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Lu X, Harman M, Todd Heniford B, Augenstein V, McIver B, Bridges W. Analyzing material changes consistent with degradation of explanted polymeric hernia mesh related to clinical characteristics. Surg Endosc 2022; 36:5121-5135. [PMID: 35257210 PMCID: PMC10851311 DOI: 10.1007/s00464-021-08882-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 11/16/2021] [Indexed: 10/18/2022]
Abstract
BACKGROUND Proposed mechanisms that potentially contribute to polypropylene mesh degradation after in vivo exposure include oxidizing species and mechanical strains induced by normal healing, tissue integration, muscle contraction, and the immediate and chronic inflammatory responses. METHODS This study explores these potential degradation mechanisms using 63 mesh implants retrieved from patients after a median implantation time of 24 months following hernia repair surgery (mesh explants) and analysis of multivariate associations between the material changes and clinical characteristics. Specifically, polypropylene mesh degradation was characterized in terms of material changes in surface oxidation, crystallinity and mechanical properties, and clinical characteristics included mesh placement location, medical history and mesh selection. RESULTS Compared to pristine control samples, subsets of mesh explants had evidence of surface oxidation, altered crystallinity, or changed mechanical properties. Using multivariate statistical approach to control for clinical characteristics, infection was a significant factor affecting changes in mesh stiffness and mesh class was a significant factor affecting polypropylene crystallinity changes. CONCLUSIONS Highly variable in vivo conditions expose mesh to mechanisms that alter clinical outcomes and potentially contribute to mesh degradation. These PP mesh explants after 0.5 to 13 years in vivo had measurable changes in surface chemistry, crystallinity and mechanical properties, with significant trends associated with factors of mesh placement, mesh class, and infection.
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Affiliation(s)
- Xinyue Lu
- Department of Bioengineering, Clemson University, Clemson, SC, 29634, USA
| | - Melinda Harman
- Department of Bioengineering, Clemson University, Clemson, SC, 29634, USA.
| | - B Todd Heniford
- Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, NC, 28204, USA
| | - Vedra Augenstein
- Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, NC, 28204, USA
| | - Brittney McIver
- Department of Bioengineering, Clemson University, Clemson, SC, 29634, USA
| | - William Bridges
- Department of Mathematical Sciences, Clemson University, Clemson, SC, 29634, USA
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2
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Kowalik CR, Zwolsman SE, Malekzadeh A, Roumen RMH, Zwaans WAR, Roovers JWPR. Are polypropylene mesh implants associated with systemic autoimmune inflammatory syndromes? A systematic review. Hernia 2022; 26:401-410. [PMID: 35020091 PMCID: PMC9012840 DOI: 10.1007/s10029-021-02553-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/20/2021] [Indexed: 11/12/2022]
Abstract
Purpose The surgical implantation of polypropylene (PP) meshes has been linked to the occurrence of systemic autoimmune disorders. We performed a systematic review to determine whether PP implants for inguinal, ventral hernia or pelvic floor surgery are associated with the development of systemic autoimmune syndromes. Methods We searched Embase, Medline, Web of Science, Scopus, Cochrane library, clinicaltrialsregister.eu, clinicaltrails.gov and WHO-ICTR platform. Last search was performed on November 24th 2021. All types of studies reporting systemic inflammatory/autoimmune response in patients having a PP implant for either pelvic floor surgery, ventral or inguinal hernia repair were included. Animal studies, case reports and articles without full text were excluded. We intended to perform a meta-analysis. The quality of evidence was assessed with the Newcastle–Ottawa Scale. This study was registered at Prospero (CRD42020220705). Results Of 2137 records identified, 4 were eligible. Two retrospective matched cohort studies focused on mesh surgery for vaginal prolapse or inguinal hernia compared to hysterectomy and colonoscopy, respectively. One cohort study compared the incidence of systemic conditions in women having urinary incontinence surgery with and without mesh. These reports had a low risk of bias. A meta-analysis showed no association when comparing systemic disease between mesh and control groups. Calculated risk ratio was 0.9 (95% CI 0.82–0.98). The fourth study was a case series with a high risk of bias, with a sample of 714 patients with systemic disease, 40 of whom had PP mesh implanted. Conclusion There is no evidence to suggest a causal relationship between being implanted with a PP mesh and the occurrence of autoimmune disorders.
Supplementary Information The online version contains supplementary material available at 10.1007/s10029-021-02553-y.
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Affiliation(s)
- C R Kowalik
- Department of Gynecology, Amsterdam University Medical Centre, Room H4-262, PO Box 22660, 1100 DD, Amsterdam, The Netherlands. .,Bergman Clinics, Amsterdam, The Netherlands.
| | - S E Zwolsman
- Department of Gynecology, Amsterdam University Medical Centre, Room H4-262, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - A Malekzadeh
- Department of Gynecology, Amsterdam University Medical Centre, Room H4-262, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - R M H Roumen
- Department of Surgery, Máxima Medical Centre, Veldhoven/Eindhoven, The Netherlands.,Research Consortium Mesh, Utrecht, The Netherlands
| | - W A R Zwaans
- Department of Surgery, Máxima Medical Centre, Veldhoven/Eindhoven, The Netherlands.,Research Consortium Mesh, Utrecht, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - J W P R Roovers
- Department of Gynecology, Amsterdam University Medical Centre, Room H4-262, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.,Research Consortium Mesh, Utrecht, The Netherlands.,Bergman Clinics, Amsterdam, The Netherlands
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3
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Abhari RE, Izett-Kay ML, Morris HL, Cartwright R, Snelling SJB. Host-biomaterial interactions in mesh complications after pelvic floor reconstructive surgery. Nat Rev Urol 2021; 18:725-738. [PMID: 34545239 DOI: 10.1038/s41585-021-00511-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2021] [Indexed: 02/08/2023]
Abstract
Polypropylene (PPL) mesh is widely used in pelvic floor reconstructive surgery for prolapse and stress urinary incontinence. However, some women, particularly those treated using transvaginal PPL mesh placement for prolapse, experience intractable pain and mesh exposure or extrusion. Explanted tissue from patients with complications following transvaginal implantation of mesh is typified by a dense fibrous capsule with an immune cell-rich infiltrate, suggesting that the host immune response has a role in transvaginal PPL mesh complications through the separate contributions of the host (patient), the biological niche within which the material is implanted and biomaterial properties of the mesh. This immune response might be strongly influenced by both the baseline inflammatory status of the patient, surgical technique and experience, and the unique hormonal, immune and microbial tissue niche of the vagina. Mesh porosity, surface area and stiffness also might have an effect on the immune and tissue response to transvaginal mesh placement. Thus, a regulatory pathway is needed for mesh development that recognizes the roles of host and biological factors in driving the immune response to mesh, as well as mandatory mesh registries and the longitudinal surveillance of patients.
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Affiliation(s)
- Roxanna E Abhari
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK.
| | - Matthew L Izett-Kay
- Department of Urogynaecology, Oxford University Hospitals NHS Trust, Oxford, UK.,Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Hayley L Morris
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Rufus Cartwright
- Department of Urogynaecology, London North West Hospitals NHS Trust, London, UK.,Department of Epidemiology & Biostatistics, Imperial College London, London, UK
| | - Sarah J B Snelling
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Oxford, UK
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4
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Farr NTH, Roman S, Schäfer J, Quade A, Lester D, Hearnden V, MacNeil S, Rodenburg C. A novel characterisation approach to reveal the mechano-chemical effects of oxidation and dynamic distension on polypropylene surgical mesh. RSC Adv 2021; 11:34710-34723. [PMID: 35494782 PMCID: PMC9042683 DOI: 10.1039/d1ra05944k] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/17/2021] [Indexed: 11/21/2022] Open
Abstract
Polypropylene (PP) surgical mesh, used successfully for the surgical repair of abdominal hernias, is associated with serious clinical complications when used in the pelvic floor for repair of stress urinary incontinence or support of pelvic organ prolapse. While manufacturers claim that the material is inert and non-degradable, there is a growing body of evidence that asserts PP fibres are subject to oxidative damage and indeed explanted material from patients suffering with clinical complications has shown some evidence of fibre cracking and oxidation. It has been proposed that a pathological cellular response to the surgical mesh contributes to the medical complications; however, the mechanisms that trigger the specific host response against the material are not well understood. Specifically, this study was constructed to investigate the mechano-chemical effects of oxidation and dynamic distension on polypropylene surgical mesh. To do this we used a novel advanced spectroscopical characterisation technique, secondary electron hyperspectral imaging (SEHI), which is based on the collection of secondary electron emission spectra in a scanning electron microscope (SEM) to reveal mechanical-chemical reactions within PP meshes.
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Affiliation(s)
- Nicholas T H Farr
- Department of Materials Science and Engineering, University of Sheffield Sir Robert Hadfield Building, Mappin Street UK
- Insigneo Institute for in silico Medicine The Pam Liversidge Building, Sir Robert Hadfield Building, Mappin Street Sheffield UK
| | - Sabiniano Roman
- Department of Materials Science and Engineering, University of Sheffield Sir Robert Hadfield Building, Mappin Street UK
| | - Jan Schäfer
- Leibniz Institute for Plasma Science and Technology (INP e.V.) Felix-Hausdorff-Str. 2 17489 Greifswald Germany
| | - Antje Quade
- Leibniz Institute for Plasma Science and Technology (INP e.V.) Felix-Hausdorff-Str. 2 17489 Greifswald Germany
| | - Daniel Lester
- Polymer Characterisation Research Technology Platform, University of Warwick Library Road CV4 7AL Coventry UK
| | - Vanessa Hearnden
- Department of Materials Science and Engineering, University of Sheffield Sir Robert Hadfield Building, Mappin Street UK
| | - Sheila MacNeil
- Department of Materials Science and Engineering, University of Sheffield Sir Robert Hadfield Building, Mappin Street UK
| | - Cornelia Rodenburg
- Department of Materials Science and Engineering, University of Sheffield Sir Robert Hadfield Building, Mappin Street UK
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Potrykus M, Redko V, Głowacka K, Piotrowicz-Cieślak A, Szarlej P, Janik H, Wolska L. Polypropylene structure alterations after 5 years of natural degradation in a waste landfill. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 758:143649. [PMID: 33293087 DOI: 10.1016/j.scitotenv.2020.143649] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/03/2020] [Accepted: 11/05/2020] [Indexed: 05/26/2023]
Abstract
Up to 25% of plastic waste in Europe is still disposed of in landfills, despite recycling efforts. The plastic waste in the landfill plot may be exposed both to abiotic and biotic degradation processes, although it is thought that most of the plastic materials tend to be resistant to biodegradation or biodeterioration even after a long time. To verify if polypropylene (PP) can undergo the process of short-term biodegradation and how this process is manifested in a municipal waste landfill, we collected a plastic sample from an already closed landfill plot estimating its age at approximately 5 years. Fourier-Transform Infrared Spectroscopy led to sample identification as PP as well as showed additional bands which are not specific to polymer structure but rather result from microbial metabolism. Differential Scanning Calorimetry was performed to examine the influence of the environmental degradation process on the degree of crystallisation of the tested PP. Moreover, significant changes on the surface of an old PP packaging were observed with Scanning Electron Microscopy (SEM) showing clear signs of PP delamination which resulted in microplastic particles formation (smaller than 5 μm in diameter). Additionally, several round and oval shaped structures were observed with SEM leading to the suspicion of biofilm formation on the PP surface. Indeed, the microorganisms were present in a vast amount on the old PP surface and possibly formed a viable biofilm as it was confirmed with fluorescence microscopy. These data show that plastic waste can be inhabited by microorganisms from the ambient environment which may probably lead to its faster degradation. However, this process should be investigated in more detail in order to shed light upon the possible risk factors of plastic biodegradation in waste landfills to the environment and human health. Even after five years, polypropylene can undergo deterioration/biodegradation in a waste landfill with viable microbial cells on its surface, possibly involved in its degradation.
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Affiliation(s)
- Marta Potrykus
- Department of Environmental Toxicology, Faculty of Health Sciences with Institute of Maritime and Tropical Medicine, Medical University of Gdansk, Debowa 23 A, 80-204 Gdansk, Poland.
| | - Vladyslav Redko
- Department of Environmental Toxicology, Faculty of Health Sciences with Institute of Maritime and Tropical Medicine, Medical University of Gdansk, Debowa 23 A, 80-204 Gdansk, Poland.
| | - Katarzyna Głowacka
- Department of Plant Physiology, Genetics and Biotechnology, Faculty of Biology and Biotechnology, University of Warmia and Mazury in Olsztyn, Oczapowskiego 1A, 10-718 Olsztyn, Poland.
| | - Agnieszka Piotrowicz-Cieślak
- Department of Plant Physiology, Genetics and Biotechnology, Faculty of Biology and Biotechnology, University of Warmia and Mazury in Olsztyn, Oczapowskiego 1A, 10-718 Olsztyn, Poland.
| | - Paweł Szarlej
- Polymer Technology Department, Chemical Faculty, Gdansk University of Technology, Gabriela Narutowicza 11/12, 80-233 Gdansk, Poland.
| | - Helena Janik
- Polymer Technology Department, Chemical Faculty, Gdansk University of Technology, Gabriela Narutowicza 11/12, 80-233 Gdansk, Poland.
| | - Lidia Wolska
- Department of Environmental Toxicology, Faculty of Health Sciences with Institute of Maritime and Tropical Medicine, Medical University of Gdansk, Debowa 23 A, 80-204 Gdansk, Poland.
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Bredikhin M, Gil D, Rex J, Cobb W, Reukov V, Vertegel A. Anti-inflammatory coating of hernia repair meshes: a 5-rabbit study. Hernia 2020; 24:1191-1199. [PMID: 32026188 PMCID: PMC7223801 DOI: 10.1007/s10029-020-02122-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 01/04/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Polymeric mesh implantation has become the golden standard in hernia repair, which nowadays is one of the most frequently performed surgeries in the world. However, many biocompatibility issues remain to be a concern for hernioplasty, with chronic pain being the most notable post-operative complication. Oxidative stress appears to be a major factor in the development of those complications. Lack of material inertness in vivo and oxidative environment formed by inflammatory cells result in both mesh deterioration and slowed healing process. In a pilot in vivo study, we prepared and characterized polypropylene hernia meshes with vitamin E (α-tocopherol)-a potent antioxidant. The results of that study supported the use of vitamin E as potential coating to alleviate post-surgical inflammation, but the pilot nature of the study yielded limited statistical data. The purpose of this study was to verify the observed trend of the pilot study statistically. METHODS In this work, we conducted a 5-animal experiment where we have implanted vitamin E-coated and uncoated control meshes into the abdominal walls of rabbits. Histology of the mesh-adjacent tissues and electron microscopy of the explanted mesh surface were conducted to characterize host tissue response to the implanted meshes. RESULTS As expected, modified meshes exhibited reduced foreign body reaction, as evidenced by histological scores for fatty infiltrates, macrophages, neovascularization, and collagen organization, as well as by the surface deterioration of the meshes. CONCLUSION In conclusion, results indicate that vitamin E coating reduces inflammatory response following hernioplasty and protects mesh material from oxidative deterioration.
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Affiliation(s)
- M Bredikhin
- Department of Bioengineering, Clemson University, 301 Rhodes Hall, Clemson, SC, 29634, USA
| | - D Gil
- Department of Bioengineering, Clemson University, 301 Rhodes Hall, Clemson, SC, 29634, USA
| | - J Rex
- Department of Bioengineering, Clemson University, 301 Rhodes Hall, Clemson, SC, 29634, USA
| | - W Cobb
- Department of Surgery, The Hernia Center, Prisma Health, 2104 Woodruff rd., Greenville, SC, 29607, USA
| | - V Reukov
- Department of Bioengineering, Clemson University, 301 Rhodes Hall, Clemson, SC, 29634, USA
| | - A Vertegel
- Department of Bioengineering, Clemson University, 301 Rhodes Hall, Clemson, SC, 29634, USA.
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7
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Huang WC, Yang JM, Chen HF. Five-year clinical and imaging outcomes of primary transobturator midurethral sling procedures for uncomplicated urodynamic stress incontinence. Maturitas 2020; 138:42-50. [DOI: 10.1016/j.maturitas.2020.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/24/2020] [Accepted: 05/08/2020] [Indexed: 10/24/2022]
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Implantation Time Has No Effect on the Morphology and Extent of Previously Reported "Degradation" of Prolene Pelvic Mesh. Female Pelvic Med Reconstr Surg 2020; 26:128-136. [PMID: 31990801 DOI: 10.1097/spv.0000000000000837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Prolene polypropylene ("Prolene") meshes demonstrate no in vivo degradation, yet some claim degradation continues until no more Prolene polypropylene can be oxidized. We studied whether implantation time affects the morphology/extent of previously reported as cracking/degradation of completely cleaned Prolene explants. METHODS Urogynecological explants (248 patients) were collected. After excluding non-Prolene/unknown meshes and those without known implantation times, completely cleaned explants (n = 205; 0.2-14.4 years implantation) were analyzed with light microscopy, scanning electron microscopy, and Fourier transform infrared spectroscopy. Based on implant times and storage (fixative or dry), representative specimens were randomly selected for comparison. Controls were unused ("exemplar") TVT specimens with and without intentional oxidation via ultraviolet light exposure. RESULTS Prolene explants included 31 dry (18 TVT; 7 Prolift; 4 Gynemesh; 2 others) and 174 wet (87 TVT; 47 Prolift; 10 Gynemesh; 30 others) specimens. Specimens had similar morphologies before cleaning. Progressive cleaning removed tissue and cracked tissue-related material exposing smooth, unoxidized, and nondegraded fibers, with no visible gradient-type/ductile damage. Fourier transform infrared spectroscopy of the explants confirmed progressive loss of proteins. Cleaning intentionally oxidized exemplars did not remove oxidized carbonyl frequencies and showed deep cracks and gross fiber rupture/embrittlement, unlike the explants and nonoxidized exemplars. CONCLUSIONS If in vivo Prolene degradation exists, there should be wide-ranging crack morphology and nonuniform crack penetration, as well as more cracking, degradation, and physical breakage for implants of longer implantation times, but this was not the case. There is no morphologic or spectral/chemical evidence of Prolene mesh degradation after up to 14.4 years in vivo.
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Abstract
OBJECTIVE To assess whether there is any association between the implantation of synthetic polypropylene mesh slings for the treatment of stress urinary incontinence (SUI) and risk of cancer. METHODS We performed a nationwide cohort study based on the general female population in Sweden. All women entered the observational period as unexposed on January 1, 1997, and contributed person-time as unexposed unless they underwent a midurethral sling procedure for SUI, after which they contributed person-time as exposed until first occurrence of any cancer, death, emigration, or end of the observational period (December 31, 2009). Occurrence of primary cancer was ascertained from the Cancer Register. Hazard ratios (HRs) with 95% CIs were calculated by Cox proportional hazards regression. RESULTS The final study population included 5,385,186 women, including 20,905 exposed, encompassing a total of 44,012,936 person-years at risk. Other than an inverse association with rectal cancer (HR 0.5, 95% CI 0.3-0.8), there were no significant differences in risk between exposed and unexposed women for pelvic organ cancers including ovarian (HR 0.8, 95% CI 0.5-1.2), endometrial (HR 1.1, 95% CI 0.8-1.4), cervical (HR 0.4, 95% CI 0.2-1.0), bladder, and urethra (HR 0.7, 95% CI 0.4-1.2). No significant association was observed between exposed women and primary cancer in any organ system when compared with unexposed women. The relative risk for cancer after exposure showed little variation over time except for an inverse overall correlation within the first 4 years of surgery (HR 0.7, 95% CI 0.7-0.8). The incidence rates per 100,000 person-years (95% CIs) for exposed vs unexposed women were 20.5 (14.3-29.5) vs 21.0 (20.6-21.5) for rectal cancer, 25.5 (18.4-35.3) vs 19.8 (19.4-20.2) for ovarian cancer, 65.0 (53.0-79.8) vs 33.1 (32.6-33.7) for endometrial cancer, 5.7 (2.8-11.3) vs 11.9 (11.6-12.2) for cervical cancer, and 19.1 (13.1-27.8) vs 13.3 (13.0-13.7) for bladder and urethra cancer. CONCLUSION Our results suggest that midurethral polypropylene sling surgery for SUI is not associated with an increased cancer risk later in life.
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Polypropylene mesh and systemic side effects in inguinal hernia repair: current evidence. Ir J Med Sci 2019; 188:1349-1356. [PMID: 30915679 DOI: 10.1007/s11845-019-02008-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 03/12/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Increasing awareness and regulatory body attention is directed towards the insertion of synthetic material for a variety of surgical procedures. This review aims to assess current evidence regarding systemic and auto-immune effects of polypropylene mesh insertion in hernia repair. METHODS The electronic literature on systemic and auto-immune effects associated with mesh insertion was examined. RESULTS Foreign body reaction following mesh implantation initiates an acute inflammatory cellular response. Involved markers such as IL-1, IL-6, IL-10 and fibrinogen are increased in circulation in the presence of mesh but return to normal at 7 days post operatively. Oxidative degradation of implanted mesh is likely, but no evidence exists to support systemic absorption or resulting disease effects. Variable cytokine production in healthy hosts leading to unpredictable or overwhelming response to implanted biomaterial warrants further investigation. Clinical studies show no associated long-term systemic effects with mesh. CONCLUSION To date, there remains no evidence to link polypropylene mesh and systemic or auto-immune symptoms. Based on current evidence, the use of polypropylene mesh is supported.
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11
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Taylor D. The failure of polypropylene surgical mesh in vivo. J Mech Behav Biomed Mater 2018; 88:370-376. [DOI: 10.1016/j.jmbbm.2018.08.041] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 05/01/2018] [Accepted: 08/27/2018] [Indexed: 10/28/2022]
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Abstract
INTRODUCTION Today the use of textile meshes has become a standard for the treatment of abdominal wall hernias and for the reinforcement of any tissue repair as the strength of the implant decreases the recurrence rates. With increasing use, side effects of the textile implants became apparent, as well. AREAS COVERED Based on publications in Medline over the past decade, general and specific benefits, as well as risks, are discussed with the challenge to define individual risk-benefit ratios. For meshes, certain high-risk or low-risk conditions can be defined. In an attempt to eliminate mesh-related risks, quality control for medical devices has meanwhile been revised. In both the USA and the EU post-market surveillance studies are required to keep medical devices approved. EXPERT COMMENTARY The impact of material on the complication rate will vary depending on the patient's co-morbidity or the risks of the procedure. Even the best material can end up with disappointing results in case of poor healing or poor surgery. On the other hand, when using high-risk devices, most of the complications after excellent surgery with excellent indication can be supposed to be mesh-related. Thus, the use of low-risk devices is recommended even though its advantage may not be demonstrable in clinical studies.
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Affiliation(s)
- Uwe Klinge
- a Department of General , Visceral and Transplant Surgery at the University Hospital of the RWTH Aachen , Aachen , Germany
| | - Bernd Klosterhalfen
- b Department of Pathology , Institute for Pathology at the Düren Hospital , Düren , Germany
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Washington KE, Quiram G, Nguyen A, Kularatne RN, Minary-Jolandan M, Zimmern P, Stefan MC. Bioerosion of Synthetic Sling Explants. ACS Biomater Sci Eng 2017; 3:2598-2605. [PMID: 33465915 DOI: 10.1021/acsbiomaterials.7b00614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This study was performed to investigate the changes over time in polypropylene (PP) mesh explants from women with stress urinary incontinence originally treated with a midurethral PP sling. Following Institutional Review Board (IRB) approval, 10 PP explants removed for pain or obstructive symptoms between January and June 2016 were analyzed through various techniques to determine the degradation of the material in vivo. Exclusion criteria were exposed or infected mesh sling or sling in place for less than six months. One pristine control was studied for comparison. The explant samples were analyzed with scanning electron microscopy to visualize the surface defects as well as infrared spectroscopy and energy dispersive X-ray spectroscopy to determine if the degradation was oxidative in nature. The results show qualitative and quantitative bioerosion over the surface of the explant samples and an increase in the content of oxygen pointing toward oxidative degradation occurring in vivo.
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Affiliation(s)
- Katherine E Washington
- Department of Chemistry and Biochemistry, The University of Texas at Dallas, Richardson, Texas 75080, United States
| | - Gina Quiram
- Department of Bioengineering, The University of Texas at Dallas, Richardson, Texas 75080, United States
| | - Angela Nguyen
- Department of Chemistry and Biochemistry, The University of Texas at Dallas, Richardson, Texas 75080, United States
| | - Ruvanthi N Kularatne
- Department of Chemistry and Biochemistry, The University of Texas at Dallas, Richardson, Texas 75080, United States
| | - Majid Minary-Jolandan
- Department of Mechanical Engineering, The University of Texas at Dallas, Richardson, Texas 75080, United States
| | - Philippe Zimmern
- Department of Urology, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75204, United States
| | - Mihaela C Stefan
- Department of Chemistry and Biochemistry, The University of Texas at Dallas, Richardson, Texas 75080, United States.,Department of Bioengineering, The University of Texas at Dallas, Richardson, Texas 75080, United States
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14
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Reply to “In vivo polypropylene mesh degradation is hardly a myth”. Int Urogynecol J 2016; 28:337-338. [DOI: 10.1007/s00192-016-3237-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 12/05/2016] [Indexed: 11/28/2022]
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15
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In vivo polypropylene mesh degradation is hardly a myth. Int Urogynecol J 2016; 28:333-335. [DOI: 10.1007/s00192-016-3233-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 12/05/2016] [Indexed: 10/20/2022]
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