesh-related complications or reoperations for chronic pain between the 2- and 5-year follow-up. Four new recurrences occurred, 2 were asymptomatic. The poly-4-hydroxybutyrate mesh is a safe mesh for hernia repair in VHWG 3 patients, which avoids long-term mesh complications like pain and mesh infection.

Urethral Mesh Assessment in Cancer Patients

Urethral mesh placement has become a common surgical intervention for the management of stress urinary incontinence. While this procedure offers significant benefits, it is not without potential complications. This review article aims to provide a comprehensive overview of urethral mesh assessment in oncologic patients. The article explores normal magnetic resonance imaging (MRI) and computed tomography (CT) mesh appearances and highlights the pathological aspects associated with urethral mesh complications including both short-term and long-term post-operative complications. By understanding the spectrum of normal findings of urethral mesh and the possible complications, clinicians can improve patient outcomes and make informed decisions regarding urethral mesh management in this patient population.

Polypropylene anterior-apical single-incision UPHOLD-LITE mesh surgery in women with severe pelvic organ prolapse: Outcome at 53 months follow up

Background and purposeWe present this current study to complement with mesh inlays plausible benefits (UPHOLD-LITE System) on available long-term study amidst FDA's concern on mesh complications. This study aims to assess the medium-term outcomes of UPHOLD-LITE system for treatment of advanced pelvic organ prolapse (POP) and its complications, and lower urinary tract symptoms. MethodsThis is a retrospective case series of 53 months follow-up of 123 consecutive patients who underwent UPHOLD-LITE system. Objective outcome measures the anatomical correction of prolapse with POP-Q ≤ Stage 1. Subjective outcome was patient's feedback to questions 2 and 3 of POPDI-6. Secondary outcome measures the quality of life, presence of lower urinary tract symptoms and complications. Quality of life is assessed by validated questionnaires on Urogenital Distress Inventory 6 (UDI-6), Incontinence Impact Questionnaire 7 (IIQ-7), Pelvic Organ Prolapse Distress Inventory 6 (POPDI-6), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire 12 (PISQ-12) at 1 and 3 years post-operatively. ResultsObjective outcome at 1 and 3 years was at 96.7 % and 95.4 % respectively. The subjective cure was 95.1 % and 91.6 %. Five-year cumulative cure rate maintained at 87.2 %. Secondary outcomes observed improvement on UDI-6, IIQ-7, POPDI-6 and PISQ-12 postoperatively. Bladder outlet obstruction improved while de novo urodynamic stress incontinence (USI) increased slightly post surgically. Mesh erosion rate was 0.8 %. ConclusionThe UPHOLD-LITE system demonstrated good medium term anatomical correction of apical and anterior prolapse, with good subjective cure and improved quality of life. Whilst complication rate was low, slight increase in de novo USI was observed.

Immunobiology of foreign body response to composite PLACL/gelatin electrospun nanofiber meshes with mesenchymal stem/stromal cells in a mouse model: Implications in pelvic floor tissue engineering and regeneration

Pelvic Organ Prolapse (POP) is a common gynaecological disorder where pelvic organs protrude into the vagina. While transvaginal mesh surgery using non-degradable polymers was a commonly accepted treatment for POP, it has been associated with high rates of adverse events such as mesh erosion, exposure and inflammation due to serious foreign body response and therefore banned from clinical use after regulatory mandates. This study proposes a tissue engineering strategy using uterine endometrium-derived mesenchymal stem/stromal cells (eMSC) delivered with degradable poly L-lactic acid-co-poly ε-caprolactone (PLACL) and gelatin (G) in form of a composite electrospun nanofibrous mesh (P + G nanomesh) and evaluates the immunomodulatory mechanism at the material interfaces. The study highlights the critical acute and chronic inflammatory markers along with remodelling factors that determine the mesh surgery outcome. We hypothesise that such a bioengineered construct enhances mesh integration and mitigates the Foreign Body Response (FBR) at the host interface associated with mesh complications. Our results show that eMSC-based nanomesh significantly increased 7 genes associated with ECM synthesis and cell adhesion including, Itgb1, Itgb2, Vcam1, Cd44, Cdh2, Tgfb1, Tgfbr1, 6 genes related to angiogenesis including Ang1, Ang2, Vegfa, Pdgfa, Serpin1, Cxcl12, and 5 genes associated with collagen remodelling Col1a1, Col3a1, Col6a1, Col6a2, Col4a5 at six weeks post-implantation. Our findings suggest that cell-based tissue-engineered constructs potentially mitigate the FBR response elicited by biomaterial implants. From a clinical perspective, this construct provides an alternative to current inadequacies in surgical outcomes by modulating the immune response, inducing angiogenesis and ECM synthesis during the acute and chronic phases of the FBR.

Baseline measures for women with mesh complications accessing a pain service (as part of the London Complex Mesh Centre).

Pelvic mesh was first used for stress urinary incontinence in 1998 following which its usage rapidly expanded to include treatment of pelvic organ prolapse. Numerous complications relating to mesh insertion soon became apparent, culminating in the Independent Medicines and Medical Devices Safety: First Do No Harm Report published by Baroness Cumberlege in 2020. Following this report, the UCLH London Complex Mesh Centre funded by NHS England, was one of a small number of specialist centres set up for mesh-injured women. The Pelvic Pain service of the Pain Management Centre at UCLH provides a service for patients attending the London Complex Mesh Centre. The aim of our study was to distinguish the differing needs of mesh-injured women from those with chronic pelvic pain by comparing patient-reported outcome measures between these two cohorts. Distribution of data was calculated using the D'Agostino-Pearson normality test. Mann-Whitney tests were used to ascertain statistical difference between the two cohorts. Ethnicity was compared between groups using Fisher's exact test. Quantile regression models were used to assess whether differences in medians between groups remained after adjustment for age and ethnicity. Statistical significance was set at p < .05. Patients with mesh were significantly older than those with chronic pelvic pain and were more likely to be of white ethnicity. After adjustment for age and ethnicity, analysis revealed that bladder interference, sex interference and DAPOS A were significantly higher amongst mesh-injured women, whereas GP and hospital admissions were significantly lower. Our data shows the importance of mesh-injured women having access to pain management services with pathways of care integrated within women's and mental health services. It is essential that these programmes include support to discuss ways of returning to sexual relationships and have models to address anxiety such as graded exposure and psychological input.

Evaluating the impact of lifting mandatory smoking cessation prior to elective abdominal wall reconstruction. A single-center experience

IntroductionMany studies identify active smoking as a significant risk factor for postoperative wound and mesh complications in patients undergoing abdominal wall reconstruction surgery. However, our group conducted an analysis using data from the ACHQC database, which revealed similar rates of surgical site infection (SSI) and surgical site occurrence requiring procedural intervention (SSOPI) between active smokers and non-smokers As a result, the Cl eveland Clinic Center for Abdominal Core Health instituted a policy change where active smokers were no longer subject to surgical delay. Our study aims to evaluate the impact of active smoking on the outcomes of these patients. MethodsWe identified active smoking patients who had undergone open, elective, clean ventral hernia repair (VHR) with transversus abdominis release (TAR) and permanent synthetic mesh at Cleveland Clinic Foundation. Propensity matching was performed to create a 1:3 ratio of “current-smokers” and “never-smokers” and compared wound complications and all 30-day morbidity between the two groups. Results106 current-smokers and 304 never-smokers were matched. Demographics were similar between the two groups after matching, with the exception of chronic obstructive pulmonary disease (COPD) (22.1% vs. 13.4%, p ​< ​.001) and body mass index (BMI) (31.1 vs. 32.6, p ​= ​.02). Rates of SSI (12.2% vs. 6.9%, p ​= ​.13), SSO (21.7% vs. 13.2%, p ​= ​.052), SSOPI (11.3% vs. 6.3%, p ​= ​.13), and reoperation (1.9% vs. 3.9%, p ​= ​.53) were not significantly different between active smokers and never-smokers correspondingly. One case (0.3%) of partial mesh excision was observed in the never-smokers group (p ​= ​1). The current-smokers group exhibited a significantly higher incidence of pneumonia compared to the never-smokers group (5.7% vs. 0.7%, p ​= ​.005). ConclusionOur study revealed that operating on active smokers did result in a slight increase in wound morbidity, although it did not reach statistical significance. Additionally, pulmonary complications were higher in the smoking group. Notably, we did not see any mesh infections in the smoking group during early follow up. We believe that this data is important for shared decision making on patients that are actively smoking contemplating elective hernia repair.

Spouses Speak Up: The Impact of Mesh Sling Complications on the Patient’s Spouse—A Qualitative Analysis Study

To examine the perspectives, attitudes, and beliefs of the spouses of women with complications of mesh midurethral sling (MUS) surgery with the goal of increasing our understanding of the multidimensional nature of MUS surgery complications. After IRB approval, the spouses of patients who underwent surgery for MUS complications at a single tertiary care institution participated in qualitative interviews. Using an interview guide with standardized prompts, semistructured interviews were conducted. Interviews were transcribed verbatim and reviewed line-by-line by two researchers independently. Inductive content analysis was used to code the transcripts and identify themes, and consensus was achieved by the research team. Seven male spouses participated in qualitative interviews, and several themes and subthemes were identified. First, spouses expressed feelings of regret. They described that their partner's dyspareunia detracted from their intimate relationship. The participants also reported the negative impact on their lives and their households. Due to the personal nature of the issue, couples would avoid involving friends and family, creating a sense of isolation. Finally, they expressed hope of finding a healthcare team experienced with mesh complications and invested in their spouse's improvement. Spouses of women who experience MUS complications serve as caregivers and provide support; they are impacted by adverse outcomes. It is important to acknowledge their role in patients' healthcare experiences and learn from their insights. Our study lays the foundation for future work and ultimately for improving the experiences of patients and their spouses with MUS surgery and potential complications.

Comparative analysis of transvaginal natural orifice transluminal endoscopic surgery versus laparoendoscopic single-site sacrocolpopexy for pelvic organ prolapse: A propensity score matching study

PurposeTo compare the safety, feasibility, and effectiveness of transvaginal natural orifice transluminal endoscopic sacrocolpopexy (vNOTES-SC) and laparoendoscopic single-site sacrocolpopexy (LESS-SC) for pelvic organ prolapse (POP). MethodNinety-four patients with POP who underwent vNOTES-SC or LESS-SC from October 2016 to November 2018 were included. The propensity score matching method was used for 1:1 matching between the two surgery groups. After matching, the general perioperative indicators, surgical complications, and the subjective and objective therapeutic effects of the two groups 3 years post-surgery were analyzed. ResultsAfter matching, 36 patients in each group were included, exhibiting balanced and comparable baseline data and an average follow-up of 48.6 ± 7.44 months. The operation time and postoperative hospitalization days were significantly reduced in the vNOTES-SC group (P < 0.05). However, perioperative complication incidence was not significantly different between the two groups (P > 0.05). Additionally, no significant differences were detected in de novo stress urinary incontinence (16.7% vs. 13.9%), de novo overactive bladder (de novo OAB, 8.3% vs. 0.0%), urination disorder (2.8% vs. 0.0%), defecation disorder (0.0% vs. 2.8%), lumbosacral pain (0.0% vs. 2.8%), or mesh complication (2.8% vs. 5.6%) incidences between the vNOTES-SC and LESS-SC groups (P > 0.05). Prolapse recurrence was not reported in either group. The quantitative description of pelvic organ position (POP-Q), Pelvic Floor Impact Questionnaire-7 (PFIQ-7), and Patient Global Impression of Improvement scale (PGI-I) scores showed improvement after the operation, but no significant differences were observed between the two groups (P > 0.05). ConclusionThe 3-year follow-up revealed that vNOTES-SC and LESS-SC had similar complications and efficacy rates. Compared with LESS-SC, vNOTES-SC resulted in shorter operation time and fewer postoperative hospitalization days (corresponding to the enhanced recovery after surgery [ERAS] concept), along with better cosmetic results without a scar. Therefore, our study findings suggest that clinicians should choose the surgery method based on the specific situation, and we recommend choosing vNOTES-SC when both surgeries are suitable.

The experience of six women living with pelvic surgical mesh complications – interventions and adaptions: a phenomenological inquiry

The experience of six women living with pelvic surgical mesh complications – interventions and adaptions: a phenomenological inquiry

SP10.1 Post operative complications and functional outcome after ventral mesh and suture rectopexy for rectal prolapse: a single centre observational study

Abstract Aims Laparoscopic ventral mesh rectopexy (LVMR) is a technique gaining more recognition for the management of pelvic floor disorders, such as external rectal prolapse (ERP), high grade internal rectal prolapse (IRP) and rectocele. The aim of this study was to evaluate post op complications (early, late and mesh) and functional outcomes after a standardized LVMR. Methods All patients who underwent Rectopexy from February 2008 to April 2021 were included into the study. The patients were evaluated preoperatively, at 3 months and 1 year postoperatively. Surgical complications, mesh complications (mesh detachment, erosion and infection) and functional results in terms of faecal incontinence, recurrence and ODS were analysed. Results 95 patients (88 – LVMR; 7 - suture Rectopexy) who underwent Rectopexy were included in the study with a mean age of 68 and female predominance of 90 patients. 30 patients had external rectal prolapse (ERP), 45 patients had internal rectal prolapse (IRP) or intussusception, 20 patients had both ERP and IRP (Table 3). 53 patients had preoperative MRI scan and 15 patients had preoperative proctogram. (Table 4). 92 patients did not have any early complications. 13 patients had late postoperative complications including recurrent prolapse, stoma formation, suture migration and incisional hernia. Mesh complications were seen in 2 patients with mesh erosion and mesh detachment, both of whom had non-absorbable stitches used. There were no post op deaths documented. During the follow up period, 12 patient developed symptoms of ODS. Conclusion LVMR is a safe and effective treatment for rectal prolapse. Careful patient selection, appropriate preoperative workup, and meticulous surgical technique undoubtedly transforms postoperative outcomes.

Abdominal wall hernia repair: from prosthetic meshes to smart materials.

Hernia reconstruction is one of the most frequently practiced surgical procedures worldwide. Plastic surgery plays a pivotal role in reestablishing desired abdominal wall structure and function without the drawbacks traditionally associated with general surgery as excessive tension, postoperative pain, poor repair outcomes, and frequent recurrence. Surgical meshes have been the preferential choice for abdominal wall hernia repair to achieve the physical integrity and equivalent components of musculofascial layers. Despite the relevant progress in recent years, there are still unsolved challenges in surgical mesh design and complication settlement. This review provides a systemic summary of the hernia surgical mesh development deeply related to abdominal wall hernia pathology and classification. Commercial meshes, the first-generation prosthetic materials, and the most commonly used repair materials in the clinic are described in detail, addressing constrain side effects and rational strategies to establish characteristics of ideal hernia repair meshes. The engineered prosthetics are defined as a transit to the biomimetic smart hernia repair scaffolds with specific advantages and disadvantages, including hydrogel scaffolds, electrospinning membranes, and three-dimensional patches. Lastly, this review critically outlines the future research direction for successful hernia repair solutions by combing state-of-the-art techniques and materials.

Case Report: Total intragastric mesh migration six years after diaphragmatic rupture and hiatal hernia surgery

Background: Mesh implementation to repair the hiatal space is already justified. Nevertheless, the use of this procedure is debated in regard of complications that may occur. Mesh erosion and migration are considered the most serious complications of mesh repairs. Case presentation: It has not yet been well described in the literature. We describe a case of mesh erosion of stomach, many years later after a prosthetic repair of a diaphragmatic rupture associated to hiatal hernia, is presented here because of its rarity. Conclusion: Few explanations have been put forward to explain this incident. Could it be due to inflammatory processes, or to the composition of the Meshes? As yet, there is no definitive explanation.

Laparoscopic sacral colpopexy without the robot: Safe, effective and easier than you think

Objective:The purpose of the study is to evaluate the outcomes of laparoscopic sacral colpopexy operations performed by faculty and resident surgeons using simple laparoscopic suturing and tying techniques, and to compare those results with those reported by other institutions performing laparoscopic and robotic sacral colpopexy. Methods:This is a retrospective cohort study of 206 consecutive laparoscopic sacral colpopexy cases (with or without concomitant procedures) between October 2014 and July 2020. Laparoscopic sacral colpopexies were performed using a carefully selected set of instruments and techniques which are quickly mastered by trainees. Residents performed up to 50% of the work in each operation. Descriptive statistics were used to compare primary outcomes with published literature. Results:The average operative time was 153.3 minutes. The overall complication rate was 16.5%, including 3.4% cystotomy, 0.5% enterotomy, 0.5% small bowel obstruction, 2.4% mesh complications including erosion, detachment and removal. Most recent follow up occurred at a mean of 325.5 days (SD 397.9) and median of 183 days (IQR 48-471) postoperatively. Recurrent prolapse was noted in 6.3% of patients and 3.9% underwent a subsequent prolapse repair. These results compare favorably with those published by other institutions. Conclusion:Using simple suturing and tying techniques, laparoscopic sacral colpopexy can be performed without robotic assistance by a large portion of laparoscopically trained surgeons, including trainee co-surgeons. Significant cost savings accrue from the use of conventional laparoscopy in place of robotic technology. Residents can participate in laparoscopic sacral colpopexy cases with comparable operative times and favorable surgical outcomes.

EDITORIAL COMMENT

Placement of prophylactic mesh at the time of ileal conduit urinary diversion is a controversial topic. On one hand, prophylactic parastomal hernia mesh has been found to decrease the rate of clinically detected parastomal hernia with no mesh complications in randomized studies 1 Liedberg F. Kollberg P. Allerbo M. et al. Preventing parastomal hernia after ileal conduit by the use of a prophylactic mesh: a randomised study. Eur Urol. 2020; 78: 757-763 Google Scholar and, as the current authors find, the approach has been found to be cost effective. 2 Saha S. Gerdtham U. Bläckberg M. Kollberg P. Liedberg F. Cost effectiveness of the use of prophylactic mesh to prevent parastomal hernia after urinary diversion with an ileal conduit. Eur Urol Open Sci. 2022; 40: 9-15 Google Scholar , 3 Kanabolo D.P.S. Park S. Prophylactic mesh placement with ileal conduit: a cost effectiveness analysis. Urology. 2023; (S0090-4295(23)00368-0)https://doi.org/10.1016/j.urology.2023.03.041 Google Scholar On the other hand, placement of prophylactic parastomal hernia mesh is not widely adopted in clinical practice. One reason for lack of adoption may be because the absolute rate of symptomatic parastomal hernia repairs that require surgical intervention is low because interventions are limited to cases with complications from the parastomal hernia such as bowel or conduit obstruction or skin breakdown from pouching challenges. Consequently, it is unclear how prophylactic mesh placement impacts the span of patient experience with parastomal hernia, which may range from asymptomatic to life threatening. Currently, no urologic studies incorporate patient-reported outcome measures regarding stoma satisfaction or impact on daily functioning, though efforts are underway to address this question in colorectal collaborative groups. 4 Blackwell S. Pinkney T. Quality of life and parastomal hernia repair: the PROPHER study. Hernia. 2020; 24: 429-430 Google Scholar As such, a key question remains unanswered in the urologic literature: Does prophylactic parastomal hernia mesh placement improve long-term patient quality of life and decrease the need for parastomal hernia repair?

Prediction of Pelvic Organ Prolapse Postsurgical Outcome Using Biomaterial-Induced Blood Cytokine Levels: Machine Learning Approach.

Pelvic organ prolapse (POP) refers to symptomatic descent of the vaginal wall. To reduce surgical failure rates, surgical correction can be augmented with the insertion of polypropylene mesh. This benefit is offset by the risk of mesh complication, predominantly mesh exposure through the vaginal wall. If mesh placement is under consideration as part of prolapse repair, patient selection and counseling would benefit from the prediction of mesh exposure; yet, no such reliable preoperative method currently exists. Past studies indicate that inflammation and associated cytokine release is correlated with mesh complication. While some degree of mesh-induced cytokine response accompanies implantation, excessive or persistent cytokine responses may elicit inflammation and implant rejection. Here, we explore the levels of biomaterial-induced blood cytokines from patients who have undergone POP repair surgery to (1) identify correlations among cytokine expression and (2) predict postsurgical mesh exposure through the vaginal wall. Blood samples from 20 female patients who previously underwent surgical intervention with transvaginal placement of polypropylene mesh to correct POP were collected for the study. These included 10 who experienced postsurgical mesh exposure through the vaginal wall and 10 who did not. Blood samples incubated with inflammatory agent lipopolysaccharide, with sterile polypropylene mesh, or alone were analyzed for plasma levels of 13 proinflammatory and anti-inflammatory cytokines using multiplex assay. Data were analyzed by principal component analysis (PCA) to uncover associations among cytokines and identify cytokine patterns that correlate with postsurgical mesh exposure through the vaginal wall. Supervised machine learning models were created to predict the presence or absence of mesh exposure and probe the number of cytokine measurements required for effective predictions. PCA revealed that proinflammatory cytokines interferon gamma, interleukin 12p70, and interleukin 2 are the largest contributors to the variance explained in PC 1, while anti-inflammatory cytokines interleukins 10, 4, and 6 are the largest contributors to the variance explained in PC 2. Additionally, PCA distinguished cytokine correlations that implicate prospective therapies to improve postsurgical outcomes. Among machine learning models trained with all 13 cytokines, the artificial neural network, the highest performing model, predicted POP surgical outcomes with 83% (15/18) accuracy; the same model predicted POP surgical outcomes with 78% (14/18) accuracy when trained with just 7 cytokines, demonstrating retention of predictive capability using a smaller cytokine group. This preliminary study, incorporating a sample size of just 20 participants, identified correlations among cytokines and demonstrated the potential of this novel approach to predict mesh exposure through the vaginal wall following transvaginal POP repair surgery. Further study with a larger sample size will be pursued to confirm these results. If corroborated, this method could provide a personalized medicine approach to assist surgeons in their recommendation of POP repair surgeries with minimal potential for adverse outcomes.

P-065 SYNTHETIC MESH VERSUS BIOLOGICAL MESH TO PREVENT INCISIONAL HERNIA AFTER LOOP-ILEOSTOMY CLOSURE: A RANDOMIZED FEASIBILITY TRIAL

Abstract Aim Up to one third of patients experience incisional hernia after loop-ileostomy closure. Biological meshes have been commonly used in contaminated surgical sites instead of synthetic ones due to complication concerns, previous data on the subject does not support this practice. The aim of this study was to evaluate the safety and efficacy of synthetic mesh compared to a biological mesh in incisional hernia prevention after loop-ileostomy closure. Materials &amp; Methods A randomized, controlled, multi-center non-inferior feasibility trial was conducted from April 2018 – November 2021. Patients (n=102) were randomized 1:1 to receive either a light-weight synthetic polypropylene mesh (Parietene MacroTM, Medtronic) (SM) or a biological mesh (PermacolTM, Medtronic) (BM) to the retrorectus space at loop-ileostomy closure after anterior resection for rectal adenocarcinoma. The primary outcome was rate of surgical site infections (SSI) at 30-day follow-up and rate of incisional hernias at 10 months follow-up. Results In total, 102 patients were randomized, of which 97 received the intended allocation. Of patients in the SM group, 1/46 (2%) had SSI and in the BM group 2/48 (4%) had SSI (p&amp;gt;0.90) at 30 days follow-up. One patient from each group underwent reoperation requiring mesh removal (p&amp;gt;0.90). At 10 months follow-up, one patient (2%) in both groups had an incisional hernia on clinical examination (p&amp;gt;0.90) at 10 months follow-up. None of the patients had underwent reoperation due to mesh or wound-related complications. Conclusions Both a synthetic mesh and biological mesh were safe and effective in incisional hernia prevention after loop-ileostomy closure.

Needs assessment regarding management decision-making for women with stress urinary incontinence (SUI)

SUI affects 46% of adult women. Ongoing concerns with surgical treatments such as risks of mesh complications and chronic pain with mid-urethral slings have prompted a re-evaluation of the informed consent and decision-making process. We aimed to identify management decision needs of SUI-affected women.

Management of vaginal mesh complications—a UK plastic surgery perspective

Management of vaginal mesh complications—a UK plastic surgery perspective