Design of surgical meshes – an engineering perspective

Pandit, Abhay; Henry, J

doi:10.3233/thc-2004-12106

Cited by 17 publications

(7 citation statements)

References 91 publications

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“…The use of hernia mesh products to surgically repair or reconstruct anatomical defects has been widely adopted: in fact, more than 80% of hernia repairs performed in United Sates use mesh products [ 8 ]. The surgical mesh firmly reinforces the weakened area and provides tension-free repair that facilitates the incorporation of fibrocollagenous tissue [ 9 ]. However, there are many types of meshes and there is a strong controversy regarding optimum performance and success of surgical procedures.…”

Section: Introductionmentioning

confidence: 99%

Past, Present and Future of Surgical Meshes: A Review

et al. 2017

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Surgical meshes, in particular those used to repair hernias, have been in use since 1891. Since then, research in the area has expanded, given the vast number of post-surgery complications such as infection, fibrosis, adhesions, mesh rejection, and hernia recurrence. Researchers have focused on the analysis and implementation of a wide range of materials: meshes with different fiber size and porosity, a variety of manufacturing methods, and certainly a variety of surgical and implantation procedures. Currently, surface modification methods and development of nanofiber based systems are actively being explored as areas of opportunity to retain material strength and increase biocompatibility of available meshes. This review summarizes the history of surgical meshes and presents an overview of commercial surgical meshes, their properties, manufacturing methods, and observed biological response, as well as the requirements for an ideal surgical mesh and potential manufacturing methods.

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Section: Introductionmentioning

confidence: 99%

Past, Present and Future of Surgical Meshes: A Review

et al. 2017

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“…Loads above the failure point can also considerably change the material and textile properties of the mesh when repeated overtime 116 . An in vitro study evaluating the dynamic creep behaviour of four commercially available PPL meshes with different pore size, bulk density and geometries under physiological conditions showed that all meshes underwent strain hardening and plastic deformation after cyclic uniaxial loading 117 .…”

Section: [H3] Biocompatibilitymentioning

confidence: 99%

“…Data from another study showed that 3 days of fatigue testing in culture conditions was enough to demonstrate strain hardening and subsequent failure of some meshes 93 . Strain hardening is a well-defined phenomenon for thermoplastics 116 that are used in engineering and, from an engineering perspective, cyclic and fatigue tests would be expected to be performed to evaluate the deformation of the mesh. Although fatigue tests have been widely used for other biomedical implants (such as heart valves and stents) they have not been used, to the best of our knowledge, to evaluate vaginal meshes as they were considered low-risk medical implants.…”

Section: [H3] Biocompatibilitymentioning

confidence: 99%

Landmarks in vaginal mesh development: polypropylene mesh for treatment of SUI and POP

et al. 2019

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Vaginal meshes used in the treatment of stress urinary incontinence (SUI) and pelvic organ prolapse (POP) have produced highly variable outcomes causing life-changing complications in some patients while providing others with effective, minimally invasive treatments. The issue surrounding the risk:benefit ratio when using the vaginal meshes is complex in which a combination of several factors, including the inherent incompatibility of the mesh material with some applications in pelvic reconstructive surgeries and the lack of appropriate regulatory approval processes at the time of premarket clearance of these products , have contributed to occurrence of complications caused by vaginal mesh. Surgical mesh used in hernia repair has evolved over many years from metal implants to knitted polymer meshes that were adopted for use in the pelvic floor for treatment of POP and SUI. The evolution of the material and textile properties of the surgical mesh was guided by clinical feedback from hernia repair procedures, which were also being modified to obtain the best outcomes with use of the mesh. Current evidence shows how surgical mesh fails biomechanically when used in pelvic floor and materials with improved performance can be developed using modern material processing and tissue engineering techniques. [H1] IntroductionVaginal meshes that are currently used in the surgical treatment of stress urinary incontinence (SUI) and pelvic organ prolapse (POP) can result in life-changing complications in some women who have vaginal mesh implants 1 . These adverse outcomes are now considered a major public health problem; New Zealand becoming the first country in the world to ban the use of transvaginal POP mesh products while still allowing transvaginal SUI meshes (except minislings) in December 2017 2 . In the UK, two public enquiries performed by the Scottish (in 2015) 3 and English (in 2017) 4 governments, in part, as a result of pressure from patient groups led to suspension of vaginal mesh products, both for SUI and POP, from July 2018 onwards 5 . The newest guidance by the National Institute of Health and Care Excellence (NICE) in the UK recommends that retropubic sling materials can be offered to women with SUI if nonsurgical management has failed 6 . In response, the British Society of Urogynaecologists expressed strong disagreement with the decision to suspend the use of vaginal mesh for SUI, but not POP, stating that this decision would deprive many women of an effective and safe treatment option as demonstrated by level I evidence 7 8 . Mesh manufacturers are currently facing lawsuits in the USA and Europe 9 . The issue with mesh repairs for SUI and POP is complex, as the vaginal mesh is implanted in the female pelvic floor in several different ways with very different outcomes in efficacy and complication outcomes. When used as a tape to treat SUI, many patients are effectively cured with the benefits outweighing the risks 10,11 , whereas when used for transvaginal POP repair, complications are more frequent 12 with...

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“…In fact, this has been a persistent issue in the literature for all locations of mesh placement since Usher et al first described using Marlex to repair incisional hernias in 1958. 29 Studies show that ideal mesh characteristics include inertness, resistance to mechanical strain, minimal foreign body reaction, flexibility, resistance to infection, rapid incorporation into autologous tissue, similar tensile strength to native tissue, low cost, and restoration of the natural movements of the abdominal wall, [30][31][32][33] but no material in use today has all of these features. As a result, there are many different mesh compositions utilized in sublay repairs.…”

Section: Component Separationmentioning

confidence: 99%

Retromuscular Sublay Technique for Ventral Hernia Repair

Rhemtulla

Fischer

2018

Seminars in Plastic Surgery

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Rives and Stoppa described the sublay technique of hernia repair more than half a century ago, but it took almost three decades to become truly appreciated and even longer for its full clinical potential and benefits to be realized. Modifications to the original operation have significantly improved surgical approaches, postsurgical outcomes, and quality of life. The retromuscular approach requires technical expertise and a firm grasp of the anatomy. With constant substitution of the terms sublay, retrorectus, retromuscular, preperitoneal, and Rives-Stoppa throughout the literature, the nuances need to be distinguished to appreciate the surgical planes encountered during the operation. This article explains the origin of the nomenclature while clarifying these terms, describing the technique, highlighting outcomes, and discussing future considerations.

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Design of surgical meshes – an engineering perspective

Cited by 17 publications

References 91 publications

Past, Present and Future of Surgical Meshes: A Review

Past, Present and Future of Surgical Meshes: A Review

Landmarks in vaginal mesh development: polypropylene mesh for treatment of SUI and POP

Retromuscular Sublay Technique for Ventral Hernia Repair

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