Polypropylene Mesh Research Articles

Mediumweight polypropylene mesh fractures after open retromuscular ventral hernia repair: incidence and associated risk factors.

Mediumweight (MW) and heavyweight (HW) polypropylene have demonstrated similar clinical and patient-reported outcomes in the setting of open retromuscular ventral hernia repair (VHR). While MW mesh has an anecdotal risk of central mesh fracture, that phenomenon is not well-characterized. We sought to assess the incidence of and risk factors for MW polypropylene mesh fractures after VHR. The ACHQC registry was queried for patients with CT-documented hernia recurrence after open retromuscular VHR with MW polypropylene mesh at our institution with 1-year follow-up between January 2014 and April 2022. Images were reviewed by five blinded surgeons at Cleveland Clinicto reach consensus that hernia recurrence mechanism was central mesh fracture.Patients without clinical recurrence or patient-reported bulge were used as a comparator group. Eighty patients were identified with radiographically documented recurrence; 28 had recurrence from mesh fractures and these were compared to 644 patients without recurrence. Incidence of MW fracture was 4.2%. Bridging of anterior fascia was more common in the group with the central mesh fracture (33.3% vs 3.3%, p < 0.001); the incidence of fracture was 30% (9/30) in patients requiring a bridged closure. Mesh fracture was associated with larger hernias (median width: 20cm [16-26] vs 15cm [12-18], p < 0.001,), length (25cm [23-30] vs 23cm [19-26], p = 0.004). MW polypropylene mechanical failures are surprisingly common, particularly in settings of bridged fascial closure and larger hernias. Use of HW polypropylene should be considered in this setting, and industry should be encouraged to create larger pieces of HW polypropylene mesh.

Comparison of Outcome between Ostomy Closure with Permanent Synthetic Mesh and Conventional Technique without Mesh to Prevent Incisional Hernia

Background: Stomal site incisional hernia is a common complication following ostomy closure. Prophylactic mesh reinforcement of the fascial defect is typically not considered due to the contaminated nature of the case. The effectiveness of prophylactic mesh placement at the time of stoma closure is unknown because of fear of mesh infection and subsequent wound complications. Purpose: To compare the results obtained by placing synthetic mesh in the stoma site during closure with conventional technique without mesh to prevent incisional. Patients and Methods: Prospective interventional study had been designed to compare the outcome of permanent synthetic mesh placement at the time of ostomy closure. Total 45 patients were selected purposively who were candidates for ostomy closure and presented at the Department of Colorectal Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU) from April 2019 to September 2020 and divided into two groups (no mesh and mesh). In the mesh group, permanent synthetic mesh (ProleneTM – Polypropylene) was placed. Primary outcome, incisional stomal hernia was assessed at regular follow-up for one year along with associated morbidities. Results: The primary outcome of this study i.e. incisional hernia (stomal site) was observed among 1 (4.8%) patients at 4th week, 3 (14.3%) at 3rd month, 7 (33.3%) at 6th month and 8 (38.1%) at 12th month follow-up in no mesh group. And, only 1 patient at 6th month and 12th month follow-up had hernia in the mesh group (Figure 3). There was no difference statistically between no mesh and mesh groups at 4th week and 3rd month but significant difference found at 6th and 12th month follow-up (p=0.280, p=0.344, p=0.033 and p=0.017, respectively). Conclusion: Prophylactic placement of permanent polypropylene mesh during ostomy closure placement significantly reduced the rate of incisional hernia without any additional morbidity. Placement of mesh was found to be both safe and effective.

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.

Modification of polypropylene mesh by titanium compound: An in Vivo and in Vitro study

Objective: Previous basic studies on the use of titanized polypropylene meshes in abdominal external hernia repair are not only limited, but also highly controversial. This study aims to investigate the modification effect of titanium compounds on polypropylene materials and compare the performance of two kinds of meshes both in vivo and in vitro.Methods: Human peritoneal mesothelial cells (HMrSV5), human epidermal fibroblasts (HSF), and human monocytic cells (THP-1) were cultured in vitro to simulate the abdominal external hernia environment. Titanized polypropylene meshes (Ti) and polypropylene mesh (Non-Ti) were co-cultured with the cells respectively. The effects of titanium compounds on cell growth were determined by cell activity and apoptosis, and the growth of cells on the mesh surface was assessed using a scanning electron microscope and a confocal microscope. In vivo experiments, different sizes titanized polypropylene meshes and polypropylene meshes were placed between the external oblique abdominal muscle and the internal oblique abdominal muscle, the parietal peritoneum, the serous layer of the descending colon, and the underside of the femoral nerve in rabbits. The effects of titanium compounds were evaluated by observing the anti-adhesion, anti-contraction, anti-fibrotic properties, and effects on nerves of the mesh.Results: Titanium compounds effectively reduced the effects of polypropylene material on cell growth, and improved the fixation and adhesion of HMrSV5, HSF and THP-1 (M0) on the surface of titanized polypropylene meshes. Furthermore, titanium compounds improved the adhesion, contraction and fibrosis of polypropylene material, as well as reduced nerve damage. This improvement demonstrated a regular trend with the type of titanized polypropylene meshes.Conclusion: The titanium compounds improved the biocompatibility of the polypropylene material, which was conducive to the fixation and adhesion of cells on the surface of the meshes, and alleviated the adhesion and contraction of the meshes, and the degree of tissue fibrosis, as well as the influence on nerves.

THE USE OF AN INTERPOSITION POLYPROPYLENE MESH IN ROTATOR CUFF REPAIR: A BIOMECHANICAL STUDY

This study aims to investigate the mechanical properties of a rotator cuff tear repaired with a polypropylene interposition graft in an ovine infraspinatus ex-vivo model.Twenty fresh shoulders from skeletally mature sheep were used in this study. A tear size of 20 mm from the tendon joint was created in the infraspinatus tendon to simulate a large tear in fifteen specimens. This was repaired with a polypropylene mesh used as an interposition graft between the ends of the tendon. Eight specimens were secured with mattress stitches while seven were secured to the remnant tendon on the greater tuberosity side by continuous stitching. Remaining five specimens with an intact tendon served as a control group. All specimens underwent cyclic loading with a universal testing machine to determine the ultimate failure load and gap distance.Gap distance increased with progressive cyclic loading through 3000 cycles for all repaired specimens. Mean gap distance after 3000 cycles for both continuous and mattress groups are 1.7 mm and 4.2 mm respectively (P = .001). Significantly higher mean ultimate failure load was also observed with 549.2 N in the continuous group, 426.6 N in the mattress group and 370 N in the intact group.The use of a polypropylene mesh as an interposition graft for large irreparable rotator cuff tears is biomechanically suitable and results in a robust repair that is comparable to an intact rotator cuff tendon. When paired with a continuous suturing technique, it demonstrates significantly resultant superior biomechanical properties that may potentially reduce re-tear rates after repairing large or massive rotator cuff tears.

Outcome of Laparostomy as a Treatment Measure for Abdominal Compartment Syndrome: A Retrospective Study

Introduction Abdominal compartment syndrome is a life-threatening condition that affects critically ill patients. When pressures inside a fixed cavity of the body increases, ischemia, muscle injury, and organ failure can result. Aim To assess the benefits and outcomes of laparostomy for abdominal compartment syndrome. Methods This retrospective study included patients who underwent a laparostomy procedure as a treatment measure for abdominal compartment syndrome, secondary to different etiologies such as sepsis and major abdominal visceral trauma. Results Although there are a few complications such as incisional hernia in the future following a laparostomy, the mortality rate following the procedure is less than &lt; 10%, thus ensuring a good prognosis for patients who present with acute surgical emergencies. It could also be further noted that an early closure by 7 to 14 days had definite beneficial outcomes as compared with delayed closure of more than 14 days. It prevented most long-term complications such as entero-atmospheric fistula formation or granuloma formation, the outcomes of which were further aided by the use of a transparent custom-made polypropylene mesh. Conclusion Laparostomy is the gold standard treatment for abdominal compartment syndrome. The use of a custom-made polypropylene mesh has proven to have the least complications in the follow-up period. Incisional hernias are the most common complications documented, followed by entero-atmospheric fistula.

Cytomorphological Effects of Lightweight and Heavyweight Polypropylene Mesh on the Ilioinguinal Nerve: An Experimental Study.

Objective This study aimed to investigate the cytomorphological effects of heavyweight and lightweight mesh on the ilioinguinal nerve in an experimental animal model. Methods Sixteen New Zealand male rabbits were included in the study. The left inguinal regions of the first six animals were assigned as controls and the right inguinal regions were assigned as the sham group. The left inguinal regions of the remaining 10 animals were assigned as the lightweight mesh group and the right inguinal regions were assigned as the heavyweight mesh group. No intervention was performed in the control group. In the sham group, only ilioinguinal nerve exploration was performed.In mesh groups, ilioinguinal nerve exploration was performed and the mesh was implanted on the ilioinguinal nerve. After three months, ilioinguinal nerve specimens were excised from both sides for cytomorphological examination. Results Myelin sheath thickening, separation of the myelin layers, and myelin vacuolization were more pronounced in the heavyweight mesh group compared to the lightweight mesh group. The G-ratio was moderately increased in the heavyweight mesh group when compared to other groups. The ratio of fibers with ≤4 µm diameter was higher in the lightweight mesh group compared toother groups, and the ratio of fibers with ≥9 µm diameter was higher in the heavyweight mesh group than in the other groups (p<0.05). Conclusion Both of the meshes induce cytomorphological alterations on the adjacent nerve tissues caused byforeign body reaction and compression. Ilioinguinal nerve degeneration was more pronounced in the heavyweight mesh than in the lightweight mesh. Histological alterations on the ilioinguinal nerves caused by different meshes may be related to chronic pain after hernia surgery. We believe our study will serve as a guide for future studies on the topic.

V12-12 ROBOT-ASSISTED CERCLAGE SACROHYSTEROPEXY

You have accessJournal of UrologyCME1 Apr 2023V12-12 ROBOT-ASSISTED CERCLAGE SACROHYSTEROPEXY Miranda Eubank, Hiroko Miyagi, Veronica Demtchouk, and Louis Moy Miranda EubankMiranda Eubank More articles by this author , Hiroko MiyagiHiroko Miyagi More articles by this author , Veronica DemtchoukVeronica Demtchouk More articles by this author , and Louis MoyLouis Moy More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003347.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Laparoscopic cerclage sacrohysteropexy is a novel surgical technique first described and performed laparoscopically by Dr. Peter Rosenblatt. It is a uterine-sparing technique that requires less suturing and dissection compared to traditional sacrocervicopexy and alternative uterine-sparing methods. His team reports equivalent anatomic outcome with reduced intraoperative time when compared to traditional sacrocervicopexy. To our knowledge, cerclage sacrohysteropexy has not yet been demonstrated robotically. METHODS: We demonstrate the cerclage sacrohysteropexy using robot-assisted laparoscopy. To achieve uterine suspension the uterine isthmus was identified. Tissue windows were dissected laterally on each side of the isthmus. Polypropylene mesh was looped through the lateral windows, encircling the isthmus. The mesh tail was pulled cephalad and secured to the sacral promontory in standard fashion. RESULTS: The patient had good apical suspension and adequate vaginal caliber at the conclusion of the case. There were no intraoperative or postoperative complications. She was doing well upon 1 month follow-up. Physical exam at the time of follow up showed a c-point of –8. CONCLUSIONS: Robot-assisted cerclage sacrohysteropexy is a viable uterine-sparing option for treatment of apical pelvic organ prolapse. It requires less suturing and dissection than other uterine-sparing and non-uterine-sparing techniques. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1068 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Miranda Eubank More articles by this author Hiroko Miyagi More articles by this author Veronica Demtchouk More articles by this author Louis Moy More articles by this author Expand All Advertisement PDF downloadLoading ...

Development of a desktop mask charger

Polypropylene mesh, integrated in N95 respirators and surgical masks that are widely used in the current crisis of COVID-19, filters aerosols via electrostatics in addition to the physical block. However, any contact to water such as storage under high humidity, exposure to exhaling breath, and washing in water removes its charges and thus compromises its filtering efficiency. We developed a desk top device based on a Cockcroft-Walton's voltage multiplier that can restore the electrostatic charge of surgical masks within 1 min and recover the filtering efficiency of the polypropylene mesh from 87% to 97%. The device is easy to operate and safe, thus may be applied for the reuse of surgical masks towards reducing the plastic wastes.

Novel Approach for Umbilical Hernia Repair Using Mesh Strips.

Two-centimeter-wide strips of macroporous polypropylene mesh were passed through the abdominal wall and tied as simple interrupted sutures to achieve umbilical hernia repair. A retrospective review of all elective umbilical hernia repairs performed by a single surgeon using the mesh strip technique between 2016 and 2021 was conducted, and patient-reported outcomes were assessed via a telephonic survey. Thirty-three patients underwent an elective, open mesh strip repair of a primary umbilical hernia and met criteria for inclusion in the study. Of these patients, 60% responded to a patient-reported outcomes telephone survey. Ninety percent of survey responders reported a pain score of 0 of 10. Additionally, 90% reported being unable to feel or palpate the knot, and 80% reported an improvement in quality of life. Mean follow-up at 3 years revealed one recurrence in the setting of ascites, yielding a recurrence rate of 3%. Primary mesh strip repair of umbilical hernias combines the simplicity of suture repair with the advantageous force distribution properties of mesh, and constitutes a safe, efficient, and effective method of repair with a low recurrence rate at long-term follow-up that is comparable to planar mesh repair.

V06-12 PROPHYLACTIC MESH STRIPS: AN EFFECTIVE WAY TO REDUCE HERNIA DURING RADICAL CYSTECTOMY

You have accessJournal of UrologyCME1 Apr 2023V06-12 PROPHYLACTIC MESH STRIPS: AN EFFECTIVE WAY TO REDUCE HERNIA DURING RADICAL CYSTECTOMY Noah Frydenlund, Eric Li, Clayton Neill, Gergory Dumanian, and Joshua J. Meeks Noah FrydenlundNoah Frydenlund More articles by this author , Eric LiEric Li More articles by this author , Clayton NeillClayton Neill More articles by this author , Gergory DumanianGergory Dumanian More articles by this author , and Joshua J. MeeksJoshua J. Meeks More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003274.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Postoperative hernia development, especially parastomal hernia (PSH), remains a challenging problem after radical cystectomy (RC). The incidence of incisional hernia (IH) has been reported to range from 5-15%, while PSHs occur between 15-65%. The use of prophylactic mesh sheets during RC has been shown to reduce the incidence of PSH in a recent randomized trial. We present our technique for the prophylactic use of soft polypropylene mesh strips as sutures at the time of RC as a potential alternative to mesh sheets and review our early experience. METHODS: A retrospective review of a single surgeon's experience with RC from January 2017 to July 2022 was performed. The inclusion criteria were the use of prophylactic parastomal and/or ventral mesh strips. Patients that required intra-operative assistance from plastic surgery for complex abdominal closure were excluded. Radiographic hernias were identified by radiology reports. Hernias that were noticeable on physical exam, symptomatic, or required operative repair were classified as clinical hernias. RESULTS: A total of 72 patients with prophylactic mesh strip placement during radical cystectomy were included. The average age was 73.5 years (Range 41-88 years), with an average follow of 10.8 months (range 1.1 – 63 months) and an average BMI of 27.9 (range 16.0 – 39.13). Sixty-one patients underwent RC with ileal conduit (IC), while 11 underwent RC with neobladder (NB) creation. 93% of the cases were performed robotically with extracorporeal diversion, and the remainder were open. In the RC with IC cohort, 54 patients had ventral and stomal mesh strips placed while 4 had ventral only and 3 had stomal only strips. Radiographic IH was reported in 6/69 (8.7%) patients with ventral mesh strips. Clinical IH was reported in 2/69 (2.9%) patients. For the RC/IC cohort, radiographic PSH was identified in 11/57 (19.3%) patients, and clinical PSH occurred in 6/57 (10.5%) patients. 2/57 (3.5%) patients underwent parastomal hernia repair, 2/57 (3.5%) developed stomal stenosis, and one patient underwent incisional hernia repair. No mesh-related complications were identified. CONCLUSIONS: The prophylactic use of mesh strips as sutures during RC may provide a safe and effective method to reduce postoperative hernia. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e512 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Noah Frydenlund More articles by this author Eric Li More articles by this author Clayton Neill More articles by this author Gergory Dumanian More articles by this author Joshua J. Meeks More articles by this author Expand All Advertisement PDF downloadLoading ...

MP07-06 TWELVE YEAR EXPERIENCE WITH SALVAGE ROBOTIC SACROCOLPOPEXY. SURGICAL TECHNIQUE AND REASONS FOR FAILURE IN THE INITIAL SURGERY

You have accessJournal of UrologyCME1 Apr 2023MP07-06 TWELVE YEAR EXPERIENCE WITH SALVAGE ROBOTIC SACROCOLPOPEXY. SURGICAL TECHNIQUE AND REASONS FOR FAILURE IN THE INITIAL SURGERY Cassandra Schuster, Spencer Kortum, Benjamin Behers, Genesis Dolgetta, Karim Ghazli, Victoria Bird, and Robert Carey Cassandra SchusterCassandra Schuster More articles by this author , Spencer KortumSpencer Kortum More articles by this author , Benjamin BehersBenjamin Behers More articles by this author , Genesis DolgettaGenesis Dolgetta More articles by this author , Karim GhazliKarim Ghazli More articles by this author , Victoria BirdVictoria Bird More articles by this author , and Robert CareyRobert Carey More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003222.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robotic sacrocolpopexy (RASCP) is a transabdominal approach for repair of pelvic organ prolapse (POP) that reliably provides durable repair of high grade prolapse. Although reoperation for recurrent prolapse after RASCP should be a rare event, the techniques and problems associated with robotic salvage in these cases is under reported. METHODS: Data is collected from an IRB-approved prospectively maintained database of robotic POP repair in a tertiary care hospital. The surgery is performed with a da Vinci Si or Xi system with 4 robotic ports and 1 assistant port by a single surgeon. Commercially available 4×24 cm Y-shaped wide pore polypropylene mesh is modified to accommodate the anterior and posterior dissections of the vaginal walls and these are attached with running barbed suture with 16-20 sites of fixation. The long Y-arm of the mesh is trimmed to size for attachment to the anterior longitudinal ligament with GoreTex sutures. Posterior peritoneal flaps are created and the entirety of the mesh and repair is completely covered by peritoneum. No mesh or suture is left exposed. Mid-urethral slings were placed at the time of salvage RASCP (sRASCP) to prevent de novo stress incontinence. All repairs restored maximal vaginal length and desired vaginal axis. All patients for RASCP had stage 4 prolapse. There were no conversions from robotic to open. RESULTS: Between 2010 and 2022, a total of 450 patients underwent RASCP at the same institution. 8 (1.8%) were done in the salvage setting with a previous attempt at open or RASCP performed and pre-existing mesh inside the abdomen. On reoperation for these RASCP patients for the purpose of salvage, 8/8 (100%) were found to have no connectivity of the mesh to the anterior longitudinal ligament (ALL). 4/8 (50%) had no connectivity to the either the anterior or posterior vaginal vault. Mean age at salvage operation was 69.5 years and mean BMI 28.5. Cases were completed with robotic console time between 105 and 123 minutes. CONCLUSIONS: sRASCP is a safe and durable surgery for repair of prolapse in the setting of a failed first attempt of RASCP with pre-existing mesh. Every case achieved excellent repair of prolapse. The most common finding is these cases was non-attachment of the mesh to the ALL. All patients required dissection of the ALL for appropriate mesh attachment. Pre-existing mesh can be used to help in repair as long as there is appropriate attachment to the vaginal vault. Pre-existing mesh should be excised if there is no useful vaginal or ALL attachment. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e86 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Cassandra Schuster More articles by this author Spencer Kortum More articles by this author Benjamin Behers More articles by this author Genesis Dolgetta More articles by this author Karim Ghazli More articles by this author Victoria Bird More articles by this author Robert Carey More articles by this author Expand All Advertisement PDF downloadLoading ...

MP07-05 RISK FACTORS ASSOCIATED WITH POST-OPERATIVE SMALL BOWEL OBSTRUCTION FOLLOWING ROBOTIC SACROCOLPOPEXY WITH 12-YEAR EXPERIENCE

You have accessJournal of UrologyCME1 Apr 2023MP07-05 RISK FACTORS ASSOCIATED WITH POST-OPERATIVE SMALL BOWEL OBSTRUCTION FOLLOWING ROBOTIC SACROCOLPOPEXY WITH 12-YEAR EXPERIENCE Cassandra Schuster, Benjamin Behers, Spencer Kortum, Genesis Dolgetta, Karim Ghazli, Victoria Bird, and Robert Carey Cassandra SchusterCassandra Schuster More articles by this author , Benjamin BehersBenjamin Behers More articles by this author , Spencer KortumSpencer Kortum More articles by this author , Genesis DolgettaGenesis Dolgetta More articles by this author , Karim GhazliKarim Ghazli More articles by this author , Victoria BirdVictoria Bird More articles by this author , and Robert CareyRobert Carey More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003222.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robotic sacrocolpopexy (RASCP) is a transabdominal approach for repair of pelvic organ prolapse (POP) that avoids placement of transvaginal mesh and provides durable repair of high grade prolapse. Given that the procedure has a trans-peritoneal component, there is a risk of reoperation due to small bowel obstruction (SBO). METHODS: Data was collected from an IRB-approved prospectively maintained database of RASCP in a tertiary care hospital. The surgery is performed with a da Vinci Si or Xi system with 4 robotic ports and 1 assistant port by a single surgeon. Commercially available 4×24 cm Y-shaped wide pore polypropylene mesh is modified to accommodate the anterior and posterior dissections of the vaginal walls and are attached with running barbed suture with 16-20 sites of fixation. The long Y-arm of the mesh is trimmed to size for attachment to the anterior longitudinal ligament with GoreTex sutures. Posterior peritoneal flaps are created and the entirety of the mesh and repair is completely covered by peritoneum. No mesh or suture is left exposed. Mid-urethral slings were placed at the time of sacrocolpopexy to prevent de novo stress incontinence. All patients for RASCP had stage 4 prolapse. There were no conversions from robotic to open. RESULTS: Between 2010 and 2022, 450 patients underwent RASCP at the same institution. 80 (17.8%) involved extensive lysis of adhesions (ELOS) and 370 did not code for ELOS. At mean 78-month (12–140 month) follow-up, there were 8 (1.8%) reoperations for SBO. 6/80 (7.5%) patients with ELOS had reoperations for SBO had ELOS. Age, BMI, procedure time, suture type, and brand of mesh were not associated with SBO. Only ELOS was found to be associated with SBO on multivariate analysis. Mean age was 66.1 years and mean BMI 28.2. Robotic console time between 59 and 123 min. All 8 reoperations for SBO had previous abdominal procedures, and 6 were coded as ELOS. There were no reoperations for SBO in patients with no previous abdominal surgery. CONCLUSIONS: RASCP is a safe and durable surgery for repair of POP. Risk of reoperation for SBO is associated with concomitant ELOS. In ELOS patients the risk of SBO is 7.5% and in patients without ELOS the risk is 0.5%. Although many patients presenting for RASCP have had previous abdominal operations, not all such patients require ELOS. For patients with histories of numerous prior bowel or abdominal surgeries who are at increased risk for ELOS at time of RASCP, careful patient selection is recommended and appropriate preoperative counseling suggested. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e86 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Cassandra Schuster More articles by this author Benjamin Behers More articles by this author Spencer Kortum More articles by this author Genesis Dolgetta More articles by this author Karim Ghazli More articles by this author Victoria Bird More articles by this author Robert Carey More articles by this author Expand All Advertisement PDF downloadLoading ...

MP07-07 ROBOTIC SACROCOLPOPEXY WITH UTERUS PRESERVATION: SURGICAL TECHNIQUE AND 12 YEAR EXPERIENCE FOR WOMEN WITH COMPLETE VAGINAL VAULT EVERSION

You have accessJournal of UrologyCME1 Apr 2023MP07-07 ROBOTIC SACROCOLPOPEXY WITH UTERUS PRESERVATION: SURGICAL TECHNIQUE AND 12 YEAR EXPERIENCE FOR WOMEN WITH COMPLETE VAGINAL VAULT EVERSION Cassandra Schuster, Benjamin Behers, Spencer Kortum, Genesis Dolgetta, Karim Ghazli, Victoria Bird, and Robert Carey Cassandra SchusterCassandra Schuster More articles by this author , Benjamin BehersBenjamin Behers More articles by this author , Spencer KortumSpencer Kortum More articles by this author , Genesis DolgettaGenesis Dolgetta More articles by this author , Karim GhazliKarim Ghazli More articles by this author , Victoria BirdVictoria Bird More articles by this author , and Robert CareyRobert Carey More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003222.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robotic sacrocolpopexy with uterus preservation (RASCP-UP) is a transabdominal approach for repair of pelvic organ prolapse (POP) that avoids placement of transvaginal mesh and preserves female sexual organs. Although hysterectomy may be performed at the time of POP repair, many women choose to preserve their uterus for reasons of sexuality, female identity, religion, maintenance of maximal vaginal length and undisturbed vaginal blood supply, and resistance to removal of a normal organ. METHODS: Data was collected from an IRB-approved prospectively maintained database of robotic POP repair in a tertiary care hospital. The surgery is performed with a da Vinci Si or Xi system with 4 robotic ports and 1 assistant port. Commercially available 4×24 cm Y-shaped wide pore polypropylene mesh is modified to accommodate >10 cm anterior and posterior dissections of the vaginal walls. The anterior vaginal wall component is brought through the broad ligament and joined with the posteriorly placed component for attachment to the anterior longitudinal ligament with GoreTex sutures. The mesh is then completely covered by peritoneum. Mid-urethral slings were placed at the time of sacrocolpopexy to prevent de novo stress incontinence. All patients for RASCP-UP had stage 4 prolapse with maximal anterior, posterior, and apical descent with the cervix at the apex of the descent. All patients had normal Pap smears and pelvic ultrasounds. RESULTS: Between 2010 and 2022, a total of 450 patients underwent RASCP at the same institution. Of these, 65 presented with complete vaginal vault eversion requesting RASCP-UP. Mean age was 65.9 years and mean BMI 28.0. Cases were completed with robotic console time between 59 and 123 minutes and all patients discharged within 24-48 hours. At mean 78-month (12 – 140 month) follow-up, there were no mesh erosions, hernias, or reoperations for prolapse. There was one reoperation for hysterectomy at 6 year follow up for suspected endometrial carcinoma and two reoperations for small bowel obstruction in patients with extensive lysis of adhesions. CONCLUSIONS: RASCP-UP is feasible for patients with severe POP who desire uterus preservation. The surgery restores normal vaginal axis and length without placement of mesh material through vaginal mucosa. Long-term results show durable functional repair. Women presenting with vaginal vault eversion and maximal descent of cervix can undergo repair of pelvic floor prolapse with concomitant hysterectomy. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e86 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Cassandra Schuster More articles by this author Benjamin Behers More articles by this author Spencer Kortum More articles by this author Genesis Dolgetta More articles by this author Karim Ghazli More articles by this author Victoria Bird More articles by this author Robert Carey More articles by this author Expand All Advertisement PDF downloadLoading ...

Early Versus Late Repair of Incisional Hernia Following Laparostomy for Enter cutaneous Fistulas Using Component Separation Technique and Onlay Placement of Polypropylene Mesh

Early Versus Late Repair of Incisional Hernia Following Laparostomy for Enter cutaneous Fistulas Using Component Separation Technique and Onlay Placement of Polypropylene Mesh

Surgical Outcomes from Lichtenstein Inguinal Hernioplasty using Polypropylene Suture Vs Skin Staples for Mesh Fixation

Objective: To compare surgical outcome of polypropylene suture and skin staples for securing mesh in Lichtenstein Inguinal Hernioplasty Methodology: There were a total of two hundred people with an inguinal hernia who were involved in the study. They were randomly randomized to receive either polypropylene mesh or staples. Each patient voluntarily undergoes a Lichtenstein tension-free inguinal hernioplasty at the THQ Kherpur operating room. This procedure is performed under spinal anesthesia, and rigorous hygiene standards are adhered to throughout the procedure. In Group A, the anchorage of the mesh was conducted using 2/0 polypropylene suture, whereas in Group B, the anchorage of the mesh was accomplished using skin staples. Both methods were successful in achieving the desired results. The operating time, total surgical time, and wound infection rates were all compared between the groups. Results: The common age in cases of Group-X 36.52+9.41 years, and 38.63+8.76 years in Group B cases. Mean postoperative pain was 2.16+1.98 in Group-X and 1.46+1.24 in Group-Y, both of which had p values of 0.0001. Mean postoperative duration in Group-X was 56.7+5.47 and 48.54+4.38 in Group-Y, both of which had p values of 0.0001. The percentage of patients who had a post-operative wound infection was reported as 22 (22%) in Group-X and 6 (6% in Group-Y), whereas 78 (78%) in Group-X and 94 (94%) in Group-Y did not develop an infection; the p value for this comparison was 0.0011. Conclusion: When performing a Lichtenstein inguinal hernioplasty, anchoring the mesh with skin staples rather than polypropylene suture results in a reduction in both the average amount of time needed for the operation as well as the amount of postoperative pain experienced by the patient. Keywords: Inguinal Hernioplasty, skin staples, polypropylene suture, outcome

Characterization and quantification of oxidative stress induced particle debris from polypropylene surgical mesh

AbstractExplanted polypropylene (PP) surgical mesh has frequently been reported to show surface alterations, such as cracks and flaking. However, to date the consequence of PP mesh degradation is not clearly understood, particularly its potential to influence the biological host response of surrounding tissues. Of particular concern is a possible host reaction to polypropylene particles released through degradation of surgical mesh in vivo. This concern is driven by previous studies which have postulated that an oxidative stress environment has the potential to etch away particles from the surface of a PP fibers. The release of such particles is of considerable significance as particles in the nano‐ to micro range have been shown to have the capacity to irritate cells and stimulate the immune system. The authors are not aware of any previous studies that have attempted to characterize, quantify or identify any particles released from PP mesh after exposure to an oxidative stress environment. Characterization of the PP mesh, post oxidative stress exposure, including identification of particles was achieved through application of a range of techniques: low voltage‐scanning electron microscopy (LV‐SEM), pyrolysis gas chromatography mass spectrometry (Pyr‐GCMS), nano‐Fourier transform infrared spectroscopy (nano‐FTIR), scattering‐type, scanning near‐field optical microscopy (s‐SNOM), atomic force microscopy (AFM), attenuated total reflectance‐Fourier transform infrared spectroscopy (ATR‐FTIR) and uniaxial tensile testing. The findings of this study indicate that oxidative stress alone is a major factor in the production of PP particle debris. PP debris identified within solution, using Pyr‐GCMS, was shown to be in order of the micron scale.

Synthetic mesh versus biological mesh to prevent incisional hernia after loop-ileostomy closure: a randomized feasibility trial

BackgroundIncisional hernia is a frequent complication after loop-ileostomy closure, rationalizing hernia prevention. Biological meshes have been widely used in contaminated surgical sites instead of synthetic meshes in fear of mesh related complications. However, previous studies on meshes does not support this practice. The aim of Preloop trial was to study the safety and efficacy of synthetic mesh compared to a biological mesh in incisional hernia prevention after loop-ileostomy closure.MethodsThe Preloop randomized, feasibility trial was conducted from April 2018 until November 2021 in four hospitals in Finland. The trial enrolled 102 patients with temporary loop-ileostomy after anterior resection for rectal cancer. The study patients were randomized 1:1 to receive either a light-weight synthetic polypropylene mesh (Parietene Macro™, Medtronic) (SM) or a biological mesh (Permacol™, Medtronic) (BM) to the retrorectus space at ileostomy closure. The primary end points were rate of surgical site infections (SSI) at 30-day follow-up and incisional hernia rate during 10 months’ follow-up period.ResultsOf 102 patients randomized, 97 received the intended allocation. At 30-day follow-up, 94 (97%) patients were evaluated. In the SM group, 1/46 (2%) had SSI. Uneventful recovery was reported in 38/46 (86%) in SM group. In the BM group, 2/48 (4%) had SSI (p > 0.90) and in 43/48 (90%) uneventful recovery was reported. The mesh was removed from one patient in both groups (p > 0.90).ConclusionsBoth a synthetic mesh and biological mesh were safe in terms of SSI after loop-ileostomy closure. Hernia prevention efficacy will be published after the study patients have completed the 10 months’ follow-up.

Assessment of feasibility of abdominal mesh vaginorectopexy in the repair of multiple pelvic organ prolapse

ABSTRACT Introduction Pelvic organ prolapse (POP) is the descent of one or more aspects of the vagina and uterus, while rectal prolapse (RP) is the protrusion of the rectum through the anal canal. Multiple POP is combined prolapse of more than one pelvic organ and it is ideally surgically treated. Vaginorectopexy is a modification of the classical ventral mesh rectopexy which may be used in case of combined prolapse of multiple pelvic organs where a polypropylene mesh is used to support pelvic tissues and repair prolapse. Aim To assess the feasibility of open abdominal mesh vaginorectopexy in the repair of multiple POP. Patients and methods This study was carried out on 20 female patients who underwent open abdominal mesh vaginorectopexy for the repair of multiple POP. Results All the cases who complained of complete RP and 90% of cases who complained of uterine prolapse were cured, while symptoms of obstructed defecation were significantly improved in 95% of cases, of which 35% were completely cured. Fecal incontinence was significantly improved in 100% and significantly cured in 80% of cases, urinary incontinence was significantly cured in 75% of cases, and 94.4% of the cases who presented with urinary symptoms (dysuria and urgency), were treated at 12 months post surgery. There was no statistically significant postoperative complications. Conclusion Abdominal mesh vaginorectopexy for the repair of multiple pelvic organ is feasible and can result in significant improvement of function and quality of life.

‘Flip-flap’ hernia sac sandwich mesh hernioplasty for giant incisional hernia

Purpose: The treatment of giant ventral hernia (GVH) with domain loss is a challenge for surgeons. This modified and simplified form of sandwich technique in a form of flip-flap repair was done to assess the outcomes of GVH repair by using the hernia sac taking into account the late complications in terms of recurrence, mesh explantation and early: SSO (surgical site occurrence). Material and method: A total of 21 patients of GVH were treated with flip-flap repair technique in the department of surgery in a teaching hospital in the central India between December 16 to June 21. In flip-flap technique the hernia sac is tailored in the best possible way, by making multiple layered flaps encasing the Polypropylene mesh in between, separating it from intraperitoneal contents and subcutaneous tissue. Results: In this prospective and interventional study, the collected data revealed the mean follow up period of 22.3 months (7months to 48months). Mean age was 44.2years (27-65 years). SSO was seen in 38% of cases mainly in the form of SSI. No explantation of mesh and recurrence was seen in any patient. Conclusion: The flip-flap repair technique is safe and effective surgical technique that can be used for the treatment of GVH regardless of the size, BMI or position of hernia.