Are polypropylene mesh implants associated with systemic autoimmune inflammatory syndromes? A systematic review

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.

Hysteroscopic resection of a uterine caesarean scar defect (niche) in women with postmenstrual spotting: a randomised controlled trial

Objective

To compare the effectiveness of a hysteroscopic niche resection versus no treatment in women with postmenstrual spotting and a uterine caesarean scar defect.

Design

Multicentre randomised controlled trial.

Setting

Eleven hospitals collaborating in a consortium for women's health research in the Netherlands.

Population

Women reporting postmenstrual spotting after a caesarean section who had a niche with a residual myometrium of ≥3 mm, measured during sonohysterography.

Methods

Women were randomly allocated to hysteroscopic niche resection or expectant management for 6 months.

Main outcome measures

The primary outcome was the number of days of postmenstrual spotting 6 months after randomisation. Secondary outcomes were spotting at the end of menstruation, intermenstrual spotting, dysuria, sonographic niche measurements, surgical parameters, quality of life, women's satisfaction, sexual function, and additional therapy. Outcomes were measured at 3 months and, except for niche measurements, also at 6 months after randomisation.

Results

We randomised 52 women to hysteroscopic niche resection and 51 women to expectant management. The median number of days of postmenstrual spotting at baseline was 8 days in both groups. At 6 months after randomisation, the median number of days of postmenstrual spotting was 4 days (interquartile range, IQR 2–7 days) in the intervention group and 7 days (IQR 3–10 days) in the control group (P = 0.04); on a scale of 0–10, discomfort as a result of spotting had a median score of 2 (IQR 0–7) in the intervention group, compared with 7 (IQR 0–8) in the control group (P = 0.02).

Conclusions

In women with a niche with a residual myometrium of ≥3 mm, hysteroscopic niche resection reduced postmenstrual spotting and spotting‐related discomfort.

Tweetable abstract

A hysteroscopic niche resection is an effective treatment to reduce niche‐related spotting.

A hysteroscopic niche resection is an effective treatment to reduce niche‐related spotting.

[Can apps encourage a healthier and more active lifestyle?]

OBJECTIVE

To present an overview of the literature on the effect of smartphone apps and activity trackers on a healthy lifestyle.

DESIGN

Systematic review.

METHOD

PubMed, the Cochrane Library, Embase and CINAHL were searched for relevant articles. Inclusion criteria were: (a) the intervention was a mobile app or activity tracker; (b) that stimulated activity and healthy diet; (c) in adults with an unhealthy lifestyle but so far without medical disorders; (d) aimed at preventative healthcare, improvement in health or healthy behaviour; and (e) measured the effect of physical activity, diet and weight.

RESULTS

We included 17 studies, of which 13 involved apps and 4 involved activity trackers. The effect of the apps on physical activity in overweight or obese people was positive in 6 studies, while no effect was found in 3 studies. There was a positive effect on diet; this was significant in 3 studies and non-significant in 2 studies. The effect on weight was positive in 6 studies, while no effect was found in 5 studies. Evidential value of the studies involving apps was poor to moderate. Activity trackers seemed to have the power to increase physical activity, but quality of these studies was poor. The effects on weight were contradictory and the effects on diet were not investigated.

CONCLUSION

Apps have a global positive effect on physical activity. The effect of apps on diet and weight is unclear, but the trend is that they improve eating patterns. Activity trackers can increase physical activity. Larger scale research with more balanced control groups and longer follow-up is, however, necessary before we can recommend the use of apps and activity trackers.