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CME objectives: Upon reviewing this manuscript, the reader should be able to 1. Outline the properties of commonly used materials, highlighting the strength and weakness of each. 2. Address mesh complications such as shrinkage, erosion, tissue-mesh interface failure, eventration, and hernia recurrence. 3. Discuss issues relating to coding, reimbursement, and cost.Colorectal surgeons encounter numerous clinical scenarios that require supplemental material to augment or replace a patient's native tissues. Tissue destruction from infection and loss of abdominal domain from damage control procedures can lead to large hernia defects. Parastomal hernias and pelvic prolapse repair frequently require mesh to strengthen a patient's attenuated fascia. Each of these circumstances has unique factors which must be taken into account in planning surgical interventions. A large number of products have been developed to meet these needs. Each of these materials has unique properties that have implications for their use in clinical practice.While there have been innumerable studies involving the use of mesh, the variety of applications, nuances of surgical technique, and differences in study design make comparisons difficult. This review will outline the properties of commonly used materials, highlighting the strength and weakness of each. It will address mesh complications such as shrinkage, erosion, tissue-mesh interface failure, eventration, and hernia recurrence. Finally, it will discuss issues relating to coding, reimbursement, and cost.For the purpose of discussion, these products are divided into two groups: synthetic and biologic mesh. Keywords► biological mesh ► synthetic mesh ► coding AbstractPreserving patients' native tissues has posed many challenges for surgeons. Increased life expectancy is leading to a proportionately older surgical population with weaker tissues. The growing population of morbidly obese patients in addition to those with multiple comorbidities which influence the native strength and perfusion of tissues compounds the surgeon's challenge. Certainly, there is a rising demand for materials to replace or augment a patient's native tissue when it has been compromised. Over time, the number of products available has increased substantially. The ideal substitute, however, is debatable. The manufacturing and processing of these materials has become more complex and this has resulted in a significant increase in cost. The composition of the mesh, clinical scenario, and operative technique all interact to impact the long-term results. Surgeons require a thorough understanding of these products to guide proper selection and use, to ensure optimal outcomes for patients, and to properly steward financial resources. This review will outline the properties of commonly used materials, highlighting the strength and weakness of each. It will then discuss recommendations regarding mesh selection, coding, and reimbursement. While general principles and trends can be highlighted, further studies of biologic versus s...

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There are similarities in the grounds, nature, and impact of litigation in the context of the countries studied. The studies included show weaknesses of health systems to ensure access to different services as well as in the introduction of new health technologies.

Transanal endoscopic microsurgery is effective and safe for the surgical resection of rectal carcinoids<2 cm in diameter, with typical features and located more than 5 cm from the anal verge. Transanal endoscopic microsurgery can be used for primary resection or for resection after incomplete colonoscopic snare excision.