Implantation Of Polypropylene Mesh Research Articles

Autoimmune/inflammatory syndrome induced by adjuvants in a patient after implantation of a polypropylene mesh for inguinal hernia repair (clinical case)

Aim. To report a clinical case of autoimmune/inflammatory syndrome, induced by adjuvants in patient after polypropylene mesh implantation for inguinal hernia repair.Materials and methods. Patient Z., male, 68 years old, was admitted to the hospital presenting muscle weakness and progressive dyspnoea. Interview and physical exam revealed signs of cognitive impairment and memory loss, proximal muscle weakness. Differential diagnosis was made to clarify genesis of symptoms, to rule out polymyositis, other systemic connective tissue diseases, oncologic diseases, hypothyroidism, infectious diseases.Results. Creatine kinase, thyroxine, thyreothropic hormone levels were normal. Clinical and immunological investigation revealed no data on polymyositis or any other systemic connective tissue disease. Yersiniosis, salmonellosis, malaria were ruled out. Chest CT scan, abdomen CT scan, gastroscopy, colonoscopy no data on the presence of malignant neoplasms. PSA level were normal. Electroneuromyography revealed signs of symmetrical axonal type damage to the motor portion of the ulnar nerves on both sides, and demyelinating type damage to the sensory portion. Prednisolone therapy was started at a dose of 40 mg per 24 hour (0.5 mg per kg), which lead to a significant clinical improvement. Based on the therapy response and positive diagnostic criteria (clinical manifestation after polypropylene mesh implantation, typical clinical manifestation – muscle weakness, chronic fatigue, cognitive impairment, neurological manifestations associated with demyelination) patient was diagnosed with autoimmune/inflammatory syndrome, induced by adjuvants (ASIA) after polypropylene mesh implantation for inguinal hernia repair.Conclusion. This clinical case report demonstrates possibility of a persistent course of the disease (symptoms were present for 15 years). Feature of this case is partial clinical improvement due to long-term uncontrolled dexamethasone use, which was prescribed empirically.

Comparative assessment of tissue response to a mesh implant made of polypropylene modified with carbon nanotubes and silver nanoparticles

Treatment of abdominal hernias remains one of the most urgent problems of modern surgery. A large number of complications after hernia operations require the development of new types of implants for tissue plastic surgery. The purpose of the study is to carry out an experimental comparative assessment of tissue reaction to the implantation of the developed polypropylene mesh implant modified with carbon nanotubes and silver nanoparticles. Research was conducted on 105 sexually mature laboratory rats in three series of experiments (35 rats each). In the first series, polypropylene mesh implants were implanted in the tissues of the anterior abdominal wall, in the second – polypropylene implants coated with an antiseptic, and in the third – polypropylene implants modified with carbon nanotubes and silver nanoparticles. Animals were removed from the experiment after preliminary anesthesia 3, 5, 7, 14, 21, 30 and 90 days after the operation. The tissues of the abdominal wall were taken together with the implants, histological preparations were made, which were stained with hematoxylin and eosin and according to Van Gieson. We studied the composition and ratio of elements of cell infiltration in tissues with further statistical processing of the obtained data. It was established that during the implantation of mesh edoprostheses, regardless of their type, necrotic changes with reactive inflammation, the presence of inflammatory cell infiltrate, tissue swelling and microcirculation disorders were detected in the tissues 3-5 days after the operation. Under the condition of implantation of the developed mesh, a less pronounced exudative phase of inflammation and an earlier onset of the reparation phase were detected. Depending on the type of implant used, the subsequent reaction differed between the groups of experimental animals, which was evidenced by the regression of inflammatory phenomena in the tissues and the processes of formation of the fibrous capsule around the implants. During the implantation of nanomodified mesh implants by the 7th day of the experiment, the exudative phase of inflammation ended and the formation of a thin connective tissue capsule began, the formation of which was completed by the 21st day of observation, while when the mesh was implanted with polypropylene and polypropylene with an antimicrobial coating, the formation of the capsule lasted up to 30 days. Thus, it was established that the exudative phase of inflammation continues in the tissues around the implantation of classic polypropylene and polypropylene meshes with an antimicrobial coating up to the 14th day of the experiment, and the connective tissue capsule is formed up to the 30th day. At the same time, in the tissues around the mesh implants made of polypropylene modified with carbon nanotubes and silver nanoparticles, the exudative phase of inflammation ended by the 7th day of the experiment. This ensured the intensity of reparative regeneration processes and the separation of the implant from the surrounding tissues by a thin connective tissue capsule for up to 21 days of observation.

Injectable Double Crosslinked Hydrogel-Polypropylene Composite Mesh for Repairing Full-Thickness Abdominal Wall Defects.

Abdominal wall defects are common clinical diseases, and mesh repair is the standard treatment method. The most commonly used polypropylene (PP) mesh in clinical practice has the advantages of good mechanical properties, stable performance, and effective tissue integration effect. However, direct contact between abdominal viscera and PP mesh can lead to severe abdominal adhesions. To prevent this, the development of a hydrogel-PP composite mesh with anti-adhesive properties may be an effective measure. Herein, biofunctional hydrogel loaded with rosmarinic acid is developed by modifying chitosan and Pluronic F127, which possesses suitable physical and chemical properties and commendable in vitro biocompatibility. In the repair of full-thickness abdominal wall defects in rats, hydrogels are injected onto the surface of PP mesh and applied to intraperitoneal repair. The results indicate that the use of hydrogel-PP composite mesh can alleviate abdominal adhesions resulting from traditional PP mesh implantation by decreasing local inflammatory response, reducing oxidative stress, and regulating the fibrinolytic system. Combined with the tissue integration ability of PP mesh, hydrogel-PP composite mesh has great potential for repairing full-thickness abdominal wall defects.

Next generation meshes for hernia repair: Polypropylene meshes coated with antimicrobial benzalkonium chloride induced proliferative activity of fibroblasts

Hernia repair is one of the most frequently performed world-wide surgical procedures in which hernia meshes are becoming increasingly used. Polypropylene (PP) mesh implants reduce the risk of recurrence and post-operative pain, although many other risks are associated with it, such as bacterial infection. In this study we developed PP meshes coated with the well-known antimicrobial compound, benzalkonium chloride (BAK) by dip-coating. Several dilutions (40, 20, 30, 10, 7.5, 5, 2.5, 1, 0.5, 0.1 and 0.05 % v/v) of commercial BAK solution (BAK diluted in 70 % ethyl alcohol at 0.1 % w/v) were used to produce antimicrobial meshes with different amounts of BAK. The dip-coating treatment with low concentrations of BAK (1, 0.5, 0.1 and 0.05 % v/v dilutions) was found to have biocompatible results in fibroblast. The use of 0.1 and 0.05 % v/v dilutions (PP meshes with up to ∼2 % w/w of BAK) showed proliferative activity on fibroblast cells, indicating that these novel antimicrobial meshes show great promise for hernia repair due to their ability to prevent infections while inducing fibroblast proliferation.

Promontofixation Using Titanium Mesh Implant in a Patient with Genital Prolapse: A Clinical Case

Introduction. Pelvic organ prolapse is increasingly spreading around the world. Therefore, surgical interventions in this pathology are becoming more frequent. Non-mesh surgery for pelvic organ prolapse is reported to have a higher incidence of disease recurrence, and polypropylene mesh implants appear to cause implant-associated complications, thereby limiting their application in clinical practice. Materials and methods. When a patient with an apical prolapse and high risk of postoperative complications sought medical care in the Clinic, the specialists decided to perform promontofixation using a titanium mesh implant. Results and discussion. The present paper describes a clinical case of surgical treatment of genital prolapse using a titanium mesh implant. Since the patient who was admitted for surgical treatment had a family history of genital prolapse, an application of non-mesh technologies implied a high probability of genital prolapse recurrence, as well as a high risk of the vaginal erosion after surgery. Therefore, a promontofixation was performed using a titanium mesh implant, and the 6-month follow-up period showed no postoperative complications. Conclusion. Analysis of postoperative complications demonstrated a considerable potential of using titanium mesh implants for the prevention of implant-associated complications.

Dysregulated wound healing in the pathogenesis of urogynecologic mesh complications

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

EXPERIMENTAL SUBSTANTIATION OF THE USE OF XENOGENIC CEREBROSPINAL FLUID IN HERNIOLOGY TO REDUCE THE PERIPROSTHETIC REACTION

The aim of this study was to experimentally validate the possibility and advisability of the treatment of polypropylene mesh implants with xenogenic cerebrospinal fluid in order to reduce a local acute inflammatory response. An experimental evaluation of the effectiveness of the proprietary method of polypropylene mesh implant processing during their implantation in the tissues of the anterior abdominal wall (Patent of Ukraine No. 146637) is presented. It has been proven that the use of the proposed new technology for the treatment of polypropylene mesh implants with a biocompatible component is a simple, safe and effective method that optimizes the reparative processes in the peri-implant zone without affecting the mechanical properties of mesh implants. All of the treatment effects were found to increase the biocompatibility and improve the survival rate of mesh implants. The thickness of the inflammatory ridge around the elements of mesh implants significantly decreased on average by 35.3% when xenogenic cerebrospinal fluid was used.

IMMUNOHISTOCHEMICAL TRENDS OF THE CONSEQUENCES OF MESH AND AUTODERM IMPLANTATION INTO THE ANTERIOR ABDOMINAL WALL IN RATS

This research involves a comparative study of the immunohistochemical features of the inflammatory response of the anterior abdominal wall tissues after implantation of the autoderm and polypropylene mesh in rats. The object of the study were 36 Wistar rats, which were divided into two groups of 18 specimens each. In the first group, a polypropylene mesh was implanted; in the second group, de-epithelialized skin (autoderm) was implanted. On days 3, 7, 14, 30, and 90, we studied: CD68 as a pan-macrophage marker, CD3 as a pan-lymphocyte marker, and Bcl-2 the apoptosis regulator. Statistical analysis was performed using the Spearman-Rho-Test. The peak of an acute inflammatory response in the tissues after the implantation of polypropylene mesh and autoderm occurs 72 hours after the surgery. Arresting of acute inflammatory response after autodermal implantation is achieved 30 days after surgery. A specific reaction of the anterior abdominal wall tissues to polypropylene, in contrast to the autoderm, is the formation of a persistent chronic inflammatory response 90 days after the operation, which is due to the starting biodegradation of the synthetic implant. The Spearman-Rho-Test showed a highly significant correlation between CD68 and CD3 (r = 0.341, p = 0.001). A high correlation was found between CD68 and Bcl-2 (r = 0.195, p = 0.033) and CD3 and Bcl-2 (r = 0.220, p = 0.021). CD3, CD68 and Bcl-2 markers give evidence of the severity of the inflammatory response.

One-stage prepectoral reconstruction with “heavy” polypropylene mesh implant support in breast cancer surgery

Background. One-stage prepectoral implant-based reconstruction (OSPIBR) using biocompatible synthetic meshes support gained wide popularity in breast cancer surgery. Optimal structure of polypropylene mesh implants (PMI) and methods of its application are actively discussed.Aim. To study the effectiveness and safety of prosthesis support with “heavy” PMI in OSPIBR. Materials and methods. During 2019-2021 18 OSPIBR with "heavy" PMI support were performed after subcutaneous mastectomies in 14 patients. Cancer was indication for surgery in 13 cases (two of them - with BRCA1 mutation) and BRCA1 mutation solely - in 1 case. Foamed polyurethane covered silicone prosthesis (Polytech, Germany) was used for OSPIBR and "heavy" PMI PROLENE™ Polypropylene Mesh (Ethicon/Johnson &amp; Johnson, USA) for prosthesis support by original method.Results. The overall complication rate was 5.6 % (1/18). It was a minor complication: limited aseptic skin necrosis along incision edge, successfully excised under local anesthesia. No cancer recurrences or capsular contracture formation were registrated during follow-up (6 months). The cosmetic outcome (Harvard score) was excellent in 11 of them and good in 3.Conclusions. "Heavy" PMI application by original technique in OSPIBR after subcutaneous mastectomy for breast cancer is a safe and effective method of prosthesis support.

Сomparison of biomechanical properties of non-absorbable and partially absorbable mesh implants used in surgery for urinary incontinence and genital prolapse: experimental study

Introduction. The amount of non-absorbable synthetic material used in the surgical treatment of pelvic organ prolapse and stress urinary incontinence has been shown to directly correlate with the risks of mesh-associated complications. Previously, we developed a partially absorbable implant. Currently, there are insufficient data on the use of partially absorbable implants in female pelvic floor reconstruction, which requires comparative biomechanical and pathomorphological studies.Objective. To compare the biomechanical properties of a new generation partially absorbable implants and nonabsorbable polypropylene mesh implants during animal model.Materials &amp; methods. Thirty-nine rabbits weighing 3200 ± 250 g were randomised into three groups depending on the implanted endoprosthesis: group 1 (n = 15) — “Axilen” implant (polydioxanone 98%, polypropylene 2%), group 2 (n = 15) — “Axilen Rapid” implant (polyglycapron 98%, polypropylene 2%), group 3 (n = 9) — “Urosling 1” implant. After implantation, rabbits of all 3 groups were divided into 3 subgroups according to the withdrawal period from the experiment: 14 days, 60 days, and 180 days. The biomaterial obtained was subjected to two studies: evaluation of the macroscopic view of the explanted mesh endoprosthesis with the formed capsule and the surrounding tissues, study of the biomechanical properties of the formed connective tissue capsule with the implant.Results. According to macroscopic evaluation, there was a less significant tissue reaction to partially absorbed implants. A comparative analysis of biomechanical indices revealed no statistically significant difference in rupture elongation at all follow-up periods among the presented groups. Tensile strength, at 60 and 180 days, was not statistically different between the groups described. At 14 days, there was a statistically significant difference in tensile strength between groups 1 and 3 (p = 0.003).Conclusion. During biomechanical animal experiments, the connective tissue capsule formed on the partially absorbable implant was not inferior to the similar parameter of the non-absorbable sample in its tensile strength, which explains a great potential for the use of partially absorbable implants in reconstructive surgery of pelvic organ prolapse and stress urinary incontinence.

EVALUATION OF POSTOPERATIVE PAIN IN PRESERVATION AND ELECTVE DISSECTION OF THE ILIOINGUINAL NERVE IN INGUINAL HERNIOPLASTY

The use of mesh techniques in the treatment of inguinal hernias significantly reduce recurrences. However the incidence of&nbsp; inguinodinia still present significant complication. The study was designed as a randomized, prospective, unilaterally blind clinical study. Forty male patients were included, to whom hernioplasty by Lichtenstein method with implantation of polypropylene mesh was performed. Patients were divided into 2 groups of twenty patients each. In first one the technique of the ilioinguinal preservation was used, and in the second one dissection of the ilioinguinal nerve was performed. At appropriate time points two types of scales were used to assessed the intensity of the pain: Numeric scale of pain (NSP) and Stanford pain scale (SPS).Data from 40 patients have been analyzed, of which 20 with preservation and 20 with dissection of the ilioinguinal nerve. Inguinodynia was present in two patients, one in each group, i.e. 5%, which indicates that there was no significant difference in the occurrence of inguinodynia in the group with preservation and dissection of the ilioingvinal nerve. No single direction can yet be given as to whether it is better to preserve or dissect the inguinal nerves, and there is also division over whether, if a neurectomy should be performed, it should be limited to the IIN or a triple neurectomy should be performed. Key words: inguinodinia, inguinal hernia, mesh techniques.

Are polypropylene mesh implants associated with systemic autoimmune inflammatory syndromes? Author’s reply

Are polypropylene mesh implants associated with systemic autoimmune inflammatory syndromes? Author’s reply

Experimental Substantiation of Application of Autoplasma to Reduce Inflammatory Response to Implants in Herniology

The article represents an experimental assessment of the effectiveness of the author's method of processing polypropylene mesh implants during their implantation in the tissue of the anterior abdominal wall (Patent of Ukraine No. 146133). It has been demonstrated that the use of the proposed new technology for processing polypropylene mesh implants with a biocompatible component, being a simple, safe, and effective method, optimizes reparative processes in the peri-implantation zone without deteriorating the mechanical properties of mesh implants (MI). All the discovered effects make it possible to increase biocompatibility and improve the survival rate of MI. The thickness of the inflammatory shaft around the elements of MI was significantly decreased, on average, by 28.4% (P&lt;0.05) when using autogenous blood plasma.

Is there a link between mesh implantation and systematic autoimmune disease?

Autoimmune/autoinflammatory syndrome induced by adjuvants (ASIA)/“Shoenfeld’s syndrome” corresponds to a spectrum of immune-mediated diseases triggered by exposure to various materials. Polypropylene (PP) mesh has become the standard for nearly all kinds of hernia repair. There are conflicting reports on the link between ASIA and PP mesh implantation for hernia repair. We reported a typical ASIA/“Shoenfeld’s syndrome” after inguinal hernia repair with PP mesh, and the patient's systematic syndrome was completely alleviated after mesh removal. The present case highlights that there is a link between ASIA/“Shoenfeld’s syndrome” and hernia repair with PP mesh, although not frequently. Both surgeons and patients should bear in mind this disease, and patients should be fully informed before surgery, and registry is an important and possible tool to evaluate and determine the frequency of ASIA after hernia repairs with PP meshes.

P080 ROUTINE ELECTIVE ILIOHYPOGASTRIC NEURECTOMY IN LICHTENSTEIN INGUINAL HERNIA REPAIR

Abstract Aim Chronic postherniorraphy pain occurs in 8-25% of patients undergoing groin hernioplasty with mesh insertion. The most common cause for inguinodynia is neuropathy resulting from nerve damage or entrapment during mesh fixation. With wide mesh insertion there is often a conflict between upper prosthesis margin and an iliohypogastric nerve. The aim of this study is to present a routine elective iliohypogastric neurectomy in Lichtenstein groin hernia repair for prevention of chronic inguinodynia. Material and Methods Between 2018 and 2020, 398 patients were admitted for open inguinal hernia repair. 218 patients underwent a Lichtenstein repair with transection of iliohypogastric nerve before implantation of 10x14 polypropylene mesh (IH group). In the control group of 180 patients all nerves were spared (C group). Follow-up was conducted on 1 POD,1 month, and 1 year after surgery. Results 1 month after a surgery a pain was reported in 24 (11%) patients in IH group (2.9% severe; 8.1% moderate; 89% no pain), and 48 (26.7%) patients in C group (3.9% severe; 22.8% moderate; 73.3% no pain). 1 year after a surgery a persistent pain was reported in 1 (0.4%) patient in IH group, and in 5 (2.8%) patients in C group. An incidence of inguinodynia was significantly lower after iliohypogastric neurectomy (0.5% vs. 2.8%; p &amp;lt; 0.001). Conclusions Routine neurectomy of iliohypogastric nerve appears to be an effective technique in chronic inguinodynia after open mech repair for inguinal hernias. Iliohypogastric nerve resection allows to place a flat synthetic mesh with wide coverage of myopectineal orifice with no need for additional mesh trimming.

The Plane of Mesh Placement Does Not Impact Abdominal Donor Site Complications in Microsurgical Breast Reconstruction.

Reinforcement of the abdominal wall with synthetic mesh in autologous breast reconstruction using abdominal free tissue transfer decreases the risk of bulging and herniation. However, the impact of the plane of mesh placement on donor site complications has not yet been investigated. We performed a retrospective analysis of 312 patients who had undergone autologous breast reconstruction with muscle-sparing transverse rectus abdominis myocutaneous (MS-TRAM) flaps or deep inferior epigastric perforator (DIEP) flaps as well as polypropylene mesh implantation at the donor site. Donor site complications were compared among patients with different flap types and different mesh positions including overlay (n = 90), inlay and overlay (I-O; n = 134), and sublay (n = 88). Abdominal hernias occurred in 2.86% of patients who had undergone MS-TRAM reconstructions and in 2.63% of patients who had undergone DIEP reconstructions. When comparing patients with different mesh positions, donor site complications occurred in 14.4% of patients with overlay mesh, 13.4% of patients with I-O mesh, and 10.2% of patients with sublay mesh (P = 0.68). Abdominal hernias occurred in 4.44% of patients with overlay mesh, 2.24% of patients with I-O mesh, and 2.27% of patients with sublay mesh (P = 0.69). Multivariable logistic regression analysis did not identify a significant association between mesh position and hernia rates as well as wound complications. Our data indicate that the plane of synthetic mesh placement in relation to the rectus abdominis muscle does not impact the rate of postoperative donor site complications in patients undergoing breast reconstruction with MS-TRAM or DIEP flaps.

MRI analysis of ACL tendon graft Intracanal Incorporation with polypropylene mesh implantation

Hamstring tendon graft remains one of the most popular for ACL reconstruction (ACLR). However, its disadvantage is long term ligamentation process and intracanal incorporation and delayed rehabilitation. One of the methods for stimulation of connective tissue growth is the implantation of polypropylene mesh (PPM), which are widely used in hernioplasty. Objective. To compare the MRI data dynamics of intracanal incorporation of tendon graft with implantation of PPM in bone canals. Methods. For evaluation of graft reconstruction in the femoral and tibial canals we used criteria based on the analysis of MRI images in PD FS and STIR sequences: the nature of the signal from the graft in the center of bone canal; general view of the graft; the nature of the MRI signal from the tissues around the graft on the tendons-bone border; the pre­sence of synovial fluid in the canals and bone edema around them. Results of MRI of 75 patients who underwent «all-inside» ACLR with semitendinosus graft were analyzed. In the study group (40 patients) were compared to control group (35 patients) additionally implanted PPM around the ends of the tendon graft. Results. Intracanal graft incorporation in the group of patients with implantation of PPM occurred faster. The nature of the signal from the center of the bone canal and on the bone-tendon border progressed significantly faster in all observed terms. In the research group there was not presence of synovial fluid in the canals along the graft. Conclusions. Implantation of PPM around the ends of the ACL tendon autograft immersed in bone canals, leads, according to MRI data, to faster intra-canal incorporation. Key words. Knee joint, anterior cruciate ligament, arthroscopy.

Morphological testicular changes following the experimental inguinal hernia repair modeling

Purpose of the study. To evaluate morphological changes in the testes in experimental animals after tension-free inguinal hernia repair modeling.Materials and methods. The study included male rabbits, aged 120 days, weighing 3.8 ± 0.9 kg. All rabbits were divided into two groups depending on the type of operation: in the first group (n = 10) of animals, we made a model of tension-free inguinal hernia repair and used a polypropylene mesh; in the second group (n = 10) of animals, we left the structures of the inguinal canal intact. Morphological assessment of spermatogenesis was performed after 40 days. All morphometric measurements were carried out on strictly cross-sections of the convoluted seminal tubules.Results. In rabbits of group 1, the volume of the testicle was significantly three times less than in animals of group 2 (p &lt; 0.05). In the animals of the first group, a significant deterioration in spermatogenesis was observed (p &lt; 0.05). Histological examination of sections of the testes of these animals showed that hypoplasia of the spermatogenic epithelium was present in the convoluted seminal tubules, in 1/8 of the tubules there was subtotal aplasia of the spermatogenic epithelium, Sertoli-Cell-Only Syndrome was detected only in 2 %. Atrophy of the convoluted seminal tubules was not recorded at this period of observation. In the animals of the control group, almost 90 % of cases of spermatogenesis disorders were not detected.Conclusions. This experimental study on rabbits showed that after using a polypropylene mesh for inguinal canal plastic, inhibition of germ cell maturation occurs after 1.5 months. Therefore, in men of reproductive age, it is necessary to use polypropylene mesh implants with caution in terms of performing inguinal hernia repair.

Effects of mesh surgery on sexual function in pelvic prolapse and urinary incontinence.

ABSTRACTPurpose:We aimed to determine pre-operative and post-operative sexual function scores of patients who underwent four-arm polypropylene mesh implantation surgery to treat urinary incontinence and pelvic organ prolapse.Materials and Methods:A prospective study from January 2011 to November 2015 including patients (n: 72) submitted to surgical mesh implantation (four-arm anterior mesh implant (Betamix POP4®, Betatech Medical, Turkey) questioned the patients with Female Sexual Function Index evaluation form. The questionnaire was applied to all patients at pre-operative, post-operative 3rd month and post-operative 1st year periods.Results:The mean age of the patients was 47.2±7.1 years. The mean Body Mass Index (kg/m2) was 28.7±3.7. The average of incontinence duration (year) was 4.6±2.6 and the average for operation time (min) was 35.7±2.1. After the urinary incontinence and pelvic organ prolapse surgery, it was observed that incontinence complaints of patients reduced. Furthermore, there was a positive change in quality of life and sexual function of patients at the post-operative period. There was a statistically significant increase according to Female Sexual Function Index score among all three periods (16%, 86% and 100% respectively, p=0.001) and improvement of sexual functions was observed.Conclusions:Transvaginal mesh use in the surgical treatment of pelvic organ prolapse improves quality of life. However, risk factors such as transvaginal mesh usage indication, surgical technique and experience of the surgeon, suitability of the material, the current health status of the patient and postoperative personal care of the patient may affect the success of operations.

The results of polypropylene mesh application at anterior cruciate ligament reconstruction

Anterior cruciate ligament (ACL) repair remains one of the most common surgeries in orthopedics and traumatology. The evolution of the ACL repair technique continues, new fixators appear, and the position of the graft, its shape and size are modified. Semi-tendon and gracilis muscle (STG) grafts are the most common used due to low-trauma and technically simple method of obtaining. Its disadvantage is a long period of intratunnel incorporation, one of the ways of this acceleration is the implantation of a polypropylene mesh. In an experiment on rabbits, we proved its positive effect. Objective. To develop a method of improving the intratunnel incorporation of STG-graft at ACL repair of the knee joint using polypropylene mesh. Methods. Results of 75 patients were analyzed. The study group consisted of 35 patients who underwent surgery during 2018–2019 using polypropylene mesh, comparative group — 40 patients who had surgical treatment in 2017. Evaluated demographic data, pre-operation period, recovery functions, complications rate, data of KOOS and IKDC scales. Results. Non-specific data of the inflammatory process (CRP and ESR) did not change significantly in patients with inserted polypropylene mesh. They did not have more pronounced pain after surgery, there were less cases of reactive synovitis with significantly minimized the number of the knee joint punctures. Restorationof knee function was faster, and early weight bearing of the leg allowed up to 6 months. Better results by the KOOS and IKDC scales received after surgery. Conclusions. Implantation of polypropylene mesh around the intratunnel part of STG-graft at ACL repair surgery did not increase the complications rate and allowed to improve the dynamics of limb function recovery up to 6 months after surgery.