Neo-osteogenesis using an intentionally exposed polypropylene membrane after tooth extraction versus guided bone regeneration technique: a single-blind randomized controlled trial / Neo-osteogénesis utilizando una membrana de polipropileno expuesta intencionalmente después de la extracción del diente versus técnica de regeneración ósea guiada: ensayo clínico aleatorizado ciego / Neo-osteogênese utilizando uma membrana de polipropileno exposta intencionalmente após extração dentária versus técnica de regeneração óssea guiada: ensaio clínico randomizado e cego

Introduction: The intentionally exposed polypropylene (PP) membrane has been proposed for guided bone regeneration (GBR) of the alveo lar bone after extraction; however, there are biological limitations to this proposal. This study aimed to describe the effects of the PP membrane on neo-osteogenesis after tooth extraction, comparing to intentionally ex posed and primary soft tissue coverage techniques. Methodology: This clinical trial followed the TIDieR checklist and guide. Clinical and histo logical parameters of alveolar repair were compared between groups: 1 (control group), without regenerative procedure; 2, GBR; and 3, inten tionally exposed membrane. Results: Group 3 showed slight effect on the quality of new bone, compared to the control group. Although the GBR was underestimated by the early exposure of the membrane, alveo lar repair and newly formed bone were superior to the other groups. Poly propylene membrane intentionally exposed compromised the volume density of the immature and mineralized bone matrix, the osteoblast and osteocyte count, and stimulated the granulation tissue formation and local inflammatory infiltrate. Conclusions: Despite the exposure of the PP membrane in GBR, this technique improved the quality of new bone and alveolar repair compared to the surgical technique of intentional exposure and alveolus only sutured.

RESUMEN Introducción: La membrana de polipropileno (PP) intencionalmente expuesta ha sido propuesta para la regeneración ósea guiada (GBR) del hueso alveolar después de la extracción; sin embargo, existen limitaciones biológicas a esta propuesta. Este estudio tuvo como objetivo describir los efectos de la membrana de PP en la neo-osteogénesis después de la extracción del diente, en comparación con las técnicas de cobertura de tejido blando primarias y expuestas intencionalmente. Metodología: Este ensayo clínico siguió la lista de verificación y la guía TIDieR. Se compararon los parámetros clínicos e histológicos de la reparación alveolar entre los grupos: 1 (grupo control), sin procedimiento regenerativo; 2, GBR; y 3, membrana expuesta intencionalmente. Resultados: el grupo 3 mostró un ligero efecto sobre la calidad del hueso nuevo, en comparación con el grupo de control. Aunque la GBR fue subestimada por la exposición temprana de la membrana, la reparación alveolar y el hueso neoformado fueron superiores a los otros grupos. La membrana de polipropileno expuesta intencionalmente comprometió la densidad de volumen de la matriz ósea inmadura y mineralizada, el recuento de osteoblastos y osteocitos, y estimuló la formación de tejido de granulación y el infiltrado inflamatorio local. Conclusiones: A pesar de la exposición de la membrana de PP en GBR, esta técnica mejoró la calidad del hueso nuevo y la reparación alveolar en comparación con la técnica quirúrgica de exposición intencional y alvéolo solo suturado.

Introdução: A membrana de polipropileno (PP) intencionalmente exposta tem sido proposta para regeneração óssea guiada (ROG) do osso alveolar após exodontia; no entanto, existem limitações biológicas a esta proposta. Este estudo teve como objetivo descrever os efeitos da membrana de PP na neo-osteogênese após a extração dentária, comparando com as técnicas de exposição intencional e cobertura primária de tecidos moles. Metodologia: Este ensaio clínico seguiu a lista de verificação e o guia TIDieR. Parâmetros clínicos e histológicos do reparo alveolar foram comparados entre os grupos: 1 (grupo controle), sem procedimento regenerativo; 2, GBR; e 3, membrana intencionalmente exposta. Resultados: O Grupo 3 apresentou leve efeito na qualidade do novo osso, em comparação com o grupo controle. Embora o GBR tenha sido subestimado pela exposição precoce da membrana, o reparo alveolar e o osso neoformado foram superiores aos outros grupos. A exposição intencional da membrana de polipropileno comprometeu a densidade volumétrica da matriz óssea imatura e mineralizada, a contagem de osteoblastos e osteócitos e estimulou a formação de tecido de granulação e infiltrado inflamatório local. Conclusões: Apesar da exposição da membrana PP na ROG, esta técnica melhorou a qualidade do novo osso e da reparação alveolar em comparação com a técnica cirúrgica de exposição intencional e alvéolo apenas suturado.

Comparison of long-term clinical outcomes between transvaginal mesh and pelvic floor reconstruction with native tissue repair in the treatment of advanced pelvic organ prolapse / 中华妇产科杂志

Objective:To study the long-term clinical effect of transvaginal mesh (TVM) and pelvic floor reconstruction with native tissue repair (NTR) in the treatment of advanced pelvic organ prolapse (POP).Methods:Totally 207 patients with advanced POP who were treated in Hunan Provincial Maternal and Child Health Care Hospital from Jan. 2016 to Sep. 2019 were enrolled. The patient′s pelvic organ prolapse quantification were all at degree Ⅲ or above, and they all complained for different degree of symptoms. They were divided into two groups according to the different surgical methods, TVM group and NTR group. In TVM group, the mesh was implanted through the vagina for pelvic floor reconstruction, while in NTR group, the traditional transvaginal hysterectomy combined with uterosacral ligament suspension and anterior and posterior wall repair, as well as perineal body repair were performed. The median follow-up time was 60 months, during the follow up time, 164 cases (79.2%, 164/207) had completed follow-up, including 76 cases in TVM group and 88 cases in NTR group. The perioperative data and complication rates of the two groups were compared, and the subjective and objective outcomes of the two groups at 1, 3 and 5 years were observed, respectively. The objective efficacy was evaluated by three composite criteria, namely: (1) the distance from the farthest end of the prolapse of the anterior and posterior wall of the vagina to the hymen is ≤0 cm, and the descending distance of the top is ≤1/2 of the total length of the vagina; (2) determine the disappearance of relevant POP symptoms according to “Do you often see or feel vaginal mass prolapse？”; (3) no further operation or pessary treatment was performed due to prolapse. If the above three criteria were met at the same time, the operation is successful; otherwise, it was recurrence. The subjective efficacy was evaluated by the pelvic floor distress inventory-short form 20 (PFDI-20) and pelvic floor impact questionnaire-short form 7 (PFIQ-7).Results:The median follow-up time of the two groups was 60 months (range: 41-82 months). Five years after the operation, the subjective and objective cure rates of TVM group were 89.5% (68/76) and 94.7% (72/76), respectively. The subjective and objective cure rates in NTR group were 80.7% (71/88) and 85.2% (75/88), respectively. There were significant differences in the subjective and objective cure rates between the two groups ( χ2=9.869, P=0.002; χ2=3.969, P=0.046). The recurrence rate of TVM group was 5.3% (4/76), and that of NTR group was 14.8% (13/88). There was a significant difference between the two groups ( P=0.046). The postoperative PFDI-20 and PFIQ-7 scores of the two groups were significantly lower than those before surgery, and there were significant differences of the two groups before and after surgery (all P<0.05). Postoperative mesh exposure in TVM group was 1.3% (1/76). Conclusions:The long-term outcomes between the two groups show that the subjective and objective outcomes of pelvic floor reconstruction in TVM group are significantly higher than those in NTR group, and the recurrence rate is significantly lower than that in NTR group. TVM has certain advantages in the treatment of advanced POP.

Comparison of scar outcomes of alar flare region using absorbable and non-absorbable sutures: a single-blind study

Abstract Objective: Formation of scar on the face after septorhinoplasty may disturb the patient due to cosmetic concerns. One of the main factors affecting scar outcomes is probably the suture material used. The aim of this study was to examine the effect of different suture materials on scar outcomes of alar base in patients undergoing septorhinoplasty. Methods: Thirty-one patients who underwent alar base intervention during primary septorhinoplasty were divided into two groups according to the suture material used as the Polypropylene group (n = 16), (Polypropylene, Prolene 6/0; Ethicon Inc., Somerville, NJ, USA) and the Polyglactin group (n = 15), (Irradiated polyglactin 911, Vicryl RapidTM 6/0; Ethicon Inc., Somerville, NJ, USA). The scar outcomes of alar base were compared between the Polypropylene and Polyglactin groups. The modified Stony Brook Scar Evaluation Scale was used to measure wound healing results at one and 12-months postoperatively for objective evaluation. Patient satisfaction questionnaire was used for subjective evaluation. Results: There were no statistically significant differences in the Stony Brook Scar Evaluation Scale and patient questionnaire scores between Polypropylene and Polyglactin groups. Irradiated Vicryl Rapid had poor cosmetic outcomes in the alar base when compared to polypropylene, indicating no statistically significant difference. Conclusion: Both sutures can be used for closure of alar base considering their advantages and disadvantages, in patients undergoing septorhinoplasty. Level of evidence: Treatment Benefits; Level 2 (Randomized Trial).

Gasparyan method of total autologous reconstruction of the aortic valve

Abstract In this case report, I describe a new technique for total reconstruction of the aortic valve with autologous pericardium. The parameters of the cusps were calculated using very simple formulas after measurement of the aortic root intercommissural distances. Glutaraldehyde-treated pericardium was trimmed along the marked line, leaving 2 mm of tissue along the fibrous annulus attachment margin for the suture and small wings on both commissural margins to secure the commissural coaptation between right and noncoronary cusps. The annular margin of each pericardial cusp was sutured to the corresponding fibrous annulus with running 4/0 polypropylene suture. The commissures of pericardial patch and the commissural coaptation between right and noncoronary cusps were secured with mattress 4/0 polypropylene sutures. The coaptation of the three cusps was checked with negative pressure on the left ventricular vent before closure of the aortotomy. Intraoperative transesophageal echocardiogram revealed a peak pressure gradient of 10 mmHg and trivial aortic regurgitation.

Which mesh should be used to repair abdominal wall defect in peritonitis? An experimental study

Background: In this study, following the Bogota bag closure of abdominal wall defects created in a rat peritonitis model, the short-term efficacy of polypropylene (PP) mesh (Prolene®, Ethicon), PP Mesh+Seprafilm®, polytetrafluoroethylene (PTFE) mesh [Infinit® Mesh (Gore)] and expanded PTFE (ePTFE) [Dualmesh®plus(Gore)] in the permanent repair of the defects was investigated.Methods: 64 rats were used. The rats were randomized into four groups, each consisting of 16 subjects: PP mesh (Group 1), PP mesh+Seprafilm (Group 2), PTFE mesh (Group 3), and ePTFE mesh (Group 4). Laparotomy was performed and abdominal wall defects were created. Contamination of the peritoneal cavity was induced, and closure was undertaken using a Bogota bag. After three days, the Bogota bag was removed, and materials were placed. At the end of the follow-up period, the rats were sacrificed. Mortality, grade of adhesion, surgical site infection (SSI), and tensile strength were evaluated.Results: Mortality was calculated as 6.3%, 50%, 25%, and 0% for Groups 1, 2, 3, and 4, respectively (p=0.002). Adhesion was observed at a rate of 61.1% in Group 1 and 38.9% in Group 2 (p=0.621). There was no adhesion in Groups 3 and 4 (p=0.001). The rate of SSI was 68.8% in Group 1, %75% in Group 2, and 100% in Groups 3 and 4 (p=0.022). Tensile strength was 2196±193.6 g/cm in Group 1 and 1906±142.1 g/cm in Group 2 (p=0.258).Conclusions: We argue that PP mesh is a suitable prosthesis for the permanent repair of contaminated abdominal wall defects despite the increased adhesion risk.

Biomechanical and adhesion comparison of linea alba prophylactic reinforcement with coated and uncoated three-dimensional T-shaped mesh in rabbits

Abstract Purpose: Incisional hernia (IH) is a frequent complication of median laparotomy. The use of prophylactic mesh to reduce IH incidence has gained increasing attention. We hypothesized that in an animal model, linea alba prophylactic reinforcement with a three-dimensional T-shaped polypropylene mesh results in greater abdominal wall resistance. Methods: Study was performed in 27 rabbits. After abdominal midline incision, animals were divided into three groups according to the laparotomy closure method used: (1)3D T-shaped coated mesh; (2)3D T-shaped uncoated mesh; and (3) closure without mesh. After 4 months, each animal's abdominal wall was resected and tensiometric tests were applied. Results included IH occurrence, adhesions to the mesh, and wound complications. Results: There was no significant difference between the groups in maximum tensile strength (p=0.250) or abdominal wall elongation under maximum stress (p=0.839). One rabbit from the control group developed IH (p=1.00). Small intestine and colon adhesions occurred only in the uncoated mesh group (p<0.001) and the degree of adhesions was higher in this group compared to the coated mesh group (p<0.05). Conclusion: Use of the current 3D T-shaped prophylactic mesh model did not result in a significant difference in tensiometric measurements when compared with simple abdominal wall closure in rabbits.

Does a bilateral polypropylene mesh alter the duct deferens morphology, testicular size and testosterone levels? Experimental study in rats

Abstract Purpose To evaluate the effect of a PP mesh on duct deferens morphology, testicular size and testosterone levels. Methods Forty adult male rats were distributed into groups: 1) no surgery; 2) inguinotomy; 3) mesh placed on the duct deferens; and 4) mesh placed on the spermatic funiculus. After 90 postoperative days, the inguinal region was resected, and blood samples were collected for the measurement of serum testosterone (pg/dl). The ducts deferens were sectioned in three axial sections according to the relationship with the mesh — cranial, medial and caudal. The wall thickness and duct deferens lumen area were measured. Results The morphology of the duct deferens was preserved in all groups. The mesh placement did not alter this morphology in any of the analyzed segments. Surgery, with or without mesh placement, did not alter the morphology, wall thickness or lumen area (p>0.05). In all operated groups, serum testosterone levels were similar (p>0.05) but there was a decrease in testicle size (p<0.05). Conclusion Surgery, with or without mesh placement, did not alter the morphology of the duct deferens and, although this treatment resulted in testicular size reduction, it did not affect serum testosterone levels.

Questionnaire survey on the application of polypropylene mesh and sling in pelvic floor reconstruction surgery in Chinese IUGA members / 中华妇产科杂志

Objective@#To investigate the similarities and differences between Chinese International Urogynecological Association (IUGA) members and international IUGA members on the treatment of pelvic organ prolapse (POP) and stress urinary incontinence (SUI) with polypropylene (PP) mesh and sling.@*Methods@#Questionnaires were sent to Chinese IUGA members by Email. The contents of the questionnaires included POP mesh, SUI slings, abdominal sacrocolpopexy (ASC), complications, patients′ awareness of rights protection, litigation and database use.Chi-square test was used to compare the proportion of Chinese IUGA members and international IUGA members to the problem alternatives.@*Results@#A total of 31 Chinese IUGA members (100%, 31/31) responded to the questionnaire. All Chinese IUGA members (100%, 31/31) recognized and used PP sling to treat SUI, 98% (917/936) of international IUGA members had used and continued to use PP sling. For ASC surgery, 81% (25/31) of Chinese IUGA members and 82% (768/936) of international IUGA members agreed with and implemented the operation (P=0.841), while 94% (29/31) of Chinese IUGA members and 72% (674/936) of international IUGA members had the same or increased surgical volume as before (P=0.019). For the treatment of POP by transvaginal implantation of PP mesh, Chinese IUGA members had significant differences with international IUGA members in terms of whether they had used (P=0.002), were using (P<0.001), reasons for not using mesh (P<0.001), and indications of mesh implantation (P<0.001). Totally 81% (25/31) of Chinese IUGA members used various databases for monitoring and follow-up, while only 62% (580/936) of international IUGA members used databases, but there was no statistical difference (P=0.092).@*Conclusion@#There are great differences in the concept and clinical application of transvaginal PP mesh implantation for POP between Chinese IUGA members and international IUGA members.

Histocompatibility of an original Chinese-made mid-urethral sling in a rabbit model / 中华妇产科杂志

Objective To evaluate the histocompatibility of an original Chinese-made mid-urethral sling (Repelvica mid-urethral sling). Methods In total 10 female New Zealand white rabbits were implanted with Repelvica mid-urethral sling or tension-free vaginal tape-obturator tape (TVT-O;Gynecare). Both brands of sling were implanted under deep fascia of the abdominal wall and in the space between vagina and bladder. All animal groups were sacrificed at set time intervals (4 weeks and 12 weeks), and the abdominal and vaginal slings were harvested for histological evaluation. Results All slings appeared to be well incorporated into the abdominal wall and anterior vaginal wall. All specimens showed a thin, loose, fibrous interface between the synthetic graft and abdominal wall or vaginal wall, along with mild inflammatory reaction from 4 weeks to 12 weeks. Abdominal grafts of Repelvica mid-urethral sling and TVT-O induced comparable tissue reaction (histological score 10.5 versus 10.5 at 4 weeks, 10.0 versus 9.5 at 12 weeks; both P>0.05). Vaginal grafts of Repelvica mid-urethral sling had lower histological score than TVT-O (histological score 6.0 versus 12.0 at 4 weeks, 8.5 versus 12.5 at 12 weeks), however the differences were not statistically significant (both P>0.05). Conclusions Chinese-made Repelvica mid-urethral sling exhibits good histocompatibility. Vaginal graft of Repelvica mid-urethral sling evoks minor tissue reaction,which could be attributed to its lightweighted property and favored its clinical application.

Questionnaire survey on the application of polypropylene mesh and sling in pelvic floor reconstruction surgery in Chinese IUGA members / 中华妇产科杂志

Objective To investigate the similarities and differences between Chinese International Urogynecological Association (IUGA) members and international IUGA members on the treatment of pelvic organ prolapse (POP) and stress urinary incontinence (SUI) with polypropylene (PP) mesh and sling. Methods Questionnaires were sent to Chinese IUGA members by Email. The contents of the questionnaires included POP mesh, SUI slings, abdominal sacrocolpopexy (ASC), complications, patients′awareness of rights protection, litigation and database use. Chi?square test was used to compare the proportion of Chinese IUGA members and international IUGA members to the problem alternatives. Results A total of 31 Chinese IUGA members (100%, 31/31) responded to the questionnaire. All Chinese IUGA members (100%, 31/31) recognized and used PP sling to treat SUI, 98% (917/936) of international IUGA members had used and continued to use PP sling. For ASC surgery, 81% (25/31) of Chinese IUGA members and 82% (768/936) of international IUGA members agreed with and implemented the operation (P=0.841), while 94% (29/31) of Chinese IUGA members and 72% (674/936) of international IUGA members had the same or increased surgical volume as before (P=0.019). For the treatment of POP by transvaginal implantation of PP mesh, Chinese IUGA members had significant differences with international IUGA members in terms of whether they had used (P=0.002), were using (P<0.001), reasons for not using mesh (P<0.001), and indications of mesh implantation (P<0.001). Totally 81% (25/31) of Chinese IUGA members used various databases for monitoring and follow?up, while only 62% (580/936) of international IUGA members used databases, but there was no statistical difference (P=0.092). Conclusion There are great differences in the concept and clinical application of transvaginal PP mesh implantation for POP between Chinese IUGA members and international IUGA members.

Pro - inflammatory cytokines and metalloproteinase activation in polypropylene mesh implant in rat subcutaneous tissue

ABSTRACT Aims and Objectives: Polypropylene meshes have been increasingly adopted for correction of pelvic organ prolapse due to its lower recurrence rate when compared to surgeries without meshes. The study of the interaction of these materials with the host tissue may contribute to the development of materials with best biocompatibility and, consequently, less complication rates. Materials and Methods: The present study compares the inflammatory reaction of standard-weight (SW) and lightweight (LW) meshes (72 g/m216g/m2 respectively), implanted in the abdomen of 20 adult rats, which were euthanized in four or 30 days. Quantification of pro-inflammatory markers, IL-1 and TNF-α, and of metalloproteinases, MMP2 and MMP3, were carried out through immunohistochemistry with AxioVision® software. Results: There were no significant differences in the quantification of IL-1 and TNF-α in LW versus SW meshes. However, IL-1 quantification increased along time (30 days >4 days, p=0.0269). Also, MMP-2 quantification was similar to SW and LW and both presented a significant increase along time (30 days >4 days, p <0.0001). MMP-3 quantification also showed no difference between the SW and LW groups, but increased along time (30 days >4 days, p=0.02). Conclusions: Mesh's density did not influence the quantification of pro-inflammatory cytokines IL-1 and TNF-α and metalloproteinases 2 and 3. The increased expression of IL-1, MMP-2 and MMP-3 over time could represent a longstanding inflammatory response after PP mesh implantation. Possibly, the occurrence of adverse events following PP prosthetic implants can be influenced by other factors, not solely related to the amount of implanted material.

Clinical management of 110 cases of polypropylene mesh and sling exposure after reconstructive pelvic floor surgery / 中华妇产科杂志

Objective To explore the clinical management and outcomes of polypropylene mesh and sling exposure after reconstructive pelvic surgery(RPS). Methods A total of 110 cases of mesh and sling exposure after RPS were analyzed, who admitted between Jan. 2002 and Oct. 2017 in First Affiliated Hospital of PLA General Hospital, in which 3 cases were referred from other hospitals. Mesh and sling exposures were identified in the outpatient clinic and categorized and managed according to International Continence Society and International Urogynecology Association(ICS-IUGA)classification about category, time and site(CTS)of mesh complication. Outpatient management included observation, topical estrogen use and mesh removal. Management in hospital included surgical removal of exposed mesh and repair of the resulting defects under the anesthesia. Seventy-four cases were managed in the outpatient setting, and 36 cases required inpatient management. Follow-up was consecutively performed from 1 month to 10 years. Objective outcome included the surgeon′s assessment of the healing state of the vaginal mucosa. Subjective outcome was evaluated with patient global impression of improvement questionnaire(PGI-I). Results One hundred and ten patients with mesh exposure were classified according to the different RPS underwent. There were 95 cases from transvaginal mesh surgery, 5 cases from anti-stress urinary incontinence sling surgery, and 10 cases from sacrocolpopxy. The outpatient group healed at an average of(3.0 ± 1.8)months. Of the 36 patients who required inpatient management, 21 cases healed completely at an average of 7 days after one surgery. The remaining 8 cases required either two or three times surgeries or conservative management. In the outpatient group, the PGI-I scale very much better was found in 65 cases(87.8％)and much better in 9 cases(12.2％). In the inpatient surgery group, the scale was very much better in 30 cases (83.3％), and much better in 6 cases(16.7％). Conclusions Among patients with mesh exposure after mesh-augmented RPS, 2/3 of patients with a CTS classification 1-3 could be managed in the office,and remaining 1/3 with CTS classification 4-6 need operation under anesthesia in hospital. If the mesh and sling exposure could be scientifically classified, according to the size, site and accompany symptoms, as well as pain, most of the mesh complications after explosure could be resolved. Using the pelvic floor repair and polypropylene mesh sling, the majority of the patients could get a better outcome, without affecting the effect of the original operation.

Comparative study of intraperitoneal adhesions related to light-weight polypropylene mesh and type I polymerized and purified bovine collagen coated light-weight polypropylene mesh in rabbits

Abstract Purpose: To compare the effectiveness of light-weight polypropylene mesh coated with polymerized and purified bovine type I collagen (Surgidry HNB) in the treatment of abdominal wall defect and the degree of adhesion formation. Methods: Two types of polypropylene mesh were implanted after creation of defect measuring 6.0cm X 5.5cm in the anterior abdominal wall of 32 male New Zealand breed rabbits, divided in two groups (n = 32): (1) light-weigh macroporous polypropylene, (2) type I polymerized and purified bovine collagen coated light-weigh macroporous polypropylene. These animals were further accessed for adhesions, histological evaluation of inflammation and wall's thickness. Results: The percentage of the area adhered in group 1 (62.31 ± 16.6) was higher compared to group 2 (22.19 ± 14.57) (p <0.05). There was an association between the percentage of the covered area by adhesions and the type of adhesion, toughness and the scores obtained by the adhesion score by correlation analysis (p <0.05). There was no difference between the groups in any variables in relation to the degree of inflammation. Conclusion: The purified type I bovine collagen coated light-weigh polypropylene mesh showed to be effective in the repair of abdominal wall defects and reducing adhesion formation.

Update on complications of synthetic suburethral slings

ABSTRACT Synthetic suburethral slings have become the most widely used technique for the surgical treatment of stress urinary incontinence. Despite its high success rates, significant complications have been reported including bleeding, urethral or bladder injury, urethral or bladder mesh erosion, intestinal perforation, vaginal extrusion of mesh, urinary tract infection, pain, urinary urgency and bladder outlet obstruction. Recent warnings from important regulatory agencies worldwide concerning safety issues of the use of mesh for urogynecological reconstruction have had a strong impact on patients as well as surgeons and manufacturers. In this paper, we reviewed the literature regarding surgical morbidity associated with synthetic suburethral slings.

Comparative study of self-fixing patch and plain polypropylene mesh in open inguinal hernia repair / 国际外科学杂志

Objective To compare and analyze the advantages and disadvantages of the application of self-fixing and plain polypropylene mesh in open inguinal hernia repair.Methods A study of 83 patients who underwent open inguinal hernia repair patients from June 2014 to June 2016 in the Department of General Surgery,AnHui No.2 Provincial People's Hospital Patients were divided into two groups according to the use of different patches,42 cases were applicated self-fixating mesh (observation group) and 41 cases were applicated the ordinary polypropylene patch (control group).The operation time,average postoperative hospitalization time,postoperative complications and Visual Analogue Score of postoperative pain were compared.The measurement data were expressed by mean standard deviation (~ ± s),and using t test,Count data were represented by frequency and percentage,and chi-square test was used for comparison between groups.Results The operation time of the observation group and the control group was (49.9 ± 6.4) minutes and (67.9 ± 6.1) minutes,and there was significant difference(P ＜ 0.05).The postoperative hospitalization time of observation group and control group was (2.5 ± 1.4) days and (2.6 ± 1.8) days,there was no significant difference (P ＞ 0.05).In the complications of the two groups,there were 1 case of scrotal edema in the observation group,and 2 cases of scrotal edema in the control group,the difference was no statistically significance.The Visual Analogue Score in two groups was (4.0 ± 0.8) score and (4.1 ± 0.7) score,there was no significant difference between the two groups (P ＞ 0.05) within 12 hours after operation.The Visual Analogue Score was (2.6 ± 0.7) score,(1.4 ± 0.5) score within 24 hours and 48 hours after operation in the observation group,and was (3.1 ± 0.6) score,(2.7 ± 0.5) score in the control group.There was a significant difference between the two groups (P ＜ 0.05).There was no obvious local pain for the observation group and had a better sense of comfort in one month follow-up after the operation.Conclusions The application of self-fixing suture free patch can reduce the operation time of patients and relieve the discomfort of postoperative pain,and has a high clinical value.

Treatment of abdominal wall hernia with suture, or polypropylene, or collagen prosthesis

ABSTRACT PURPOSE: To develop an experimental model for incisional hernias and to compare morphological and functional aspects of hernia repairs by suture, polypropylene mesh and collagen mesh. METHODS: A defect measuring 7cm x 2cm was created in the anterior abdominal of 28 New Zealand male rabbits, divided into four groups (n = 7): (1) control, (2) suture of the anterior sheath of the rectus abdominal muscle, (3) setting of polypropylene mesh, and (4) setting of collagen mesh. On the 90th postoperative day, the animals were examined to verify the presence of incisional hernia. Samples of abdominal wall and scar were collected for histological study. RESULTS: Incisional hernia was identified in 85.7% of the control group, 57.1% of the suture group, 42.9% of the collagen mesh group, and none in the polypropylene mesh group (p = 0.015). Mesh exposure could be identified in 71.4% of the animals in group 3 and in no animal in group 4 (p = 0.021). The polypropylene mesh is effective in the treatment of abdominal wall defects, causing an intense inflammatory reaction. CONCLUSION: The collagen mesh is biocompatible, producing a minimal inflammatory reaction, but fails in the treatment of abdominal wall defects.

Host inflammatory response to polypropylene implants: insights from a quantitative immunohistochemical and birefringence analysis in a rat subcutaneous model

ABSTRACT Objectives To describe acute and sub acute aspects of histological and immunohistochemical response to PP implant in a rat subcutaneous model based on objective methods. Materials and Methods Thirty rats had a PP mesh subcutaneously implanted and the same dissection on the other side of abdomen but without mesh (sham). The animals were euthanized after 4 and 30 days. Six slides were prepared using the tissue removed: one stained with hematoxylin-eosin (inflammation assessment); one unstained (birefringence evaluation) and four slides for immunohistochemical processing: IL-1 and TNF-α (pro-inflammatory cytokines), MMP-2 (collagen metabolism) and CD-31 (angiogenesis). The area of inflammation, the birefringence index, the area of immunoreactivity and the number of vessels were objectively measured. Results A larger area of inflammatory reaction was observed in PP compared to sham on the 4th and on the 30th day (p=0.0002). After 4 days, PP presented higher TNF (p=0.0001) immunoreactivity than sham and no differences were observed in MMP-2 (p=0.06) and IL-1 (p=0.08). After 30 days, a reduction of IL-1 (p=0.010) and TNF (p=0.016) for PP and of IL-1 (p=0.010) for sham were observed. Moreover, area of MMP-2 immunoreactivity decreased over time for PP group (p=0.018). Birefringence index and vessel counting showed no differences between PP and sham (p=0.27 and p=0.58, respectively). Conclusions The implantation of monofilament and macroporous polypropylene in the subcutaneous of rats resulted in increased inflammatory activity and higher TNF production in the early post implant phase. After 30 days, PP has similar cytokines immunoreactivity, vessel density and extracellular matrix organization.

Estudo das telas cirúrgicas de polipropileno/poliglecaprone-25 e polipropileno monofilamentar no reparo de hérnias inguinais / Study of surgical meshes of polypropylene/poliglecaprone-25 and monofilament polypropylene in the repair of inguinal hernias

OBJETIVO: Aferir complicações pós-operatórias imediatas e tardias em pacientes portadores de hérnia inguinal submetidos à correção cirúrgica, comparando a utilização da tela de polipropileno monofilamentar com a tela de polipropileno/poliglecaprone-25. MÉTODOS: Estudo retrospectivo dos pacientes submetidos ao reparo inguinal com uso de tela cirúrgica, avaliando as complicações precoces e tardias por meio de levantamento de prontuários e contato telefônico. Foram utilizadas telas de polipropileno monofilamentar e telas polipropileno com poliglecaprone-25, sendo os pacientes alocados em cada um dos grupos de forma aleatorizada. RESULTADOS: Foram incluídos 114 pacientes no estudo submetidos ao reparo inguinal pela técnica de Lichtenstein. No grupo que utilizou a tela de polipropileno monofilamentar (81,5%), foram identificados quatro pacientes (4,30%) com seroma, dois (2,15%) com hematoma, dois (2,15%) apresentaram infecção de ferida operatória, três (3,22%) apresentaram hipoestesia, nove (9,67%) apresentaram dor ou desconforto crônico na região inguinal e não houve casos de recorrência da hérnia no período. No grupo que utilizou a tela de polipropileno/poliglecaprone-25 (18,5%), foram identificados um paciente (4,76%) com seroma e um (4,76%) com hipoestesia e dois pacientes (9,52%) apresentaram desconforto ou dor crônica. CONCLUSÃO: O reparo inguinal com uso de tela foi o meio mais eficiente para o tratamento da hérnia inguinal apresentando baixos índices de complicação e fácil aplicabilidade O uso das telas de polipropileno/poliglecaprone-25 ainda não está totalmente estabelecido, apresentando taxas globais de complicações iguais às telas de polipropileno monofilamentar.

OBJECTIVE: To assess postoperative early and late complications in patients with inguinal hernia undergoing surgical correction, comparing the use of monofilament polypropylene mesh with polypropylene/poliglecaprone-25 mesh. METHODS: A retrospective study of patients undergoing inguinal repair with the use of surgical mesh, evaluating early and late complications through the analysis of medical records, and telephone contact. Monofilament polypropylene mesh and polypropylene/polyglecaprone-25 mesh were used, with the patients being randomly allocated to each group. RESULTS:The study included 114 patients who underwent inguinal repair through Lichtenstein technique. In the group that used the monofilament polypropylene mesh (81.5%) 4 patients (4.30%) were identified with seroma, 2 patients (2.15%) with hematoma, 2 patients (2.15%) had surgical wound infection, 3 patients (3.22%) had hypoesthesia, 9 patients (9.67%) had chronic pain or discomfort in the groin, and there were no cases of recurrence of hernia in the period. In the group that used the polypropylene/poliglecaprone-25 mesh (18.5%), 1 patient (4.76%) had seroma, 1 patient (4.76%) had hypoesthesia, and 2 patients (9.52%) showed chronic discomfort or pain. CONCLUSION: The inguinal repair with mesh use is the most efficient treatment for inguinal hernia, showing low rate of complications, and being easy to apply. The use of polypropylene/poliglecaprone-25 mesh is not yet fully established, presenting overall rates of complications similar to monofilament polypropylene mesh.

Uso de duas telas de polipropileno na área doadora do TRAM para reconstrução mamária: avaliação na incidência de hérnia e abaulamento abdominal / Use of a double-layer polypropylene mesh in the donor area of a TRAM flap for breast reconstruction: evaluation of the incidence of hernia and abdominal bulging

Introdução: O retalho transverso do músculo reto abdominal (TRAM) é um método bem estabelecido para reconstrução mamária. Apresenta como principal desvantagem o grande defeito da área doadora, podendo causar fraqueza da parede abdominal, hérnias e abaulamentos. Diversas táticas de fechamento do defeito da área doadora foram descritas, incluindo fechamento direto da aponeurose do músculo reto abdominal e uso de telas de polipropileno. O objetivo deste estudo foi avaliar os índices de abaulamento e hérnia no pós-operatório de TRAM utilizando a tática cirúrgica de fechamento da área doadora com duas telas de polipropileno. Métodos: Estudo prospectivo em 24 pacientes submetidos à reconstrução mamária unilateral com TRAM monopediculado ou bipediculado e reparo da área doadora com duas telas de polipropileno. Os pacientes foram avaliados quanto à incidência de hérnia e abaulamento no pós-operatório de 3, 6 e 12 meses. Resultados: Ocorreu um caso (4,16%) de abaulamento abdominal e nenhum caso de hérnia. Não houve casos de infecção ou extrusão da tela. Conclusão: O uso de duas telas de polipropileno na área doadora do TRAM propiciou baixa incidência de hérnias e abaulamentos abdominais.

Introduction: The transverse rectus abdominis myocutaneous flap is a well stablished surgery for breast reconstruction. Its main disadvantage is a large defect in its donor site, leading to weakness in the abdominal wall. Many surgical tactics has been described to address the donor site defect, including direct closure of the muscular aponeurotic and use of polypropylene mesh. The purpose of this study was to assess abdominal hernia and bulge after TRAM flap breast reconstruction using two layers of polypropylene mesh in the donor site defect. Methods: Prospective study in 24 patients who had unilateral TRAM flap breast reconstruction with two layers of polypropylene mesh to close the donor site defect. The patients were evaluated in 3.6 and 12 months of postoperative time for incidence of abdominal hernia and bulge. Results: It was observed one case of abdominal bulge (4.16%) and no case of abdominal hernia. There were no cases of mesh infection or extrusion. Conclusion: The use of two layers of polypropylene mesh in the donor site defect of TRAM flap breast reconstruction resulted in low incidence of abdominal hernia and bulge.

New strategies to improve results of mesh surgeries for vaginal prolapses repair – an update

ABSTRACTThe use of meshes has become the first option for the treatment of soft tissue disorders as hernias and stress urinary incontinence and widely used in vaginal prolapse's treatment. However, complications related to mesh issues cannot be neglected. Various strategies have been used to improve tissue integration of prosthetic meshes and reduce related complications. The aim of this review is to present the state of art of mesh innovations, presenting the whole arsenal which has been studied worldwide since composite meshes, coated meshes, collagen's derived meshes and tissue engineered prostheses, with focus on its biocompatibility and technical innovations, especially for vaginal prolapse surgery.