Mesh Insertion Research Articles

Sex-Specific Gene Knockdown in Mouse Fetal Germ Cells.

Fetal germ cells are the precursors of oocytes and sperm. Gene function during germ cell sex differentiation is often studied through the production and analysis of transgenic and knockout models. However, these techniques are time and resource consuming. We have established a gene knockdown system for mouse fetal germ cells, combining electroporation (EP) and a germ cell culture method. GFP-positive male germ cells were isolated from 13.5 days post coitum (dpc) Oct4-GFP Tg gonads and transfected with shRNA vectors via EP. After EP, the germ cells were placed on mesh inserts and cultured for 2, 4 and 6 days. First, we examined knockdown of Gapdh, a housekeeping gene in male germ cells. Vectors with Gapdh shRNA sequences were transfected into the isolated male germ cells (1.5 –2 × 105 cells). Two days after EP, Gapdh expression in the transfected cells was successfully suppressed to 20% of the non-targeting controls. Next, we attempted knockdown of DNA methyltransferase-like (Dnmt3l). Dnmt3l is essential for establishing male-specific methylation imprints and its expression is initiated in the male germ cells by 15.5 dpc. Dnmt3l shRNA vectors were transfected into the male germ cells. Two days after EP, Dnmt3l expression in the transfected cells was drastically decreased to 10% of the non-targeting control. This level of suppression was stably maintained for 6 days in cultured germ cells. We next performed immunocytochemical staining for DNMT3L. Six days after EP, DNMT3L protein was clearly localized in the nuclei in the control cells. On the contrary, DNMT3L expression was not detected in the germ cells transfected with the Dnmt3l shRNA vector. These results demonstrate that our gene knockdown system should be an effective tool for functional analysis of sex-specific genes in fetal germ cells in vitro. This research was supported by the National Institutes of Health Grant P20RR024206 to YY, National Institutes of Health Grant G12RR003061 to YY, and NIH/NIDDK STEP-UP to SK.

Experimental Investigation on the Use of Wire Mesh Inserts and Structured Tubes in Thermosyphon Reboilers

AbstractEs werden experimentelle Untersuchungen zum Einsatz von Turbulenzpromotoren in Naturumlaufverdampfern vorgestellt. An einem Einrohr‐Naturumlaufverdampfer wurde das fluiddynamische und wärmetechnische Verhalten bei der Verdampfung von Wasser sowie eines Wasser/Glycerin‐Gemisches untersucht. Bei der Verdampfung von Wasser wurde insbesondere mit dem innenberippten Rohr eine Stabilisierung der Fluiddynamik und deutliche Erhöhung des Wärmeübergangs festgestellt. Für das Wasser/Glycerin‐Gemisch zeigte das Drahtgestrick‐Insert die besten Ergebnisse.

Assessment of Diffusion Operators in a Novel Moving Particle Method

In this study, solution effectiveness is assessed to gether with its accuracy and required computational cost for three diffusion operators in a newly developed moving-particle method (MPPM) to simulate incompressible flow. The salient feature in the present particle method is the insertion of a pressure mesh within the computational particle cloud to deal with the pressure-related operators in governing equations. Three formulations to realize the velocity diffusion operator are built on particle smoothing (PS), local mesh (LM), and smoothing difference (SD) procedures. Taylor-series analyses are performed to show their formal accuracy, which is also verified by a given two-dimensional solution profile with randomly scattered particle distributions. Solution accuracy and computational cost are evaluated by solving some classic benchmark problems in comparisons with available analytical, experimental, or numerical results. Based on the evidence drawn from numerical experiment, it is concluded that the local mesh (LM) formulation is most competitive, since it can provide as accurate result as SD; while SD requires much heavier computational load to yield an accurate solution.

Single-incision apical and posterior mesh repair: 1-year prospective outcomes

The objective of this study was to assess the safety and efficacy of the Elevate Apical and Posterior single-incision mesh system (SIMS) with IntePro Lite for pelvic organ prolapse repair. This prospective multicenter study included 139 women with ≥ stage II posterior vaginal prolapse and/or apical descent who underwent placement of type I polypropylene mesh through a single transvaginal incision with no external needle passes. Primary endpoint was the percent of patients with posterior and/or apical stage ≤ I ("cure") at follow-up. Secondary endpoints included, but were not limited to, rate of mesh extrusion and disease-specific quality of life outcomes. At 12 months, objective posterior wall and apical cure rates were 92.5 and 89.2 %, respectively, with an extrusion rate of 6.5 %. The SIMS appears to be effective and safe in treating patients with posterior vaginal and/or apical prolapse. The risks and benefits of transvaginal synthetic mesh insertion should be considered.

Induced Osteogenesis Using a New Periosteal Distractor

We developed a new device mainly composed of a titanium mesh to distract the periosteum. The purpose of this study is to evaluate induced osteogenesis by periosteal distraction with the new device. We divided 12 Japanese male rabbits into 3 groups, with 4 rabbits in each. In all groups the calvarial periosteum was reflected, and 1 side of the titanium mesh was fixed to the bone surface with 2 micro-screws. In groups 1 and 2, an elevation screw was inserted into a serrated hole on the other side of the plate 7 days after surgery. Then the device was activated at a rate of 0.5 mm every 12 hours for 5 days. At 4 weeks of the consolidation period, group 1 was killed, followed by group 2 at 6 weeks. Group 3 (control) received no screws, and hence no activation was performed. In group 3, 2 animals were killed 4 weeks after titanium mesh insertion, followed by the other 2 animals at 6 weeks. The device was designed to simultaneously distract the periosteum at different rates along its inclined surface. Newly formed bone was histologically and radiographically evaluated. The new device effectively induced osteogenesis and successfully distracted the soft tissue after 6 weeks in a rabbit model. The new device is slim, and the procedure is straightforward. Thus, periosteal distraction with this device can potentially be used for vertical and horizontal ridge augmentation in the oral cavity. In addition, the results suggest that connective tissue growth in the distraction site might be controlled by reducing the speed of periosteal distraction.

A three-incision approach to treat persistent vaginal exposure and sinus tract formation related to ObTape mesh insertion.

Mentor Corporation's ObTape has been associated with considerable morbidity. An unacceptably high exposure rate has been noted, and in some cases, multiple procedures may be necessary for complete mesh removal. We evaluated a patient who had prior ObTape placement complicated with persistent vaginal discharge and granulation tissue formation related to persistent mesh exposure (3Bc-T2-S2) followed by sinus tract formation (6Cd-T3-S3) according to the International Urogynecological Association Classification. We performed a three-incision approach (abdominal, vaginal, and groin) for the complete removal of the retained portion of the transobturator tape. This three-incision technique represents a viable option for removal of transobturator tape causing persistent clinical issues.

Outcomes and predictors of failure of trocar-guided vaginal mesh surgery for pelvic organ prolapse

The objective of the study was to compare the 1 year conventional and composite outcomes of trocar-guided vaginal mesh surgery and the identification of the predictors of failure. This was a prospective observational cohort study. Failure outcome definitions were as follows: I, prolapse stage II or greater in mesh treated compartments; II, overall prolapse stage II or greater; III, composite outcome of overall prolapse greater than the hymen and the presence of bulge symptoms or repeat surgery. We used logistic regression to identify predictors of failure. The results of the study were 1 year follow-up of 433 patients. Treated compartment failure (I) was 15% (95% confidence interval [CI], 12-19). Overall prolapse failure (II) was 41% (95% CI, 36-45). Composite failure (III) was 9% (95% CI, 7-13). Predictor of failure in all outcomes was the combined anterior/posterior mesh with the uterus in situ. Outcome of prolapse surgery depends on outcome definition. The mesh treated compartment failure outcome (I) and the composite failure outcome (III) appeared not to be statistically different. Consistent factor for failure in all outcomes was the combined anterior/posterior mesh insertion with the uterus in situ.

Development of de novo prolapse in untreated vaginal compartments after prolapse repair with and without mesh: a secondary analysis of a randomised controlled trial

To compare the de novo prolapse rate in the untreated vaginal compartments following conventional vaginal prolapse repair and tension-free vaginal mesh repair. Secondary analysis of a randomised controlled trial. Thirteen centres in the Netherlands. Women with recurrent pelvic organ prolapse stage II or higher. Random assignment to either conventional vaginal native tissue repair or vaginal mesh insertion. de novo pelvic organ prolapse stage II or higher in the untreated vaginal compartments at 12 months after surgery. de novo pelvic organ prolapse at and beyond the hymen, de novo prolapse beyond the hymen and prolapse domain scores of the Urogenital Distress Inventory. At 12 months ten of 59 women (17%) in the conventional group versus 29 of 62 women (47%) in the mesh group were diagnosed with a de novo pelvic organ prolapse stage II or higher in the untreated compartment (P < 0.001, odds ratio 4.3, 95% confidence interval 1.9-10.0). Additional apical support to a mesh-augmented anterior repair significantly reduced the de novo prolapse rate. Women with a de novo prolapse in the mesh-treated group demonstrated significantly higher mean bother scores on the domain genital prolapse of the Urogenital Distress Inventory score (13.1 ± 24.2) compared with those without de novo prolapse (2.9 ± 13.9) (P = 0.03). Mesh-augmented prolapse repair in only one vaginal compartment is associated with a higher de novo prolapse rate in the untreated compartments compared with conventional vaginal native tissue repair in women with recurrent pelvic organ prolapse.

Traumatic diaphragmatic ruptures: clinical presentation, diagnosis and surgical approach in adults.

Objective: Traumatic diaphragmatic injuries are rare, but potentially life-threatening due to herniation of abdominal organs into the pleural cavities. They can be easily overlooked on initial diagnostics and a high index of suspicion is required. The aim of this retrospective study was to analyze the clinical presentation, diagnostic methods and surgical management of patients with diaphragmatic rupture at our institution. Methods: A retrospective study was performed to analyze our experience with patients suffering from traumatic diaphragmatic rupture. Charts were reviewed for sex, age, side-location, concomitant injuries, time-to-diagnosis, diagnostic methods, surgical approach and outcome.Results: Fourteen patients (median age: 46 yrs, range 18–71, 9 male, 5 female) with diaphragmatic injuries (left side: 10, right side: 4) were treated between July 2003 and September 2011. Mechanism of injury was a penetrating trauma (14%), blunt trauma (50%) and others (36%). Associated abdominal injuries included spleen rupture (n=3), liver laceration (n=2), abdominal wall laceration (n=2) and gastric perforation (n=1). Computed tomography was the most sensitive diagnostic method. All patients underwent trans-abdominal repair of the diaphragmatic defect (direct suture: 10, prosthetic mesh insertion: 4). Associated abdominal procedures included splenectomy (n=3), liver packing (n=2), abdominal wall reconstruction (n=2) and partial gastric resection (n=1). Morbidity and hospital mortality rate were 36% and 0%, respectively. Median postoperative hospital stay was 17 days (range: 7–40 days). Conclusion: Morbidity and mortality of diaphragmatic ruptures are mainly determined by associated injuries or complications of diaphragmatic herniation like incarceration of viscera or lung failure. Early diagnosis helps to prevent severe complications. Spiral CT-scan is the most reliable tool for acute diagnosis of diaphragmatic rupture and associated visceral lacerations. Laparotomy is an adequate surgical approach for diaphragmatic repair, especially in cases of associated abdominal organ injury.

Outcome of Repeat Surgery for Genital Prolapse using Prolift-Mesh

Introduction: Urogenital prolapse can have a significant impact on quality of life. The life time risk of requiring surgery for urogenital prolapse is 11%. Prolift mesh has recently been introduced to reduce repeat operation rate and for long-term benefit Objective: To evaluate the outcome of the treatment of urogenital prolapse with synthetic mesh. Methods: A retrospective review of case notes of all women who underwent prolift mesh insertion for prolapse between July 2004 and June 2005, at Royal Alexandra Hospital Paisley UK. We looked at the presenting complaints, previous operation, intraoperative complications and complications at six weeks and six months follow-up. Results: Twenty-two procedures were carried out in the twelve months period. Age of the patients ranged from 55 to 82 years (median 64yrs). Eleven had anterior Prolift (50%), Seven had posterior Prolift 31.8% and four total Prolift 18%. There were no intraoperative complications. Operation times range from 40-60minutes, while the blood loss was 400millilitres on average. All the patients had previous surgery for prolapse. Eight patients had anterior repair, six patients had posterior repair, and three patients had abdominal hysterectomy. Vaginal hysterectomy was carried out with mesh insertion as a concomitant procedure in seven cases (31.25%).All patients were seen at six weeks and six months after the surgery. Complications rate included mesh erosion one patient and suture material protruding in the vagina one patient, one patient had failed prolift-operation. All the twenty-one patients were cured giving 95.4% success rate. Conclusion: The use of prolene mesh in repeat pelvic reconstructive surgery was associated with good outcome and minimal complications in this study.

One hundred percent fascial approximation can be achieved in the postinjury open abdomen with a sequential closure protocol

Multiple techniques have been introduced to obtain fascial closure for the open abdomen. Vacuum-assisted closure has reduced but not eliminated the use of either split-thickness skin grafts to cover the exposed bowel or mesh (prosthetic or biological) approximation of the fascia. We hypothesized that a sequential closure technique performed by a systematic protocol would achieve a higher rate of primary fascial closure than other described techniques. Our technique of sequential fascial closure was initiated in 2005. Patients with a postinjury open abdomen undergoing the technique were compared with those patients who did not follow the protocol. In brief, vacuum-assisted closure white sponges cover the bowel; the fascia is placed under moderate tension over the white sponges with no. 1-polydioxanone sutures; the black sponge is placed on top of this with the standard occlusive dressing; patients undergo partial fascial closure and replacement of the sponge sandwich every 2 days until completely closed. Protocol violations were defined as not returning to the operating room every other day and absence of fascial retention sutures. Patients who died before return to the operating room in the first 48 hours were excluded. One hundred consecutive patients underwent damage control surgery during the five-year study period and survived to second laparotomy; 49 patients attained fascial closure at the second laparotomy. Fifty-one patients required an open abdomen after the second laparotomy and comprise the study population. The majority were men (80%) with a mean age of 34.7 years ± 2.0 years, mean injury severity score of 37.1 ± 2.4, and mean abdominal trauma index of 26.4 ± 2.1. Average initial base deficit was 15.7 ± 0.6 and 24-hour red cell transfusions were 20.4 ± 2.4 units. Of the 51 patients, 29 followed the protocol and 100% had fascial closure. Of the 22 patients who did not follow the protocol, 12 (55%) attained fascial closure. There were no significant differences in injury severity score, abdominal trauma index, base deficit, or red cell transfusions between the two groups. A methodical approach with sequential fascial closure achieves 100% fascial approximation in our experience. This technique reduces the morbidity of the open abdomen and the cost of either complex abdominal reconstruction or biological mesh insertion.

A Moving Particle Method with Embedded Pressure Mesh (MPPM) for Incompressible Flow Calculations

An accurate moving particle method for incompressible flow calculations is presented in this article. The major distinctive feature in this proposition is the insertion of a pressure mesh within the particle cloud to handle the continuity constraint. It is motivated by the thought that pressure should be a field variable rather than a material one moving with fluid flow. Both the diffusion and convection operators are executed on the particle locations, while the projection operator to retain a convergence-free velocity field is manipulated on the inserted pressure mesh. It will yield a diagonally dominant and constant-coefficient matrix equation to update the pressure field. Besides the advantages gained to enforce the continuity constraint, the auxiliary mesh can significantly enhance the particle searching efficiency in the particle smoothing process. Numerical verifications on some benchmark problems indicate that the present proposition will provide accurate results for incompressible flow calculations.

Mesh infection after inguinal hernia mesh repair

Infection after repair of groin hernia is rare, even since the advent of mesh repair. The debate remains open about antibiotic prophylaxis. Assess incidence of this kind of complication, determine criteria of diagnosis and strategy of therapy by examining the collective experience of 32 surgeons. Fifty surgeons were asked to report their experience with mesh repair of inguinal hernias and specifically mesh infection. Diagnosis and therapy for each mesh infection were detailed. Forty-five cases were reported in 38 patients who had undergone open or laparoscopic mesh repair. Diagnosis was straightforward and established at a variable delay after mesh insertion: 51% during the first postoperative month; 26% more than one year after the procedure. Infection cured in 33 patients after mesh removal, in one step in 14 cases, but after many attempts for conservative therapy in 19 cases; the mean delay to cure was 12.5 months. Visceral resections had to be associated with mesh removal in 13% of cases. This is the largest series of mesh infections after inguinal hernia repair reported in the literature. According to the evidence provided here, mesh removal appears to be the most appropriate treatment of this rare and serious complication.

Sexual Function Following Trocar‐guided Mesh or Vaginal Native Tissue Repair in Recurrent Prolapse: A Randomized Controlled Trial

Surgical treatment of pelvic organ prolapse (POP) affects sexual function. Generally, this results in improved sexual function, but deterioration is reported also. The purpose of this study was to evaluate and compare sexual function in patients with recurrent POP undergoing either a vaginal surgical repair with native tissue or a trocar-guided mesh insertion. Sexually active patients randomly assigned to either native tissue repair or trocar-guided mesh insertion, which had completed the pelvic organ prolapse (POP)/urinary incontinence sexual questionnaire (PISQ-12) both at baseline and at 12 months, were included. Total, subscale, and individual question analysis were performed. Logistic regression was used to identify factors that were independently associated with improvement/deterioration in total PISQ-12 scores. Primary outcome was sexual function at 12 months following surgery, measured by the short form of the pelvic organ prolapse/urinary incontinence sexual questionnaire (PISQ-12). Secondary outcomes were the identification of factors independently associated with change in PISQ-12 scores and changes in individual PISQ-12 question scores. Sixty patients were included; 32 in the mesh arm and 28 in the native tissue arm. At 12 months, PISQ-12 scores were not different in both treatment arms (34.3, standard deviation [SD] 6.7 vs. 34.7, SD 5.7), but improvement was detected in the native tissue arm, whereas PISQ-12 total score remained unchanged in the mesh arm. Deteriorations were observed in the behavioral/emotive subscale and partner-related items in the mesh arm. In the native tissue arm, significant improvements in the physical and partner-related subscales were observed. The presence of mesh exposure was independently associated with deterioration in total PISQ-12 score. At 12 months, PISQ-12 scores were not different in either treatment arm, but were affected differently by trocar-guided mesh insertion or by native tissue repair. Mesh exposure was independently associated with deterioration in sexual function.

Risk Factors for Exposure, Pain, and Dyspareunia After Tension-Free Vaginal Mesh Procedure

To identify possible risk factors for exposure, dyspareunia, and pain after insertion of tension-free vaginal mesh in pelvic organ prolapse surgery. This was a prospective observational cohort study. Consecutive women who underwent surgery with a trocar-guided tension-free vaginal mesh kit were included and evaluated at 6 weeks and at 6 and 12 months after surgery with respect to anatomy and complications. Logistic regression analysis was performed to identify risk factors for exposure, dyspareunia, and pain. Two hundred ninety-four patients were included. Exposure was found in 34 patients (12%). Smoking and total mesh were risk factors for exposure (odds ratio [OR] 3.1, 95% confidence interval [CI] 1.1-8.7 and OR 3.0, 95% CI 1.2-7.0, respectively). Clinical and surgical experience were inversely related to the risk of exposure (OR 0.5, 95% CI 0.3-0.8 per decade). Pain (OR 3.2, 95% CI 1.2-8.4) and dyspareunia (OR 4.7, 95% CI 1.7-12.8) before surgery were predictive for pain and dyspareunia after surgery, respectively. Pain after surgery was found in 35 out of 275 (13%) patients and dyspareunia was found in 77 out of 171 (45%) patients. Smoking, total tension-free vaginal mesh, and experience were predictive factors for mesh exposure.

Panniculectomy: an alternative approach to the revision of a difficult stoma

We describe a modified abdominoplasty technique as an alternative approach to the revision of a difficult stoma. A patient with a retracted colostomy secondary to change in abdominal wall contour following significant weight loss was treated with this technique. The patient had previous colostomy revision with marlex mesh insertion for combined parastomal and massive ventral hernia repair. A preoperatively marked crescent shaped left upper quadrant segment of skin and subcutaneous fat was excised and the defect was approximated in multiple layers. This shifted the stoma opening cephalad and eliminated the cutaneous crease that originally made it difficult to obtain a proper stoma seal. At one year follow up the patient was extremely satisfied with the results and was able to properly pouch the stoma. Modified abdominoplasty can be used as an alternative, low morbid approach in dealing with selected patients with difficult stoma problems.

Trocar-Guided Mesh Compared With Conventional Vaginal Repair in Recurrent Prolapse: A Randomized Controlled Trial

OBJECTIVE: To compare efficacy and safety of trocar-guided tension-free vaginal mesh insertion with conventional vaginal prolapse repair in patients with recurrent pelvic organ prolapse. METHODS: Patients with recurrent pelvic organ prolapse stage II or higher were randomly assigned to either conventional vaginal prolapse surgery or polypropylene mesh insertion. Primary outcome was anatomic failure (pelvic organ prolapse stage II or higher) in the treated vaginal compartments. Secondary outcomes were subjective improvement, effects on bother, quality of life, and adverse events. Questionnaires such as the Incontinence Impact Questionnaire and Urogenital Distress Inventory were administered at baseline, 6 months, and 12 months. Anatomic outcomes were assessed by an unblinded surgeon. Power calculation with alpha=0.05 and beta=0.80 indicated that 194 patients were needed. RESULTS: Ninety-seven women underwent conventional repair and 93 mesh repair. The follow-up rate after 12 months was 186 of 190 patients (98%). Twelve months postsurgery, anatomic failure in the treated compartment was observed in 38 of 84 patients (45.2%) in the conventional group and in eight of 83 patients (9.6%) in the mesh group (P<.001; odds ratio, 7.7; 95% confidence interval, 3.3-18). Patients in either group reported less bulge and overactive bladder symptoms. Subjective improvement was reported by 64 of 80 patients (80%) in the conventional group compared with 63 of 78 patients (81%) in the mesh group. Mesh exposure was detected in 14 of 83 patients (16.9%). CONCLUSION: At 12 months, the number of anatomic failures observed after tension-free vaginal mesh insertion was less than after conventional vaginal prolapse repair. Symptom decrease and improvement of quality of life were equal in both groups. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00372190. LEVEL OF EVIDENCE: I.

Adipose tissue‐derived stromal cells protect hair cells from aminoglycoside

Previous studies have demonstrated the therapeutic paracrine activity of adipose tissue-derived stromal cells (ADSCs). This study aimed to examine the ADSC potential for protecting auditory hair cells from aminoglycoside toxicity via paracrine of multiple growth factors and cytokines. Experimental study. We assessed hair cell protection from neomycin toxicity by ADSC-derived factors using an explant culture system, in which cochlear explants and ADSCs were separated by a culture mesh insert to avoid direct contact. We measured the levels of growth factors and cytokines in ADSC culture media using an enzyme-linked immunosorbent assay (ELISA). Neomycin induced severe degeneration of auditory hair cells in cochlear explants, but co-culture with ADSCs significantly increased the number of surviving hair cells in explants. ELISA analysis revealed that ADSCs secreted insulin-like growth factor-1, nerve growth factor, vascular epithelial growth factor, transforming growth factor β1, monocyte chemotactic protein-1, and most prominently hepatocyte growth factor. These findings demonstrate that ADSCs have the capacity to protect auditory hair cells, and can be a useful strategy to develop therapy for deafness in the clinic. The multiple paracrine growth factors and cytokines secreted by ADSCs might be involved in this effect. Laryngoscope, 2011.

Trocar-Guided Mesh Compared With Conventional Vaginal Repair in Recurrent Prolapse

To compare efficacy and safety of trocar-guided tension-free vaginal mesh insertion with conventional vaginal prolapse repair in patients with recurrent pelvic organ prolapse. Patients with recurrent pelvic organ prolapse stage II or higher were randomly assigned to either conventional vaginal prolapse surgery or polypropylene mesh insertion. Primary outcome was anatomic failure (pelvic organ prolapse stage II or higher) in the treated vaginal compartments. Secondary outcomes were subjective improvement, effects on bother, quality of life, and adverse events. Questionnaires such as the Incontinence Impact Questionnaire and Urogenital Distress Inventory were administered at baseline, 6 months, and 12 months. Anatomic outcomes were assessed by an unblinded surgeon. Power calculation with α=0.05 and β=0.80 indicated that 194 patients were needed. Ninety-seven women underwent conventional repair and 93 mesh repair. The follow-up rate after 12 months was 186 of 190 patients (98%). Twelve months postsurgery, anatomic failure in the treated compartment was observed in 38 of 84 patients (45.2%) in the conventional group and in eight of 83 patients (9.6%) in the mesh group (P<.001; odds ratio, 7.7; 95% confidence interval, 3.3-18). Patients in either group reported less bulge and overactive bladder symptoms. Subjective improvement was reported by 64 of 80 patients (80%) in the conventional group compared with 63 of 78 patients (81%) in the mesh group. Mesh exposure was detected in 14 of 83 patients (16.9%). At 12 months, the number of anatomic failures observed after tension-free vaginal mesh insertion was less than after conventional vaginal prolapse repair. Symptom decrease and improvement of quality of life were equal in both groups. ClinicalTrials.gov, www.clinicaltrials.gov, NCT00372190. I.

Results from Over One Year of Follow-Up for Absorbable Mesh Insertion in Partial Mastectomy

PurposeRecently, several clinicians have reported the advantages of simplicity and cosmetic satisfaction of absorbable mesh insertion. However, there is insufficient evidence regardint its long-term outcomes. We have investigated the surgical complications and postoperative examination from the oncologic viewpoint.Materials and MethodsFrom February 2008 to March 2009, 34 breast cancer patients underwent curative surgery with absorbable mesh insertion in Samsung Medical Center. Patient characteristics and follow up results including complications, clinical and radiological findings were retrospectively investigated.ResultsThe mean age of the study population was 50.1±8.9 years old (range 31-82) with a mean tumor size of 3±1.8 cm (range 0.8-10.5), and the excised breast tissue showed a mean volume of 156.1±99.8 mL (range 27-550). Over the median follow-up period of 18±4.6 months (range 3-25), mesh associated complications, including severe pain or discomfort, edema, and recurrent fluid collection, occurred in nine patients (26.5%). In three cases (8.8%), recurrent mastitis resulted in mesh removal or surgical intervention. In the postoperative radiologic survey, the most common finding was fluid collection, which occurred in five patients (16.1%), including one case with organizing hematoma. Fat necrosis and microcalcifications were found in three patients (9.7%).ConclusionAbsorbable mesh insertion has been established as a technically feasible, time-saving procedure after breast excision. However, the follow-up results showed some noticeable side effects and the oncologic safety of the procedure is unconfirmed. Therefore, we suggest that mesh insertion should be considered only in select cases and should be followed-up carefully.