Mesh Devices Research Articles

Tacker Fixation versus Suturing of Mesh in Laparoscopic Inguinal Hernia Repair

Abstract Background Laparoscopic hernia repair is more difficult technically than open surgery and there is evidence of learning curve in its performance and many complications which reported from laparoscopic procedure is due to learning curve lead to operative complications. Objective To compare the outcome results of the fixation of mesh by intracorporeal sutures and by tackers in TAPP hernia repair. Patients and Methods In our study, 30 patients were included divided on two groups, 15 for each. Group A; fixation mesh with tackers, Group B; fixation mesh with intracorporeal sutures. Both groups were compared in terms of operative technique, operative time, mesh device fixation cost, intra & post operative complications, early post operative pain within two weeks and in first month, hospital stay, restriction of physical activity and incidence of recurrence and chronic pain. Results We found that using Intracorporeal sutures for fixation mesh is available, cheaper and more handle than using the Tackers which are expensive and less available so it makes a laparoscopic hernia more practical and decrease need for open surgery so we avoid the complication of open surgery. Both techniques are considered safe and effective with similar rates of recurrence and chronic pain although further wider scale studies are recommended. Conclusion TAPP hernia is considered safe as all perioperative complications are well tolerated by patients and mostly there was no need for a second operative intervention. Mesh fixation technique did not affect long-term persistent pain. A large number of patients reported persistent pain regardless of mesh fixation technique, which emphasizes the need for preoperative information. Preoperative pain was a risk factor for persistent pain. The optimal surgical approach must be selected individually for the patient, taking into account patient age, hernia size, unilateral or bilateral, primary or recurrent status, strangulation and type of anesthesia, occupation, and leisure activities. Both techniques are effective in the management of inguinal hernia and were associated with same recurrence rate. However, due to small sample size and short follow up duration, longer- term studies are also recommended.

Anatomical outcomes and complications of sacrocolpopexy using Surelift Uplift mesh: A multicentric observational study.

The study evaluated the anatomical and functional outcomes, as well as the safety data of laparoscopic sacrocolpopexy (LSC) for pelvic organ prolapse (POP) using a lightweight macroporous mesh. A multicentric observational study was developed including five expert centers between March 2011 and December 2019. Inclusion criteria were female patients with symptomatic ≥stage II POP (POP-Q classification), who underwent a LSC. A lightweight and macroporous mesh device (Surelift Uplift) was used. Baseline anatomical positions were evaluated using POP-Q stage. The anatomical outcomes and procedural complications were assessed during the postoperative period. Primary outcomes were anatomical success, defined as POP-Q stage ≤I, and subjective success, defined as no bothersome bulge symptoms, and no repeat surgery or pessary use for recurrent prolapse. A total of 325 LSCs were analyzed with a median patient age of 66 (interquartile range [IQR] 61-73). After a median follow-up of 68 months (IQR 46.5-89), anatomical success was found in 88.9%, whereas subjective success was seen in 98.5% of the patients. Recurrent prolapse presented as cystocele (1.5%). Reported complications were bladder (4.6%) or rectum lesions (0.6%), de novo urinary incontinence (12.9%), and mesh extrusion (1.2%). LSC provides significant clinical improvement and excellent anatomical results, with a low risk of serious complications for women with ≥2 grade POP in a real clinical practice setting.

CORRELATE OF SOCIO-ECONOMIC CHARACTERISTICS AND USE OF ANTI-BURGLARY DEVICES IN RESIDENTIAL AREA OF OGBOMOSO, NIGERIA

This study examines relationship between the residents’ Socio-economic Status (SeS) and choices in the adoption of anti-burglary devices across the residential zones of Ogbomoso City. It surveys households’ houses and their environments across the Core, Intermediate and Suburb residential zones of the study area. The variables used to examine the analysis of installed anti-burglary devices include the adoption of iron / steel bar, electronic devices, wire mesh, ethno-medical, and others. The examination of the aforementioned devices in relation to the socio-economic status of residents using Spearman’s rho Correlation analysis revealed that there is positive correlation between monthly income of residents and all the housing anti-burglary devices adopted with the p-values of 0.000, 0.010, 0.000, and 0.014 for Iron/steel bar, electronic devices, wire mesh and ethno-medical devices respectively. It further revealed that education has a significant correlation but negative with ethno-medical devices due to the p-value of 0.051and r-value of -0.070. This implies that increase in education reduces the use of ethno-medical devices in the study area. The study concluded that Socio-economics Status of residents have a great influence on the type and choice of anti-burglary devices adopted in the fight against residential burglary and home invasion across the City.

Automated dispensing and fractionation of nanoparticles and viral vectors through a quantitative nanopore mesh device

Automated dispensing and fractionation of nanoparticles and viral vectors through a quantitative nanopore mesh device

The transvaginal mesh class action: a tertiary teaching hospital experience of all mid-urethral sling procedures performed between 1999 and 2017.

Class action against Ethicon (J&J), manufacturer of transvaginal mesh devices, including mid-urethral slings (MUS), was brought to the Federal Court of Australia in 2016 by Shine Lawyers. As a result, subpoenas to all hospitals and networks were received, which overrode patient privacy concerns. This medical record search allowed a complete audit and communication with patients to offer clinical review. This enabled a review of complications, readmission and re-operation for women who underwent a MUS for stress urinary incontinence. A cohort study of women who underwent MUS treatment for stress urinary incontinence (SUI) at a single tertiary teaching hospital between 1999 and 2017 was carried out. The main outcome measures were the rate of readmission and re-operation following MUS procedures. These include voiding dysfunction managed by sling loosening or sling division, mesh pain or exposure managed by mesh removal and reoperation for recurrent stress urinary incontinence. Between 1999 and 2017, a total of 1,462 women were identified as having a MUS; of these, 1,195 (81.7%) had full patient records available. Voiding dysfunction requiring surgical intervention with sling loosening or division was 3%, excision for mesh exposure was 2%, and partial or complete excision for pain was 1% at a median of 10 years from index surgery. The reoperation rate for recurrent stress urinary incontinence was 3%. This audit of all MUS procedures performed at a tertiary centre confirms an overall low rate of readmission for complications and recurrent SUI surgery; this justifies its continued availability with appropriate informed consent.

An expanding horizon: Recyclable dual-functional size-adjusted fluorinated mesh devices for large-scale oily wastewater remediation

The general lack of water resources makes the treatment of oily wastewater as an urgent concern, which causes catastrophic damage to ecosystems and environment. Construction of a universal oil/water separator is not an easy task, because the reported processes are relatively complex and it is difficult to achieve industrial large-scale production. To overcome this problem, herein, using the low-cost and frequently-used metal (stainless steel, etc.) meshes as raw materials, two kinds of oil/water separators with different moving models have firstly designed via a universal technique of a facile chemical etching and fluoridation coating process. The newly synthesized superhydrophobic/superoilphilic stainless steel or copper mesh with surface morphology, high purity and structure stability displayed an excellent anti-wetting property (high water contact angle of >157°) after a series of tests of immersion, droplet rolling-off, anti-impacting process, 30days exposure aging in open-air, etc. In addition, experimental results revealed that the fresh and aging separators can maintain excellent oily wastewater remediation efficiency up to ∼99% even after 25 separation cycles, making them economical and commercially viable. This study provides a novel perspective for advancement in designing oil/water separator with low cost, less energy consumption and high efficiency for universal application.

OC-073 THE 3-D FUNNEL MESH TECHNIQUE FOR PARASTOMAL HERNIA REPAIR

Abstract Background In previous studies, three-dimensional funnel mesh devices have been used successfully for the repair of PSHs by combining a laparoscopic and ostomy-opening approach Methods We performed an analysis of prospectively collected data of patients who underwent a same-sided stoma reposition with 3D funnel-shaped mesh augmentation in intraperitoneal- onlay position at three departments between the years of 2012 and 2021. 56 patients received an implant with 2.5 cm funnel length and 25 patients with 4cm funnel length. Primary outcome parameters were surgical complications and recurrence rate. Results 81 patients could be included in this analysis. PSH repair was performed in 91% as elective surgery and in 87% in laparoscopic technique. A concomitant incisional hernia (EHS type 2 and 4) was found in 39% and repaired in a single-step procedure with PSH. Major postoperative complications requiring redo surgery were identified in 9.8% (8/81). Overall recurrence rate was 11% (9/81). Only 1 recurrence occurred in the group of 4 cm long implants (1/25= 4%). Median follow-up time was 44 months, and a 1-year follow-up rate of 91.4% was reached. Conclusion PSH repair with 3D funnel mesh in IPOM technique is safe, efficient and easy to perform providing advantageous results compared to other techniques. However the origin mesh funnel (2.5cm length) becomes shortened over time and further shrinkage happens eccentric concerning the flat mesh parts widening the funnel. Changing mesh construction according to consequently use the narrowest funnel (2cm) and it`s lengthening to 4cm led to reduction in recurrence without increasing implant-associated complications

SJLA_2024_A16: Unusual Complications of Open Preperitoneal Tension-Free Inguinal Hernia Repair

Background: The purpose of this study is to report two patients referred to our hospital after developing unusual complications attributed to prior open preperitoneal tension-free inguinal hernia repair. Methods: Case # 1 A 75-year-old male developed a left proximal thigh abscess requiring incision and drainage 5 years after open prosthetic, preperitoneal inguinal hernia repair with single-layer mesh. A pelvic computed tomography (CT) scan demonstrated an abscess in the left inguinal preperitoneal space as well as diverticulosis but no diverticulitis. A colonoscopy was negative for any additional findings. The patient underwent groin exploration, debridement of the inguinal canal and sinus tract, and mesh resection followed by JP drain placement. The inguinal defect was repaired utilizing the should ice technique. Intraoperative cultures revealed penicillin-resistant Staphylococcus aureus. The drain was removed on postoperative day nine, and his recovery remains uneventful without hernia recurrence or infectious complications at 11-month follow-up. Case # 2 An 82-year-old man developed progressive left lower extremity edema and disabling claudication 1 month after open prosthetic inguinal hernia repair with a bilayer disc mesh. Venous duplex imaging revealed compression of the left common femoral and external iliac veins. A CT angiogram demonstrated left external iliac and common femoral artery thrombosis and a 5.2 cm fluid collection consistent with hematoma. An inferior vena cava filter was placed. The common femoral artery was controlled after initial exploration revealed a common femoral artery pseudoaneurysm. The mesh was densely adherent to the external iliac vein and was thus not resected. The common femoral artery pseudoaneurysm was repaired and the profunda femoris artery over sewn. An external iliac to superficial femoral artery 8 mm Polytetrafluoroethylene bypass graft was placed. The patient was discharged on systemic anticoagulation without claudication on postoperative day thirteen. Results: Laparoscopic inguinal hernia repair and novel, open techniques and mesh devices have popularized the placement of mesh in the preperitoneal space. Acute, severe vascular complications and latent infectious complications can occur after open, preperitoneal tension-free inguinal hernia repair and may require remedial surgery. CT scans and angiogram pictures are available. Discussion: Laparoscopic inguinal hernia repair and novel, open techniques and mesh devices have popularized the placement of mesh in the preperitoneal space. Acute, severe vascular complications and latent infectious complications can occur after open, preperitoneal tension-free inguinal hernia repair and may require remedial surgery. CT scans and angiogram pictures are available. Conclusion: Laparoscopic inguinal hernia repair and novel, open techniques and mesh devices have popularized the placement of mesh in the preperitoneal space. Acute, severe vascular complications and latent infectious complications can occur after open, preperitoneal tension-free inguinal hernia repair and may require remedial surgery. CT scans and angiogram pictures are available.

Anti-adhesive bioresorbable elastomer-coated composite hernia mesh that reduce intraperitoneal adhesions

Intraperitoneal adhesions (IAs) are a major complication arising from abdominal repair surgeries, including hernia repair procedures. Herein, we fabricated a composite mesh device using a macroporous monofilament polypropylene mesh and a degradable elastomer coating designed to meet the requirements of this clinical application. The degradable elastomer was synthesized using an organo-base catalyzed thiol-yne addition polymerization that affords independent control of degradation rate and mechanical properties. The elastomeric coating was further enhanced by the covalent tethering of antifouling zwitterion molecules. Mechanical testing demonstrated the elastomer forms a robust coating on the polypropylene mesh does not exhibit micro-fractures, cracks or mechanical delamination under cyclic fatigue testing that exceeds peak abdominal loads (50 N/cm). Quartz crystal microbalance measurements showed the zwitterionic functionalized elastomer further reduced fibrinogen adsorption by 73% in vitro when compared to unfunctionalized elastomer controls. The elastomer exhibited degradation with limited tissue response in a 10-week murine subcutaneous implantation model. We also evaluated the composite mesh in an 84-day study in a rabbit cecal abrasion hernia adhesion model. The zwitterionic composite mesh significantly reduced the extent and tenacity of IAs by 94% and 90% respectively with respect to uncoated polypropylene mesh. The resulting composite mesh device is an excellent candidate to reduce complications related to abdominal repair through suppressed fouling and adhesion formation, reduced tissue inflammation, and appropriate degradation rate.

Biomimetic Transparent Nanoplasmonic Meshes by Reverse-Nanoimprinting for Bio-Interfaced Spatiotemporal Multimodal SERS Bioanalysis.

Multicellular systems, such as microbial biofilms and cancerous tumors, feature complex biological activities coordinated by cellular interactions mediated via different signaling and regulatory pathways, which are intrinsically heterogeneous, dynamic, and adaptive. However, due to their invasiveness or their inability to interface with native cellular networks, standard bioanalysis methods do not allow in situ spatiotemporal biochemical monitoring of multicellular systems to capture holistic spatiotemporal pictures of systems-level biology. Here, a high-throughput reverse nanoimprint lithography approach is reported to create biomimetic transparent nanoplasmonic microporous mesh (BTNMM) devices with ultrathin flexible microporous structures for spatiotemporal multimodal surface-enhanced Raman spectroscopy (SERS) measurements at the bio-interface. It is demonstrated that BTNMMs, supporting uniform and ultrasensitive SERS hotspots, can simultaneously enable spatiotemporal multimodal SERS measurements for targeted pH sensing and non-targeted molecular detection to resolve the diffusion dynamics for pH, adenine, and Rhodamine 6G molecules in agarose gel. Moreover, it is demonstrated that BTNMMs can act as multifunctional bio-interfaced SERS sensors to conduct in situ spatiotemporal pH mapping and molecular profiling of Escherichia coli biofilms. It is envisioned that the ultrasensitive multimodal SERS capability, transport permeability, and biomechanical compatibility of the BTNMMs can open exciting avenues for bio-interfaced multifunctional sensing applications both in vitro and in vivo.

A time-dependent offset field approach to simulating realistic interactions between beating hearts and surgical devices in virtual interventional radiology.

Endovascular interventional radiology (IR) is a minimally invasive procedure for the treatment of vascular diseases. This procedure requires physicians to be highly skilled at manipulating interventional devices under the guidance of two-dimensional X-ray imaging. By offering a non-error-sensitive and radiation-free environment, a virtual reality-based simulator provides a promising alternative for surgical skills training and surgery planning. Building a realistic and interactive simulator is a challenging task. To achieve better realism, this paper proposes a novel method of simulating the heartbeat for both standard and patient-specific anatomical data. A time-dependent offset field approach is proposed to efficiently and stably simulate the interactive behavior between the dynamic heart mesh and surgical devices. For medical imaging simulation, we propose a GPU-based linear depth subtraction method to approximate fluoroscopic images based on the attenuation of the X-ray. On this basis, a topology-based flow map method is proposed to simulate the propagation of the contrast medium in angiography. Experimental results show that the proposed algorithm can simulate heartbeat stably for meshes with varying geometrical shapes and complexities. In efficiency, the dynamic heart mesh can interact with surgical devices stably at 60 frames/s. Under the simulated fluoroscopic imaging effect, the injected contrast medium can realistically visualize both dynamic and static vessels. In a face validity by medical students and clinicians, the category of effectiveness score 8.35 out of 10 on average, demonstrating that our simulator is useful in surgical skills training and surgery planning.

Effect of Poly-L-Lactic Acid Mesh Augmentation on Cyclic Gap Formation in Transosseous Patellar Tendon Repair: A Biomechanical Study.

No previous study has investigated poly-L-lactic acid (PLLA) surgical mesh augmentation in the repair of inferior pole patellar tendon rupture. We compared the biomechanical properties of transosseous patellar tendon repair with PLLA surgical mesh augmentation to transosseous repair without augmentation. Ten matched pairs of cadaveric knees were used. Specimens in each pair were randomized to undergo the transosseous technique alone or the transosseous technique augmented with a PLLA surgical mesh. An inferior pole patellar tendon rupture was simulated and the repair procedure was performed. Specimens were cyclically loaded for 500 cycles. Gap formation was measured using two sensors placed medial and lateral to the repair site. After cyclic loading, load to failure was determined by pulling the tendon at a constant rate until a sudden decrease in load occurred. The primary outcome measure was cyclic gap formation at the medial and lateral sensors. Compared with controls, specimens that underwent PLLA mesh-augmented repair had significantly lower medial gap formation at all testing intervals up to 500 cycles (p < 0.05) and significantly lower lateral gap formation at all testing intervals from 10 to 500 cycles (p < 0.05). Transosseous patellar tendon repair augmented with a PLLA woven mesh device provided significantly greater resistance to gap formation compared with transosseous repair alone. These results suggest that PLLA mesh augmentation of the transosseous technique is biomechanically effective for patellar tendon repair.

Terahertz Plasmonic Sensor Based on Metal-Insulator Composite Woven-Wire Mesh.

Terahertz (THz) spectroscopy has been proven as an effective detection means for the label-free and nondestructive sensing of biochemical molecules based on their unique roto-vibrational transitions. However, the conventional THz spectroscopic system is unsuitable for minute material sensing due to its far-field detection scheme, low sample amount, and lack of spectral characteristics, leading to low absorption cross-sections and sensitivity. In this study, a 3D plasmonic structure based on a metal-coated woven-wire mesh (MCWM) was experimentally and numerically demonstrated for sensing trace amounts of analytes combined with THz spectroscopy. Dual sharp spectral features were exhibited in the transmission spectrum, originating from the resonant excitation of THz surface electromagnetic modes via the aperture and periodicity of the MCWM unit cell. According to the finite element simulation, an enhanced and localized surface field was formed at THz resonant frequencies and was concentrated at the metal gaps near the periodic corrugations of the MCWM, resulting in enormous resonant dip shifts caused by the tiny variations in membrane thicknesses and refractive indices. Different types and quantities of analytes, including hydrophilic biopolymer (PAA) membrane, nonuniformly distributed microparticles to mimic macro-biomolecules or cells, and electrolyte salts of PBS, were successfully identified by the MCWM sensor with the best thickness and refractive index sensitivities approaching 8.26 GHz/μm and 547 GHz/RIU, respectively. The demonstrated detection limit of thickness and molecular concentration could respectively achieve nanometer and femtomolar scales in PAA macromolecular detection, surpassing the available metallic mesh devices. The MCWM-based sensing platform presents a rapid, inexpensive, and simple analysis method, potentially paving the way for a new generation of label-free microanalysis sensors.

Aqueous dispersions of oxygen nanobubbles for potential application in inhalation therapy

Inhalation is a non-invasive method of local drug delivery to the respiratory system. This study analyzed the potential use of aqueous dispersion of oxygen nanobubbles (ADON) as a drug carrier with the additional function of oxygen supplementation to diseased lungs. The suitability of the membrane-based method of ADON preparation and, next, the stability of ADON properties during storage and after aerosolization in nebulizers of various designs (jet, ultrasonic, and two vibrating mesh devices) was investigated. The increased oxygen content in the aerosol generated in two mesh nebulizers suggests that the proposed concept may be helpful in the oxygen supplementation during drug delivery by aerosol inhalation without using an additional oxygen source. This application can increase the overall effectiveness of lung disease treatment and pulmonary rehabilitation.

A feasibility study on the application of mesh grids for heliostat wind load reduction

This study examines the effectiveness of mesh grids in heliostat field perimeter fences and edge-mounted devices for heliostat wind load reduction. Two experimental studies were conducted: (1) the effect of mesh porosity and non-dimensional longitudinal distance of a perimeter fence upstream on the forces on a heliostat, and (2) the effect of mesh porosity and non-dimensional height-chord ratio of a heliostat edge-mounted mesh device on the heliostat loads. The experiments were conducted using an instrumented heliostat model positioned in the atmospheric test section of the Adelaide Wind Tunnel. It was found that perimeter mesh fences reduce peak loads by up to 50% and edge-mounted porous mesh devices reduce peak loads by up to 30% at the expense of increasing loads at different elevation angles. The porosity and height-chord ratio of an edge-mounted mesh were found to be important parameters influencing the maximum drag and lift reductions in operating and stow positions. The results of this work show the potential of mesh grids for reducing wind load on heliostats, and the importance of conducting a detailed techno-economic analysis on mesh grids throughout a heliostat field. The application of mesh grids on commercial-scale heliostats requires a further evaluation of the reduction of heliostat wind loads and thus cost of a field through mitigation of the incoming ABL turbulence and wake-induced turbulence from upstream heliostats.

Analysis of Environmental and Pathogenic Bacteria Attached to Aerosol Particles Size-Separated with a Metal Mesh Device.

Metal mesh devices (MMDs) are novel materials that enable the precise separation of particles by size. Structurally, MMDs consist of a periodic arrangement of square apertures of characteristic shapes and sizes on a thin nickel membrane. The present study describes the separation of aerosol particles using palm-top-size collection devices equipped with three types of MMDs differing in pore size. Aerosols were collected at a farm located in the suburbs of Nairobi, Kenya; aerosol particles were isolated, and pathogenic bacteria were identified in this microflora by next-generation sequencing analysis. The composition of the microflora in aerosol particles was found to depend on particle size. Gene fragments were obtained from the collected aerosols by PCR using primers specific for the genus Mycobacterium. This analysis showed that Mycobacterium obuense, a non-tuberculous species of mycobacteria that causes lung diseases, was present in these aerosols. These findings showed that application of this MMD analytical protocol to aerosol particles can facilitate the investigation of airborne pathogenic bacteria.

A collagen membrane for periosteal expansion osteogenesis using a timed-release system in rabbit calvaria

BackgroundThe purpose of this study was to evaluate the effects of resorbable membranes, combined with a shape memory alloy (SMA) mesh device, on bone formation using a timed-release system for periosteal expansion osteogenesis (TIME-PEO).Materials and methodsTwelve Japanese white rabbits were used in this study. An SMA device was inserted under the forehead periosteum, pushed and bent for attachment to the bone surface, and then fixed using resorbable thread. The rabbits were divided into four groups: C1 (5 weeks postoperatively without membrane), C2 (8 weeks postoperatively without membrane), E1 (5 weeks postoperatively with membrane), and E2 (8 weeks postoperatively with membrane). The rabbits were killed 5 or 8 weeks after the operation and the newly formed bone was assessed histologically and radiographically.ResultsSMA devices, concealed under soft tissue until the time of euthanasia, did not cause active inflammation. The mean activation height, from the original bone surface to the midpoint of the mesh, was 3.1 ± 0.6 mm. Newly formed bone was observed, and most of the subperiosteal space underneath the device was occupied by fibrous tissue. Immature bone was present at the outer surface of the original skull bone in all groups. On histomorphometric analysis, there was no significant difference in the volume of the new bone between C1 and E1 (p = 0.885), and C2 and E2 (p = 0.545).ConclusionsPEO using an SMA mesh device, which is based on guided bone regeneration (in atrophic alveolar bone), shows promise as an alternative for bone augmentation, irrespective of whether a resorbable membrane is used.

High survival of bovine mature oocytes after nylon mesh vitrification, as assessed by intracytoplasmic sperm injection.

Intracytoplasmic sperm injection (ICSI) is an alternative technique to in vitro fertilization (IVF) for producing transferable blastocysts, especially in combination with cryopreserved oocytes, when the IVF system does not work sufficiently. The present study was conducted to directly compare the efficacy of producing bovine blastocysts by ICSI and IVF from vitrified-warmed and fresh oocytes. Denuded oocytes with a detectable first polar body were vitrified-warmed using a nylon mesh device. In the non-vitrified control group, blastocyst yields 8 days after IVF and ICSI were 32.0 and 26.8%, respectively. Oocyte vitrification and subsequent IVF resulted in an impaired blastocyst yield (15.0%); however, such a loss of efficacy due to vitrification was not observed in the ICSI group (blastocyst yield, 25.2%). The alignment of cortical granules beneath the oolemma was comparable between the fresh control and vitrified-warmed oocytes. Here, we report the high survival of vitrified-warmed bovine oocytes, as assessed by ICSI.

The Long-Term Impact of Vaginal Surgical Mesh Devices in UK Primary Care: A Cohort Study in the Clinical Practice Research Datalink.

PurposeStress urinary incontinence (SUI) and pelvic organ prolapse (POP) may be treated with surgical mesh devices; evidence of their long-term complications is lacking.Patients and MethodsRates of diagnoses of depression, anxiety or self-harm (composite measure) and sexual dysfunction, and rates of prescriptions for antibiotics and opioids were estimated in women with and without mesh surgery, with a diagnostic SUI/POP code, registered in the Clinical Practice Research Datalink (CPRD) gold database.ResultsThere were 220,544 women eligible for inclusion; 74% (n = 162,687) had SUI, 37% (n = 82,123) had POP, and 11% (n = 24,266) had both. Women undergoing mesh surgery for SUI or POP had about 1.1 times higher rates of antibiotic use. Women with no previous history of the outcome, who underwent mesh surgery had 2.43 (95% CI 2.19–2.70) and 1.47 (95% CI 1.19–1.81) times higher rates of depression, anxiety, or self-harm, 1.88 (95% CI 1.50–2.36) and 1.64 (95% CI 1.02–2.63) times higher rates of sexual dysfunction and 1.40 (95% CI 1.26–1.56) and 1.23 (95% CI 1.01–1.49) times higher opioid use for SUI and POP, respectively. Women with a history of depression, anxiety and self-harm had 0.3 times lower rates of these outcomes with SUI or POP mesh surgery (HR for SUI 0.70 (95% CI 0.67-0.73), HR for POP 0.72 (95% CI 0.65-0.79)). Women with a history of opioid use who had POP mesh surgery had about 0.09 times lower rates (HR 0.91 (95% CI 0.86–0.96)) of prescriptions. Negative control outcome analyses showed no evidence of an association between asthma consultations and mesh surgery in women with POP, but the rate was 0.09 times lower (HR 0.91 (95% CI 0.87–0.94)) in women with SUI mesh surgery, suggesting that study results are subject to some residual confounding.ConclusionMesh surgery was associated with poor mental and sexual health outcomes, alongside increased opioid and antibiotic use, in women with no history of these outcomes and improved mental health, and lower opioid use, in women with a previous history of these outcomes. Although our results suggest an influence of residual confounding, careful consideration of the benefits and risk of mesh surgery for women with SUI or POP on an individual basis is required.

O46 SUTURABLE MESH IMPROVES OUTCOMES FOR LAPAROTOMY CLOSURE IN COMPARISON TO POLYPROPYLENE SUTURE IN A REALISTIC PORCINE MODEL

Abstract Aim Laparotomy closures fail due to suture pull-through. We hypothesize that a novel suturable mesh device may limit pull-through via mechanisms of force distribution at the suture-tissue interface and fibrous encapsulation of the device filaments. This new tissue approximation device may lead to improved outcomes for laparotomy closure. Material and Methods Fifteen domestic swine 74 kg in size were randomly allocated to three groups for epigastric laparotomy closure with either size 0 suturable mesh, number 1 suturable mesh, or number 1 polypropylene. All three devices were placed in running fashion with 1 cm bites and 1 cm travels. Primary endpoints were hernia formation at 13 weeks and a semiquantitative analysis of the histological tissue response. Secondary endpoints included adhesions, surgical site occurrence (SSO), and documentation of “loose sutures”. Results There were numerically fewer hernias in the number 1 suturable mesh group. Nine of the 10 suturable mesh devices were well encapsulated within the tissues and could not be pulled away, while 4 of the 5 polypropylene sutures were loose. Adhesions were least for number 1 suturable mesh. Histologically, the suturable mesh implanted devices showed good fibrovascular ingrowth and were judged to be “non-irritants”. The soft tissue response was statistically greater (p = .006) for the number 1 suturable mesh than for the number 1 polypropylene. Conclusions The mechanism of how meshes support closure sites is clearly demonstrated with this model. Suturable mesh has the potential to change surgical algorithms for abdominal wall closure.