Analyzing material changes consistent with degradation of explanted polymeric hernia mesh related to clinical characteristics

Lu, Xinyue; Harman, Melinda K.; Heniford, B. Todd; Augenstein, Vedra A.; McIver, Brittney; Bridges, William B.

doi:10.1007/s00464-021-08882-4

Cited by 2 publications

(3 citation statements)

References 49 publications

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“…The Ti coating does not prevent the degradation of PP, which is visible through cracks and flaking of the fiber surface on SEM images. This observation of cracks and flaking is consistent with the results of studies on non‐titanised explanted PP meshes 5,6,28,29 …”

Section: Resultssupporting

confidence: 89%

“…This observation of cracks and flaking is consistent with the results of studies on non‐titanised explanted PP meshes. 5 , 6 , 28 , 29 …”

Section: Resultsmentioning

confidence: 99%

“…This observation of cracks and flaking is consistent with the results of studies on non-titanised explanted PP meshes. 5,6,28,29 The effects of mesh degradation on the biological host response are not yet clear. However, the release of PP particles in the nano-to micrometer range irritate cells and stimulates the immune system 9 or contribute to increase inflammation via surface enlargement and may explain the relatively strong foreign body reaction of non-titanised PP.…”

Section: Evaluation Of Surface Morphology By Sem Bse and Se Imagingmentioning

confidence: 99%

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Characterization in respect to degradation of titanium‐coated polypropylene surgical mesh explanted from humans

2023

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Titanium-coated polypropylene (Ti-PP) mesh was introduced in 2002 as a surgical mesh for the treatment of hernias and shortly after for pelvic floor surgery, with the aim of improving biocompatibility when compared to non-titanised/regular PP mesh implants. The application of a titanium coating could also be beneficial to address concerns regarding the exposure of PP in an in vivo environment. Many studies have shown that PP, although it is widely accepted as a stable polymer, is subject to oxidation and degradation, such degradation affects the mechanical behavior, that is, the stiffness and tensile strength of PP mesh. Despite the wide clinical use of Ti-PP surgical meshes, no study has yet investigated the residual material properties post clinical deployment and subsequent explantation. In this study, two explanted Ti-PP mesh samples each having different incorporation durations from two patients were examined. Material analysis conducted within this study includes the following techniques: attenuated total reflectance-Fourier transform infrared spectroscopy (ATR-FTIR), Raman spectroscopy, low voltagescanning electron microscopy (LV-SEM), backscattered electron (BSE) imaging, energy dispersive X-ray spectroscopy (EDS) and secondary election hyperspectral imaging (SEHI). The hypothesis of this study is that the Ti coating successfully shields the PP mesh from oxidative stress in vivo and thus protects it from degradation. The results of this analysis show for the first time evidence of bulk oxidation, surface degradation, and environmental stress cracking on explanted Ti-PP meshes.

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Section: Resultssupporting

confidence: 89%

“…This observation of cracks and flaking is consistent with the results of studies on non‐titanised explanted PP meshes. 5 , 6 , 28 , 29 …”

Section: Resultsmentioning

confidence: 99%

Section: Evaluation Of Surface Morphology By Sem Bse and Se Imagingmentioning

confidence: 99%

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Characterization in respect to degradation of titanium‐coated polypropylene surgical mesh explanted from humans

2023

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Hernia mesh infection treatment following the repair of abdominal wall hernias: A single-center experience

Wang

Fan

et al. 2022

Front. Surg.

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IntroductionThe mesh-based repair of abdominal wall hernias is a commonly employed approach as it is easy to implement and associated with low rates of hernia recurrence. However, the occurrence of hernia mesh infections following such repair can be extremely serious, and no clinical consensus regarding the optimal treatment of such infections has been established. This study was thus developed to review the management of hernia mesh infection cases treated at our center, summarizing the demographic and clinical characteristics of affected patients and summarizing our associated therapeutic experiences.MethodsData pertaining to 64 cases of hernia mesh infections treated at our center were retrospectively reviewed. Data were obtained from patient medical records, including general situation, hernia type, prior hernia repair approaches, type of mesh, and postoperative condition. Other reviewed outcomes include bacteriological and imaging findings, as well as treatment outcomes. In cases where conservative management was not successful, the approach to mesh removal (laparoscopic vs. open) was made based on the primary surgical approach and the type of material used for the repair.ResultsIn total, 42 patients underwent primary open inguinal hernioplasty (including plug repair, preperitoneal mesh repair, and Lichtenstein repair), while 11 patients underwent laparoscopic repair (9 transabdominal preperitoneal, TAPP and 2 totally extraperitoneal,TEP), and 11 patients with incisional hernias underwent the intraperitoneal onlay mesh (IPOM) procedure. Six patients exhibited mesh erosion of the internal organs. Of these patients, 38 underwent mesh removal via open debridement, while 9 underwent laparoscopic exploration and open debridement, and 1 underwent laparoscopic mesh removal. No patients exhibited serious postoperative sequelae, serious complications, or mortality after the treatment of mesh infections.One patient experienced postoperative infection recurrence following partial mesh removal, with the appearance of a small fistula. Hernias recurred in 2 patients following mesh removal, and 1 patient underwent repair via laparoscopic IPOM.ConclusionsWhile conservative treatment can cure early mesh infections, there is nonetheless a risk that these infections will recur. In view of the variety of surgical intervention of abdominal wall hernias at present,treatment of mesh infection should be individualized. Our findings suggest that hernias repaired via the placement of mesh in the preperitoneal space can more readily contribute to internal organ erosion and late-onset infections, with open debridement often being unable to completely remove the mesh without causing collateral damage. Laparoscopic exploration is an effective and minimally invasive approach to detecting internal organ involvement and removing the infected hernia mesh from affected patients.

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Analyzing material changes consistent with degradation of explanted polymeric hernia mesh related to clinical characteristics

Cited by 2 publications

References 49 publications

Characterization in respect to degradation of titanium‐coated polypropylene surgical mesh explanted from humans

Characterization in respect to degradation of titanium‐coated polypropylene surgical mesh explanted from humans

Hernia mesh infection treatment following the repair of abdominal wall hernias: A single-center experience

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