Polypropylene as a reinforcement in pelvic surgery is not inert: comparative analysis of 100 explants
- 514 Downloads
Introduction and hypothesis
Currently, most implants used for reinforcement in surgical treatment of pelvic floor disorders are knitted monofilament polypropylene (PP). While previously recognized as inert, PP is associated with high complication rates. Some recent literature suggests polyester prosthetics based on poly(ethylene terephthalate) (PET), which may be more inert in vivo.
A sample of 100 implants explanted from patients due to complications was examined to evaluate the relative degradation characteristics of PP and PET prosthetics. Histological, microscopic (scanning electron microscopy, SEM) and chemical analysis (Fourier transform infrared (FTIR) spectroscopy and differential scanning calorimetry (DSC)) were conducted on these explants.
Poly(ethylene terephtahlate) explants appeared to sustain less degradation in vivo than the PP explants observed in this cohort.
This is the first study to evaluate synthetic implants used in a vaginal approach for pelvic floor reinforcement. The study provides evidence contrary to published literature characterizing PP as inert in such applications. Additionally, the study suggests the need for clinical trials comparatively investigating the performance of new types of monofilament prosthetics, such as those comprising PET.
KeywordsBiomaterials Histological examination Pelvic floor disorders Polyester Polypropylene Vaginal surgery
Pelvic floor disorder
Low density polypropylene monofilament
High density polypropylene monofilament
Nonknitted nonwoven polypropylene
Fourier transform infrared spectroscopy
Differential scanning calorimetry
Scanning electron microscopy
Many thanks to Jean-Pierre Laugier for his tremendous pedagogic work with SEM at the CCMA.
Conflicts of interest
The work and research of H. Yahi were supported by a grant from SOFRADIM; S. Montanari is an affiliate of Covidien; Henri Clavé has an educational position for Ethicon Europe.
- 4.Debodinance P, Berrocal J, Clave H, Cosson M, Garbin O, Jacquetin B et al (2004) Changing attitudes on the surgical treatment of urogenital prolapse: birth of the tension-free vaginal mesh. J Gynecol Obstet Biol Reprod (Paris) 33:577–588Google Scholar
- 13.Lefranc O, Bayon Y, Montanari S, Gravagna Ph (in press) Reinforcement materials in Soft Tissue Repair: Key paramaters controlling tolerance and performance-current and future trends in mesh development, in new techniques in genital prolapse surgery.Drs. Theobald P, Zimmerman CW, Davila GW (Eds.)Google Scholar
- 21.Coda A, Bendavid R, Botto-Micca F, Bossoti M, Bona A (2003) Structural alterations of prosthetic meshes in humans. Hernia 7:44–49Google Scholar
- 22.Debodinance P, Delporte P, Engrand J, Boulogne M (2002) Development of a better tolerated prosthetic materials: applications in gynecological surgery. J Gynecol Obstet Biol Reprod (Paris) 31:527–540Google Scholar