Ultrasound visualization of sacrocolpopexy polyvinylidene fluoride meshes containing paramagnetic Fe particles compared with polypropylene mesh

Polyvinylidene Fluoride Mesh Use in Laparoscopic Ventral Mesh Rectopexy in Patients with Obstructive Defecation Syndrome for the First Time

BACKGROUND

Obstructive defecation syndrome (ODS) affects quality of life of patients to a great extent by disturbing defecation. Laparoscopic ventral mesh rectopexy (LVMR) has gained much attention in the recent years. Common synthetic used meshes have a risk of erosion for adjacent pelvic organs leading to some complications. The aim of this study was to assess the outcomes of LVMR using polyvinylidene fluoride (PVDF) mesh in patients with ODS for the first time.Methods and Materials: In this experimental study, patients with a history of ODS and associated signs and symptoms such as descending perineum, rectocele, enterocele, intussusception, rectal prolapse or a combined disorder were recruited. The patients underwent LVMR using a PVDF mesh. They were followed using the Constipation Scoring System (CSS) score. Participants were followed up for 12 months after surgery. Complications and CSS for each patient and its changes were the main outcomes of this study.

RESULTS

Of 156 patients, 155 had a 12-month complete follow-up. Thirty-nine (25.2%) were male and 116 (74.8%) female. Mean ± SD age of participants was 45.61 ± 14.02 years. The overall complication rate was 3.87%. No major mesh-related complications were recorded. Four cases (2.58%) of trocar site hernia were reported. Also, two cases (1.29%) of postoperative bleeding occurred. CSS before the operation and 1, 3, and 12 months after it were 11.04 ± 5.93, 7.98 ± 4.85, 5.46 ± 3.70 and 4.09 ± 2.98, respectively (p < 0.001).

CONCLUSION

Synthetic meshes might cause severe erosion in pelvic organs. However, at least in short-term follow-up, PVDF mesh seems to be safe and effective in LVMR, with the advantage of being cheaper.

Medium-term outcome of laparoscopic sacrocolpopexy using polivinylidene fluoride as compared to a hybrid polyglecaprone and polypropylene mesh: A matched control study

AIM

To compare 2-year outcomes of laparoscopic sacrocolpopexy (LSCP) either with polyvinylidene fluoride (PVDF) or hybrid polypropylene containing a resorbable polyglecaprone (PP+ PG) mesh.

MATERIALS AND METHODS

Retrospective audit on 105 consecutive patients undergoing LSCP a with PVDF-mesh (DynaMesh, FEG Textiltechniken), matched by prolapse stage and cervicopexy or vault suspension to 105 controls undergoing LSCP with a hybrid PP + PG-mesh (Ultrapro, Ethicon). Patients are part of an ongoing prospective study. The primary outcome measure was the Patient Global Impression of Change score (PGIC), the coprimary variable was failure rate at the vault (≤1 cm). Other outcomes were intraoperative and postoperative complications within 3 months categorized by the Clavien-Dindo classification, reinterventions, graft-related complications (GRCs) and functional outcomes. All assessments were performed by an independent assessor. Data are reported as median (interquartile range) number and percent as appropriate, the Mann-Whitney U, χ² , or Fisher exact were used for comparison.

RESULTS

Patient satisfaction in the PVDF group, as measured with the PGIC, was high (90.9% PGIC, ≥4) as well as was the anatomical success (97.3%) at a follow-up of 26 months. These outcomes were comparable to those of PP + PG-patients (84.8% PGIC, ≥4; 94.9% anatomical success). There were five patients (2.4%) with Dindo-III or higher complications and three patients had GRCs (1.5%), without differences between mesh type. Level-II posterior defects (Bp ≥ -1) were less likely in PVDF patients (34.1% vs 50% for PP + PG-patients; P = .003). Women in the PVDF group also were less bothered by prolapse (7.5% vs 26.4%; P = .001), yet they complained more of constipation (15.0% vs 9.0%; P = .01).

CONCLUSION

There were no differences in patient satisfaction and anatomical outcomes after LSCP either with PVDF or PP + PG mesh.

Vaginal hysterectomy with bilateral sacrospinous fixation plus an anterior mesh versus abdominal sacrocervicopexy for the treatment of primary apical prolapse in postmenopausal women: a randomized controlled study

INTRODUCTION AND HYPOTHESIS

We compared vaginal hysterectomy with bilateral sacrospinous fixation plus an anterior polyvinylidene fluoride mesh versus abdominal sacrocolpopexy for the treatment of primary apical prolapse in postmenopausal women.

METHODS

A prospective, randomized, single-blind, parallel study [Registro Brasileiro de Ensaios Clinicos (REBEC) trial register code RBR-7t6rg2] was performed from October 2015 to May 2016. A total of 71 postmenopausal women with advanced pelvic organ prolapse (POP) and undergoing surgery were randomized to the abdominal sacrocolpopexy (ASC) (n = 36) or the vaginal sacrospinous fixation with anterior mesh (VSF-AM) (n = 35) groups. Pelvic Organ Prolapse Quantification (POP-Q) system classification was performed for objective assessment, and the International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS), International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), and International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB) questionnaires were filled out for subjective evaluation by women before and 1 year after surgery. All procedures were performed by a single surgeon.

RESULTS

Both groups had improvement in almost POP-Q points (except for vaginal length in the VSF-AM group) and all ICIQ scores. The ASC group had a longer operative time (129 versus 117 min, p = 0.0038) and duration for return to activities (103 versus 57 days, p < .05). Four women (11%) in the VSF-AM group were reoperated versus none from the ASC group (p = .05).

CONCLUSIONS

Although the study did not achieve the planned recruitment, after 12 months of follow-up, ASC did not differ from VSF-AM in objective and subjective scores (ICIQ questionnaires; POP-Q measurements). Recovery time was longer after open abdominal surgery.