Host–biomaterial interactions in mesh complications after pelvic floor reconstructive surgery

Abstract

Polypropylene (PPL) mesh is widely used in pelvic floor reconstructive surgery for prolapse and stress urinary incontinence. However, some women, particularly those women treated using transvaginal PPL mesh placement for prolapse, experience intractable pain and mesh exposure or extrusion. Explanted tissue from patients with complications following transvaginal implantation of mesh is typified by a dense fibrous capsule with an immune-cell rich infiltrate suggesting that the host immune response has a role in transvaginal PPL mesh complications through the separate contributions of the host (patient), the biological niche within which the material is implanted, and biomaterial properties of the mesh. This immune response might be strongly influenced by both the baseline inflammatory status of the patient, surgical technique and experience, and the unique hormonal, immune and microbial tissue niche of the vagina. Mesh porosity, surface area and stiffness also might have an effect on the immune and tissue response to transvaginal mesh placement. Thus, a regulatory pathway is needed for mesh development that recognizes the roles of host and biological factors in driving the immune response to mesh alongside mandatory mesh registries and the longitudinal surveillance of patients.

Tannic acid-loaded hydrogel coating endues polypropylene mesh with hemostatic and anti-inflammatory capacity for facilitating pelvic floor repair

“…2g ). During the early stage of hydrogel-complexes implantation, the degradation of TA@GelMA hydrogel coating would be gradually synchronous with remodeling and regeneration with new tissue, and TA was released for reducing and regulating the inflammatory immune cell infiltrated microenvironment induced by PPM implantation [ 1 ]. Conversely, slower biodegradation rate of GelMA hydrogel coating could lead to chronic inflammation and hinder the integration of tissues and PPM.…”

“…S1e ). Explanted mesh from women with complications showed poorly regulated inflammation with a fibrous capsule [ 1 ]. And there were no exposition, abscess and fold in two groups.…”

“…Polypropylene mesh (PPM) is made of polypropylene (PP) monofilaments, which has high chemical stability and relatively good mechanical property as the standard material. PPM is used to treat pelvic organ prolapse (POP) clinically, which significantly improves anatomic correction in prolapsed patients [ 1 , 2 ]. However, the occurrence of complications due to mesh exposure seriously affects the life quality of patients [ 3 , 4 ].…”

“…Pathological evidences suggest that the vast majority of complications are related to acute or chronic inflammation induced by heterologous mesh materials [ 4 , 5 ]. The main influencing factor of exposure is the poor histocompatibility of the mesh causing the inflammatory response around the mesh [ 1 , 2 , 6 ]. A risk of postoperative hematoma has been reported recently [ 7 ].…”

“…Inhibition of postoperative inflammatory response and extracellular matrix (ECM) degradation is the key to reducing mesh exposure and corrosion [ 1 , 10 ]. Various cells and cytokines are involved in various acute and chronic inflammatory processes after mesh implantation [ 1 , 11 ]. Macrophages can be divided into two main subtypes, M1 and M2.…”