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International Urogynecology Journal

, Volume 21, Issue 3, pp 261–270 | Cite as

Polypropylene as a reinforcement in pelvic surgery is not inert: comparative analysis of 100 explants

  • Arnaud Clavé
  • Hannah Yahi
  • Jean-Claude Hammou
  • Suzelei Montanari
  • Pierre Gounon
  • Henri Clavé
Original Article

Abstract

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.

Methods

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.

Results

Poly(ethylene terephtahlate) explants appeared to sustain less degradation in vivo than the PP explants observed in this cohort.

Conclusions

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.

Keywords

Biomaterials Histological examination Pelvic floor disorders Polyester Polypropylene Vaginal surgery 

Abbreviations

PFD

Pelvic floor disorder

PP

Polypropylene

PET

Poly(ethylene terephthalate)

PPMF

Polypropylene monofilament

LDPPMF

Low density polypropylene monofilament

HDPPMF

High density polypropylene monofilament

NKNW

Nonknitted nonwoven polypropylene

PGA

Poly(glycolic acid)

FTIR

Fourier transform infrared spectroscopy

DSC

Differential scanning calorimetry

SEM

Scanning electron microscopy

Notes

Acknowledgment

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.

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Copyright information

© The International Urogynecological Association 2009

Authors and Affiliations

  • Arnaud Clavé
    • 1
  • Hannah Yahi
    • 2
  • Jean-Claude Hammou
    • 3
  • Suzelei Montanari
    • 4
  • Pierre Gounon
    • 5
  • Henri Clavé
    • 6
  1. 1.Service de Chirurgie (Pr Lefèvre)CHRU Brest Faculté de Médecine, Université de Bretagne OccidentaleBrestFrance
  2. 2.Service de Gynécologie (Pr Cosson)CHRU LilleLilleFrance
  3. 3.Laboratoire d’AnatomopathologieNiceFrance
  4. 4.Research and Development DepartmentCovidienTrévouxFrance
  5. 5.Centre Commun de Microscopie Appliquée (CCMA)Université de Nice Sophia-AntipolisNiceFrance
  6. 6.Département de Chirurgie GynécologiqueClinique Saint GeorgeNiceFrance

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