Ultrasound appearances after mesh implantation - Evidence of mesh contraction or folding?

Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University in Prague and General University Hospital, Apolinarska 18, Prague 2 128 00, Czech Republic.
International Urogynecology Journal (Impact Factor: 1.96). 10/2010; 22(5):529-33. DOI: 10.1007/s00192-010-1308-9
Source: PubMed

ABSTRACT Polypropylene meshes are frequently used in abdominal and vaginal reconstructive surgery. Recently, several authors have claimed that mesh-associated complications may be linked to mesh shrinkage. We have performed a prospective study with postoperative follow-up by ultrasound examination at two time points after Prolift anterior implantation to assess changes in the ultrasound appearance of mesh implants over time.
We assessed 36 patients who had undergone mesh implantation with Prolift anterior mesh for the correction of symptomatic anterior vaginal wall prolapse. During the surgery, we measured the actual midline length of the mesh (initial length). On the fourth postoperative day, we performed a vaginal ultrasound examination (US) to measure mesh length in the midsagittal plane. A second US was performed 3-5 months after surgery to repeat this measurement.
There was a significant difference in mesh length determined before and 4 days after surgery (90.3 vs. 57.1 mm, P = <0.0001) indicating intraoperative folding. On comparing early and late postoperative ultrasound measurements, there was a reduction in length from 57.1 to 48.3 mm (P < 0.0001), indicating possible shrinkage or retraction.
Intraoperative folding seems to be responsible for a large part of the difference between preoperative (in vitro) and postoperative (US) measurements of mesh dimensions, suggesting that surgical techniques may require adjustment.

Download full-text


Available from: Kamil Svabik, Dec 18, 2013
123 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: The surgical therapy of hernias is increasingly based on reinforcement with alloplastic material, in particular surgical meshes. The biological response to these foreign bodies largely depends on the selected material and its structure. In comparison to the physiological scar process following a simple abdominal wall incision, the chronic inflammation at the interface to the polymers lead to specific morphological alterations. In the present study two meshes with different pore sizes were implanted into rats: a heavy-weight and small-pore-sized mesh (hw-mesh) made of nonabsorbable polypropylene monofilaments and a low-weight large-pore-sized mesh consisting of polypropylene and of absorbable polyglactin multifilaments (lw-mesh). A suture repair of a laparotomy served as control. After 7, 14, 21, and 90 days the mesh area was analyzed with regard to tissue and cellular response. Over the whole observation period morphometric analysis indicated an improved integration of the lw-mesh with reduction of both inflammation and fibrosis, whereas the hw-mesh induced an intense chronic inflammation concomitant with an intensified bridging scar reaction. On the cellular level these findings correspond to an elevated cell turnover, characterized by increased rates of apoptotic and proliferating cells. In contrast, the tissue reaction to the lw-mesh achieved levels almost similar to those of the physiological scaring process in the control group. In conclusion, the present data confirm the development of a chronic inflammatory foreign body reaction at the interface to both hw-meshes and lw-meshes; however, the use of lw-meshes showed superior tissue integration. With regard to the quite similar polymer surface the pore size appears to be of major importance in tissue reaction and for the biocompatibility of mesh structures.
    Journal of Surgical Research 05/2002; 103(2):208-14. DOI:10.1006/jsre.2002.6358 · 1.94 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: We compared inflammatory response, fibrosis and biomechanical properties of different polypropylene materials from one manufacturer (Tyco Healthcare) in a rat model for primary fascial repair. Full-thickness abdominal wall defects were primarily repaired using 'overlay' technique. Multifilament implants were Surgipro SPM and SPMW, the latter a wider-weave type of the former. Monofilament SPMM implants and polypropylene suture repair (Surgipro II) served as controls. Explants were evaluated macroscopically and changes in thickness, shrinkage and tensile strength were measured. Inflammatory and connective tissue response was assessed on haematoxylin-eosin and Movat stains. Immunohistochemistry was done to localise rat macrophages/monocytes. Multifilament materials induced a shorter acute inflammatory response and more pronounced chronic inflammatory reaction compared to monofilament implants. Macrophages could be found deep in interstices 7.5 by 12.5 microm. No difference in collagen deposition and neovascularisation was observed. At 90 days time point, explants reconstructed with tighter woven multifilament SPM were weaker than sutured or SPMM controls. Overall shrinkage of 10% was comparable for all groups.
    International Urogynecology Journal 07/2007; 18(6):619-26. DOI:10.1007/s00192-006-0202-y · 1.96 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To investigate whether the sonographically measured size of the mesh implant in women who had undergone vaginal polypropylene mesh repair 6 weeks previously correlates with the original size of the mesh and whether the mesh ensures complete support of the anterior or posterior compartment. Forty postmenopausal women with anterior or posterior vaginal wall prolapse and sonographically proven cystocele (n = 20) or rectocele (n = 20) were evaluated preoperatively and 6 weeks after vaginal mesh repair. Introital ultrasound was performed to identify the polypropylene mesh and measure its distal to proximal length and configuration as well as its thickness. The initial mesh length was compared with that measured by ultrasound 6 weeks postoperatively. Vaginal length was measured pre- and postoperatively. The mean +/- SD age of the women was 68 +/- 7 years. The 20 women with cystocele underwent repair by means of anterior transobturator mesh implantation; the initial mesh length was 6.8 +/- 1.1 cm versus 2.9 +/- 0.6 cm postoperatively. The 20 women with rectocele underwent repair by posterior transischioanal mesh implantation; the initial mesh length was 9.9 +/- 0.8 cm versus 3.3 +/- 0.5 cm postoperatively. The mesh supported 43.4% of the length of the anterior vaginal wall and this value was 53.7% for the posterior wall (P = 0.016). Sonography is recommended for postoperative evaluation of the anterior and posterior mesh positions after prolapse surgery. There is a considerable discrepancy between the implanted mesh size and the length measured 6 weeks later by postoperative ultrasound. Published by John Wiley & Sons, Ltd.
    Ultrasound in Obstetrics and Gynecology 04/2007; 29(4):449-52. DOI:10.1002/uog.3962 · 3.85 Impact Factor
Show more