Many properties of polypropylene mesh that are causative in producing the complications that our patients are experiencing were published in the literature prior to the marketing of most currently used mesh configurations and mesh kits. These factors were not sufficiently taken into account prior to the sale of these products for use in patients. This report indicates when this information was available to both mesh kit manufacturers and the Food and Drug Administration.

/pdf/degradation-infection-and-heat-effects-on-polypropylene-mesh-4cxoz49zkx.pdf

Degradation, infection and heat effects on polypropylene mesh for pelvic implantation: what was known and when it was known

5 Four RAND-36 dimensions showed improvement in both the older and younger patient groups after open inguinal hernia repair: pain, limitations caused by physical health problems, physical functioning, and social functioning. Complication rates between age groups did not differ. Higher preoperative visual analogue scale (VAS) score (odds ratio, OR, 1.15, p < 0.006), mid-weight mesh (OR 2.28, p = 0.012), complications (OR 5.16, p = 0.002), recurrence (OR 6.76, p = 0.005), and younger age (OR 1.02, p = 0.027) increased the chances of chronic pain one year after open inguinal hernia repair. Higher VAS score after hernioplasty was predicted by higher preoperative VAS scores (regression coefficient, RC, 0.10, p < 0.001), heavyweight mesh (RC 0.50, p = 0.046), complications (RC 0.76, p = 0.016), and recurrence (RC 1.49, p = 0.001). At one year, pain while resting was present in 6.6% of patients, and a 1.2% recurrence rate was observed among database patients. CONCLUSIONS: Standard tension-free repair of inguinal hernia yields comparable clinical outcomes to self-fixating polypropylene / polylactic acid composite mesh in the short term and to polypropylene double-layer mesh in the long term. Attachment of a light-weight polypropylene mesh with a coat of absorbing polylactic acid microhooks or with permanent polypropylene sutures yields equivalent clinical outcomes at one year after surgery. Elderly patients display similar quality of life gains from open mesh-based inguinal hernia repair as younger patients. Greater preoperative pain, heavier meshes, complications, recurrence, and patient’s younger age predict the presence of chronic post-hernioplasty pain or more intense postoperative inguinal pain. The clear majority of patients are satisfied with open hernia repair.

/pdf/short-and-long-term-results-and-quality-of-life-in-open-zw4kj328zk.pdf

Short- and long-term results and quality of life in open inguinal hernia repair

Pelvic organ prolapsed (POP) is a dysfunctional disease in female pelvic floor that affects a lot of women worldwide, and reduces their quality of life. Currently, trans-vaginal knitted polypropylene meshes are used as secondary treatment, for anatomical correction of the dysfunctional tissues. However, the meshes can create sever adverse complications in some patients, such as chronic pain and dypareunia, in longer-term. In the hope of finding an alternative surgical treatment, we developed nanofibrous matrices produces by electrospinning, based on different degradable and non-degradable materials. These electrospun matrices resemble the natural architecture of the extracellular matrix (ECM) and therefore considered as "biomimetic". In this thesis, we demonstrated through in-vitro models, that such synthetic mimic of the ECM, facilitates the adhesion of both healthy and diseased (from POP-patients) human vaginal fibroblasts to the biomaterial and therefore improves their interactional functions like proliferation and new collagen deposition. In addition, we showed that changing the micro-structural properties of the biomimetic matrices, such as fiber size, impacts not only the mechanical behaviour of the matrices but also the cellular responses. This finding can be used as a baseline for design of the new generation of biomimetic implants for pelvic floor. Further, we designed an in-vitro dynamic culture system, in which cell-seeded matrices were subjected to cyclic mechanical loading. Our finding revealed that a gentle straining of POP-cells on electrospun matrices, advances their regenerative potential at morphological and gene expression levels. Taken together, the findings of this thesis, provides a proof-of-concept for using electrospun matrices as an alternative implant for pelvic floor repair, given that in future studies the design parameters are proved efficient and safe.

/pdf/biomimetic-matrices-for-pelvic-floor-repair-2sxwwinnwt.pdf

Biomimetic matrices for pelvic floor repair

Introduction and hypothesis
To evaluate the effect of surgical instruments handling on polypropylene mesh using scanning electron microscopy (SEM).

Evaluation of surgical instrument handling on polypropylene mesh using scanning electron microscopy

Carl Heneghan and colleagues describe how failings in the process for the marketing approval of implantable transvaginal mesh devices may have exposed women to avoidable harms and how to avoid their repetition

/pdf/transvaginal-mesh-failure-lessons-for-regulation-of-17rhmve3rt.pdf

Transvaginal mesh failure: lessons for regulation of implantable devices.

Monofilament polypropylene (PP) fibers, very similar to fibers that have been used as monofilament tailstrings of interuterinc contraceptive devices, were suspended vertically in bacterial liquid monocultures so that a portion of a fiber extended above the liquid surface. In some cases these highly oriented, cold drawn fibers were abraded prior to insertion in the cultures in order to produce surface roughness characterized by axial channels and protruding microfibrils that partially peeled from the fiber surface thereby forming the channels. Extent of migration on a fiber was assessed by aseptically cutting it into small segments, followed by culturing each segment on agar containing growth medium. Such assessment of the PP fibers after 48 h of incubation in the cultures revealed upward migration of Eschericia coli, Pseudomonas aeruginosa, and Staphylococcus aureus over significantly longer distances on the pre-roughened fibers than on those not so pre-treated. Mean measured distances of migration during...

Surface roughness enhances upward migration of bacteria on polymer fibers above liquid cultures.

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Surface roughness enhances upward migration of bacteria on polymer fibers above liquid cultures.