Monofilament Polypropylene Mesh Research Articles

Low-Weight Polypropylene Mesh for Anterior Vaginal Wall Prolapse

To compare anterior colporrhaphy with and without a tailored mesh. Postmenopausal women with anterior vaginal prolapse to the hymen or beyond were randomly assigned to undergo traditional anterior colporrhaphy alone or reinforced with mesh. The low-weight monofilament polypropylene mesh was self-tailored, having four arms and being placed over the plicated fascia. Before and 2 and 12 months after surgery, participants were evaluated by physical examination, postvoidal residual urine measurement and standard questions covering prolapse-related symptoms. The primary outcome was recurrence of anterior vaginal prolapse at 12 months. Secondary outcomes included operative complications, symptom resolution, and postvoidal urine residual volume. Of the 202 women randomly assigned, 201 were operated on (97 without, 104 with mesh). Thirty-seven women (38.5%) in the no-mesh and seven (6.7%) in the mesh group experienced a recurrence of anterior wall prolapse (P<.001) at 12 months; as a result, the number needed to treat for benefit was four. The mean (standard deviation) postvoidal residual urine volume was lower in patients with mesh than in those undergoing the traditional operation: 25 (26) mL and 41 (57) mL (P=.01). Twenty-three women (23%) with mesh and 9 (10%) with no mesh reported stress urinary incontinence (P=.02). In 18 (17.3%), exposure of the mesh was noted, mainly asymptomatic. Anterior colporrhaphy, reinforced with, tailored mesh significantly reduced the rate of recurrence of anterior vaginal wall prolapse compared with the traditional operation, but was associated more often with stress urinary incontinence.

Follow-up after polypropylene mesh repair of anterior and posterior compartments in patients with recurrent prolapse

To retrospectively analyze the outcome of surgery in women followed up for 1 year after vaginal repair with the Apogee (support of posterior vaginal wall) or Perigee (support of anterior vaginal wall) system. A total of 120 patients with recurrent cystocele and/or rectocele or with combined vaginal vault prolapse were treated by either posterior or anterior mesh interposition depending on the defect. Follow-up after 1 year (+/-31 days) comprised a vaginal examination with prolapse grading using the POP-Q system, measurement of vaginal length, evaluation of the vaginal mucosa, and exploration for mesh erosions. Postoperatively, 112 (93%) women were free of vaginal prolapse, whereas 8 (7%) had level 2 defects. Erosions occurred significantly more often (p = 0.042) in patients treated with the Perigee system. Our results suggest that the Apogee and Perigee repair systems (monofilament polypropylene mesh) yield excellent short-term results after 1 year.

Vaginal erosion after hybrid midurethral sling placement

Midurethral polypropylene slings are popular procedures for the treatment of stress urinary incontinence in women. Several commercially manufactured sling kits are available that use proprietary monofilament polypropylene mesh placed between the vaginal wall and midurethral segment. The BioArc sling system is a hybrid sling system that uses polypropylene mesh for fixation and autologous fascia for suburethral support. We report what we believe to be the first case of vaginal erosion after midurethral sling placement using this hybrid system.

Is the Lichtenstein Operation of Strangulated Groin Hernia a Safe Procedure?

In spite of many published articles describing the hernia repairs, there are only a few original reports concerning the polymer mesh application during emergency procedures for strangulated inguinal hernias. The aim of our study was to evaluate the results of the Lichtenstein and Bassini operations for strangulated groin hernias and to show the changing number of the tension-free repairs. From 1997 to 2004, the Bassini procedure was performed in 21 patients, 6 of whom underwent small intestine resection and 2 others required resection of the necrotic omentum. The strangulated intestinal loop or omentum were released in 13 cases. After the repair 1 patient died of shock caused by intestinal necrosis. Of 56 patients who underwent an emergency Lichtenstein procedure, 55 were followed-up. A small intestine resection was performed in 2 cases to correct segmental necrosis. The gangrenous omental appendix of the sigmoid colon was excised in 1 patient, and necrotic omental fragments were resected in 2 cases. The strangulated intestinal loop or omentum was released in 51 patients. All patients were given wide-spectrum antibiotics intravenously. Between 1997 and 2000 tension-free procedures were performed in half of the patients undergoing emergency operation for strangulated hernia; between 2001 and 2004 such procedures were employed in more than 90% of the cases. In 2 patients we observed a small inflammatory infiltration of the wound that resolved within several days after Lichtenstein repair. A serous fluid collection was present in 2 cases. The treatment consisted of puncture and was successful in both cases. The use of monofilament polypropylene mesh for strangulated inguinal hernia repair is safe, and the risk of the local infectious complications is low.

Mesh augmentation during pelvic-floor reconstructive surgery: risks and benefits

Synthetic meshes are increasingly used in the surgical management of stress urinary incontinence and pelvic-organ prolapse in an attempt to improve success rates and increase the longevity of repairs. This review describes and analyses complications following pelvic-floor procedures employing synthetic meshes. Type I monofilament polypropylene mesh with a large pore size is currently the mesh of choice. Chronic inflammation is a typical host response, whereas acute inflammation and predominant CD20+ lymphocyte infiltration represent an adverse host reaction and may result in defective healing. Mesh properties influence the performance and complication rate. Mesh-related complications after midurethral slings and mesh sacrocolpopexies with monofilament polypropylene are rare. An up to 26% mesh erosion rate and up to 38% dyspareunia rate with vaginally introduced mesh for pelvic-organ prolapse repair has been reported. Concurrent hysterectomy seems to increase mesh erosion rates. Surgeons should be aware of the potential complications of synthetic meshes. Until data on the safety and efficacy of synthetic mesh in vaginal reconstructive surgery emerge, its routine use outside of clinical trials cannot be recommended.

Transobturatorische Implantation alloplastischer Netze zur Therapie von Beckenbodendefekten

Purpose: Alloplastic mesh implantation is frequently used in reconstructive pelvic floor surgery, although there are only few study results on the safety and cure rates. In a multiinstitutional observation study we analyzed the safety of a vaginal implantation technique with transobturatoric and sacrospinous fixation of alloplastic meshes in the anterior and central compartment of the pelvic floor. Material and Methods: Nine urogynecologic centers used a questionnaire to collect data from the surgeries retrospectively. Every patient with a transobturatoric monofilament polypropylene mesh implantation was included into the study; there were no exclusion criteria. Results: A transobturatoric mesh was implanted in 183 patients with cystoceles, vaginal vault prolapse or uterine descensus. Intraoperative complications were observed in 7.1 % of patients (6 x blood loss > 500 ml, 4 bladder and 3 rectum lesions, a ureter injury occurred during hysterectomy). Only one bladder lesion occurred during the transobturatoric mesh suspension. During the early postoperative period as an inpatient, 14.3% of patients showed some irregularities (16 x residual urine > 100 ml, 3 infections with fever, 6 postoperative hemorrhages, 10 x moderate or severe pain). A follow-up examination after 3 to 6 months was performed in 128 patients and no complications were found in 78.9%. A recurrence was observed in 4%, residual urine > 100 ml in 2.4%, pain in 3.2% and pain during intercourse in 2.4%. A mesh erosion was observed in 8% of patients treated with the recommended surgery technique. Although the method was not intended as a surgical procedure for incontinence, incontinence disappeared in 76.4% of the initially urge or stress incontinent patients. De novo incontinence was observed in 2.4%. Conclusion: Transobturatoric fixation with and without additional sacrospinous fixation of an alloplastic mesh is a safe and effective method for the treatment of pelvic floor defects.

Transfascial vaginal tape for surgical treatment of stress urinary incontinence

Introduction In the past decade, two minimally invasive, mid-urethral sling procedures have been developed to correct stress urinary incontinence: the tension-free vaginal tape and the transobturator tape. Using similar surgical principles, we describe the placement of a sling located at the mid-urethral level and placed laterally in the previously perforated endopelvic fascia. This technique was termed transfascial vaginal tape. Technical Considerations A 2 to 3-cm-long vertical incision was made at the mid-urethral level. A suburethral tunnel was created bilaterally in the anterior vaginal wall until the endopelvic fascia and retropubic space were reached. A 1.5 × 8-cm monofilament polypropylene mesh was placed under the mid-urethra and laterally in the previously perforated endopelvic fascia. Bilaterally, the sling was sutured to the urethropelvic ligaments. Conclusions We describe a new, simple, safe, minimally invasive, tension-free, and cost-effective technique for the treatment of female stress urinary incontinence.

Efficacy and Safety of Cystocele Repair Reinforced with a Monofilament Polypropylene Mesh

Purpose: Although surgical options for a cystocele repair have changed diversely over the past twenty years, a 29% recurrence rate after an operation has been reported. We assessed the efficacy and safety of a cystocele repair using monofilament polypropylene mesh (MPM) to reinforce the weakened muscular pelvic floor. Materials and Methods: 28 women underwent a cystocele repair using MPM. According to the International Continence Society (ICS) stage classification, 5, 20 and 3 women had stages II, III and IV cystocele, respectively. The operations were performed through the vaginal approach. An anterior colporrhaphy was performed, and mesh (15x5cm), with the lateral extensions, was then positioned into the retropubic space, without fixation, for tension free support of the bladder. The cure of cystocele was defined as stage 0, improvement as stage I, and failed treatment as stage II or greater. Results: The mean follow-up, catheterization time and hospital stay were 20.4±3.2 months, 2.4±1.2 days and 6.6±3.4 days, respectively. The anatomical cure rate of cystocele was 89.3% (25/28). The cystocele repair improved 2 patients, but failed in 1. No significant intraoperative complications occurred. The postoperative complications included voiding difficulty (2 cases), vaginal bleeding around the suture site (1 case) and de novo urgency (2 cases). There were no mesh related complications. Conclusions: Cystocele repair using MPM showed a success rate of 89.3%, with no complications associated with the use of mesh. This procedure seems to be safe and efficient, but a prospective randomized trial and longer follow-up will be required to confirm these results. (Korean J Urol 2006;47:640-644) ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ

Results of Marlex mesh abdominal rectopexy for rectal prolapse in 100 consecutive patients.

One hundred and six consecutive patients were seen between January 1973 and January 1982 with a circumferential full thickness rectal prolapse. One hundred were treated by abdominal rectopexy using a rectangular sling of monofilament knitted polypropylene (Marlex) mesh sutured to the sacrum and to the lateral ligaments of the mobilized rectum. There were only 9 men in the series and 23 per cent of the patients were over the age of 80 years. Sixty-seven of the patients gave a history of faecal incontinence. Previous unsuccessful treatment for rectal prolapse included a Thiersch wire or a Silastic perianal sling in 19, electrical therapy in 12, rectopexy with polyvinyl alcohol sponge (Ivalon) in 5 and pelvic floor repair in 2. There were no operative deaths following Marlex mesh rectopexy. Twelve patients had their operation performed under spinal anaesthesia because they were considered unfit for general anaesthesia. No patient developed a recurrent rectal prolapse, but 24 of the 67 patients who had incontinence experienced persistent incontinence after rectopexy (36 per cent); 10 of these patients subsequently had a postanal repair with good results. Rectopexy had no influence on anal canal pressures. Marlex mesh rectopexy is a safe and effective operation for rectal prolapse. It appears to be superior to other operations in that, so far, there has been no recurrence.

Vaginal mesh extrusion associated with use of Mentor transobturator sling

Objectives To describe my experience of vaginal mesh extrusion using the monofilament polypropylene transobturator sling, the Mentor ObTape. The Mentor ObTape was the first transobturator sling developed as an alternative to the retropubic commercially available suburethral slings for providing mid-urethral support as treatment of female stress urinary incontinence. Methods Thirty patients underwent transobturator suburethral sling placement for anatomic stress urinary incontinence using the ObTape from October 2003 to January 2005. A retrospective chart review was performed to retrieve data on the safety, efficacy, complications, and outcomes using this product. Results Six patients (20%) to date have presented with defective vaginal healing manifested by extrusion of the sling material. Five patients required surgical removal of the sling material, and one underwent a trial of conservative management. No urethral erosions were noted. Conclusions In my experience, the Mentor ObTape sling, which uses a nonwoven, minimally elastic, micropore, monofilament polypropylene mesh, incurs an unacceptably high rate of defective vaginal wound healing and mesh extrusion.

Influence of polyglecaprone 25 (Monocryl) supplementation on the biocompatibility of a polypropylene mesh for hernia repair

Supplementary polyglecaprone 25 (Monocryl) monofilaments were added to a lightweight pure monofilament polypropylene mesh (PP mesh) to improve intraoperative handling (PP+M mesh). This study was designed to evaluate the influence of this additional supplementation on the biocompatibility in a rodent animal model. Two mesh materials, a composite mesh (PP+M) and the pure polypropylene variant (PP), were compared after subcutaneous implantation in a standardized rat model. Histological analysis of the inflammatory response was performed after 28, 56 and 84 days of implantation. Material absorption, inflammatory tissue reaction, fibrosis and granuloma formation were investigated, as well as the percentage of proliferating and apoptotic cells at the interface. Both mesh materials showed a slight foreign body reaction involving mainly macrophages and foreign body giant cells. Total absorption of the Monocryl filaments of the PP+M mesh occurred between 56 and 84 days of implantation. Both the inflammatory and the fibrotic reaction were decreased (n.s.) in the PP+M mesh group compared to the pure PP mesh. Whereas the percentage of proliferating cells showed no significant difference, the rate of apoptotic cells was significantly decreased in the PP+M mesh group over the whole implantation period. Compared to the pure polypropylene mesh, our data confirm that the use of a polypropylene mesh supplemented with absorbable Monocryl filaments is feasible without additional short-term mesh-related complications in the experimental model or negative side effects on biocompatibility.

Transobturator SAFYRE sling is as effective as the transvaginal procedure

SAFYRE is a monofilament polypropylene mesh held between two self-anchoring silicone columns that associates universal approach with readjustability. This unique feature allows for comparing two different approaches, i.e., transvaginal and transobturator, using the same sling. A total of 226 patients with clinical and urodynamic diagnosis of SUI underwent SAFYRE sling procedure, which was performed either by transvaginal (group 1; 126 patients) or transobturator approach (group 2; 100 patients). The mean age was 63 years, in group 1 and 61 years in group 2. Physical examination, stress and pad test and urodynamic assessment were performed before the surgery. The average follow-up period was 18 months in group 1 and 14 months in group 2. There was no difference in cure rate in both groups. The mean operative time was longer (25 min) in group 1 than in group 2 (15 min) (P<0.05). Bladder injury was significative greater in transvaginal group [respectively, 12/126 (0%) versus 0/100 (0%)]. Postoperatively, 20.6% of the patients presented transient irritative voiding symptoms in group transvaginal group as opposed to 10% in transobturator group. SAFYRE sling performed by transobturator approach is as effective as the transvaginal procedure. Fewer complications and less operative time were additional advantages of the transobturator approach.

Abdominal sacrocolpopexy for vault prolapse without burial of mesh: a case series

To audit the clinical outcome of abdominal vault suspension (sacrocolpopexy, hysteropexy or cervicopexy) using non-absorbable mesh, without burial by closure of the peritoneum. A case series. Urogynaecology units of four hospitals. One hundred and twenty-eight women having open or laparoscopic sacrocolpopexy (121), hysteropexy (6) or cervicopexy (1) using non-absorbable mesh for vault prolapse. Patients had suspension of the vault, uterus or cervix from the sacral promontory using a monofilament polypropylene mesh. The pelvic peritoneum was not closed over the mesh. Patients were followed up every six months. Incidence of bowel complications as a consequence of the mesh; cure rate of prolapse and incidence of other post-operative complications; rate of re-operation for prolapse or incontinence. After a median follow up of 19 months (1.5-62), there were no bowel complications as a result of non-burial of mesh. Three patients had asymptomatic vaginal mesh erosion, which required minor surgical intervention. Ninety percent of patients had good resolution of their prolapse symptoms while 10% of patients required further surgery. Leaving the mesh uncovered by the pelvic peritoneum was not associated with complications. It appears safe to perform vault suspension without closing the peritoneum.

Malla de polipropileno monofilamento libre de tensión en la reparación concomitante de cistocele y rectocele

ObjectiveWe presented our experience in the concomitant correction of cystocele and rectocele with polypropylene monofilament mesh (Gynemesh PS), with transvaginal free tension technique. MethodDuring 2004 correction was made in 7 patients, Urogynecologic and Vaginal Surgery Unit of Gynecology and Obstetrics Department, Las Condes Clinic. Medium age 54 years old, weight 64 kgs. In four patients we used a third mesh for correction of urinary incontinence by TVT-O. ResultsThey don’t present intraoperative complications, neither in immediate or delayed postoperative time. We not observed hematoma, infection, erosion or exposition mesh. Cure of cystocele and rectocele was in the 100% of patients. Complications have not appeared, 4 cases completed three months of observation, 2 cases two months and 1 case one month. DiscussionThe use of protesic polypropylene multifilament macropore mesh in the concomitant correction of cistocele and rectocele, by transvaginal route with tension free technique seems to be a safe and effective surgery procedure.

Histological studies of monofilament and multifilament polypropylene mesh implants demonstrate equivalent penetration of macrophages between fibrils

The tissue reaction to implanted monofilamentous and multifilamentous polypropylene mesh was compared in samples removed at operation from the perivaginal area of a 58 year old patient. The fibrils of both were surrounded by collagenous connective tissue, collagen types I and III, and proteoglycans. Smaller, less compacted bundles were seen in the vicinity of the monofilamentous mesh than around the multifilamentous mesh, and in addition, a greater number of inflammatory cells and larger multinucleate giant cells were seen apposed to the monofilamentous mesh. Following this, eight rats were implanted with multifilamentous synthetic polypropylene tape and examined at two, four, six and eight weeks after surgery. Macrophages and multinucleated giant cells were seen in the immediate vicinity of the fibrils, while fibrovascular connective tissue surrounded the implantation site. These observations do not support the prevailing hypotheses that macrophages cannot penetrate between the fibrils of multifilament tape. They do suggest that differences in tensile strength may be present in the artificial neoligaments created by the two tapes.

Cure de cystocèle par voie vaginale. Prothèse de polypropylène sous-vésicale transversale libre. Technique et résultats

Objective. – To evaluate mid term results, tolerance and efficiency of interposition of a tension-free polypropylene monofilament mesh by vaginal approach for the repair of cystoceles. Patients and methods. – Fourty consecutive women underwent this new procedure between March 2001 and September 2002. After complete dissection of the cystocele, the polypropylene mesh (Gynemesh ®, Gynecare, Ethicon, Johnson & Johnson, France), proper cut-out was positioned under the bladder without any fixation. The lateral extensions of the mesh where introduced in the para-vesical spaces in contact with the arcus tendinus fascia pelvis. Results. – Before surgery all patients had cystocele of more or equal than grade II according to the POP-Q classification. Eight had grade II cystocele (20%) and 32 had grade III cystocele (80%). Thirty women had associated posterior or median prolapse (82.5%). Thirty women had urinary incontinence (75%). Mean age was 63.9 years (51–78). The procedure was performed without any difficulty in all cases. Duration of a cystocele cure procedure was 20 min ± 2.2 (16–24). Mean follow-up is 16.4 months ± 4.7 (12–24). The early complication rate was 7.5% (two vaginal erosions and one complete exposition of the mesh which requires secondary ablation). There was no mesh infection. The success rate was 95%. The satisfaction index overpasses 80% in 95% of our patients 6 months after the cystocele repair. Discussion and conclusions. – The interposition of a sub-vesical transversal tension-free polypropylene mesh by the vaginal route seems to be an excellent procedure in the definitive surgical treatment of grades II and III anterior vaginal wall prolapse. This new procedure is simple, mini-invasive, reproducible and efficient with low morbidity and good tolerance.

Lichtenstein repair for incarcerated groin hernias.

To evaluate the use of Lichtenstein tension-free repair for incarcerated groin hernias. Prospective consecutive series. Tertiary academic surgery department, Poland. 27 patients whose incarcerated groin hernias were operated on between November 1997 and June 2001. Tension-free hernia repair by the Lichtenstein technique. Morbidity, recurrence rates and mortality. There were 2 postoperative deaths unrelated to implantation of the mesh (myocardial and cerebral infarction). In 1 patient a subcutaneous fluid collection was noted and was successfully treated by evacuation of the fluid. The remaining 24 patients had no complications during follow-up (mean 18 months, range 2-42 months). Monofilament polypropylene mesh can be successfully used not only in elective operations, but also in emergency operations for incarcerated inguinal hernias.

Functional and morphological evaluation of a low-weight, monofilament polypropylene mesh for hernia repair.

With more than 1 million implantations per year worldwide, mesh repair has become a standard procedure for the treatment of hernias. Apart from various technical problems, the type of material has been proven to be of considerable importance for the functional and histological outcome, particularly for long-term implantation. Whereas the advantageous application of low-weight, large-pore meshes based on multifilaments can be stated without doubt, it is still open whether similar results can be achieved on the basis of pure monofilaments. In the present study, a low-weight polypropylene mesh (LW) made purely of monofilaments was compared to a common heavy-weight polypropylene mesh (HW) in regard to the functional consequences and the tissue response. After implantation in rats as an inlay for 3--90 days, the abdominal-wall mobility of the implant region was recorded by 3D stereography, and the tensile strength of both the suture zone and the mesh was measured. The morphometry of the histological reaction in regard to the inflammatory infiltrate, the connective tissue, the number of granulocytes, macrophages, and fibroblasts served to reflect the tissue response. As parameters for the remodeling process at the interface the cellular activation was evaluated by TUNEL (DNA-strand breaks or apoptosis, respectively), Ki 67 (cell proliferation), and HSP 70 (cell stress). The measured tensile strength of the LW mesh confirmed a sufficient strength of the material-reduced mesh modification. After implantation the consecutive impairment of the abdominal-wall mobility was reduced compared to the HW mesh, concomitant to the reduced fibrotic level at the interface. At the end of the observation period the foreign-body reaction was significantly lowered for the LW mesh, almost reaching physiological values. In conclusion, these data confirm the improved biocompatibility of material-reduced mesh implants.

Use of polypropylene prostheses for strangulated inguinal and incisional hernias.

We used monofilament polypropylene prostheses in 20 emergency operations for strangulated hernias. Sixteen of the operated patients had groin hernias (five of them recurrent), two had incisional and one had a Spigel's type hernia. Intestinal resection was performed because of bowel wall necrosis in one of the patients. During the postoperative period, we observed only one minor complication (a seroma formation). During the follow-up, no recurrence was observed. In our opinion, the use of monofilament polypropylene mesh in emergency hernia operations is safe, simple and effective.

Enterocutaneous fistula 14 years after prosthetic mesh repair of a ventral incisional hernia: A life-long risk?

THE PATIENT was an 82-year-old woman with Munchausen syndrome who had undergone multiple abdominal operations, including appendectomy, cholecystectomy, hysterectomy, bilateral salpingooophorectomy, splenectomy, adhesiolysis, and right hemicolectomy. She also had undergone three operations to repair a recurrent ventral incisional hernia. The last repair, in which Marlex mesh was used, had been performed 14 years before. In that procedure a subfascial technique was used, with the mesh being secured to the edges of the fascial defect. Tissue interposition between small-bowel loops and mesh was not possible because of a lack of omentum as a result of the prior operations. The patient had been in relatively good health for the last 14 years until she experienced spontaneous drainage of enteric contents from the midabdominal wall. She had no signs of sepsis, although she was malnourished. A fistulogram confirmed communication with the midjejunum. No mucosal irregularities were seen on the small-bowel series. A CT scan of the abdomen did not reveal any intraperitoneal collections. An 8-week trial of bowel rest, total parenteral nutrition, and somatostatin failed to spontaneously close the fistula. After the patient was nutritionally repleted, an exploratory laparotomy to resect the enterocutaneous fistula was performed. At the time of surgery, multiple adhesions were present between bowel loops . A loop of jejunum was densely adherent to the mesh, which had eroded into the bowel wall in one area (Figure). We resected this segment of jejunum, as well as all of the involved mesh, and performed a primary stapled anastomosis. The patient’s abdominal fascia was severely attenuated and, after excision of the remaining mesh, a 4 × 6-cm defect was present. The wound was closed with retention sutures, and the area of the fascial defect was allowed to heal by secondary intention. The postoperative course was complicated only by delayed return of bowel function, and the patient was discharged on postoperative day 13, tolerating a regular diet.