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

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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.

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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

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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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Authors and Affiliations

  1. Service de Chirurgie (Pr Lefèvre), CHRU Brest Faculté de Médecine, Université de Bretagne Occidentale, Brest, France

    Arnaud Clavé

  2. Service de Gynécologie (Pr Cosson), CHRU Lille, Lille, France

    Hannah Yahi

  3. Laboratoire d’Anatomopathologie, Nice, France

    Jean-Claude Hammou

  4. Research and Development Department, Covidien, Trévoux, France

    Suzelei Montanari

  5. Centre Commun de Microscopie Appliquée (CCMA), Université de Nice Sophia-Antipolis, Nice, France

    Pierre Gounon

  6. Département de Chirurgie Gynécologique, Clinique Saint George, 24, Avenue de Flirey, 06000, Nice, France

    Henri Clavé

Authors
  1. Arnaud Clavé
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  2. Hannah Yahi
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  3. Jean-Claude Hammou
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  4. Suzelei Montanari
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  5. Pierre Gounon
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  6. Henri Clavé
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Correspondence to Henri Clavé.

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Clavé, A., Yahi, H., Hammou, JC. et al. Polypropylene as a reinforcement in pelvic surgery is not inert: comparative analysis of 100 explants. Int Urogynecol J 21, 261–270 (2010). https://doi.org/10.1007/s00192-009-1021-8

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  • DOI: https://doi.org/10.1007/s00192-009-1021-8

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