Graft‐related complications and biaxial tensiometry following experimental vaginal implantation of flat mesh of variable dimensions. Issue 2 (14th December 2012)

• Record Type: Journal Article
• Authors: Manodoro, S; Endo, M; Uvin, P; Albersen, M; Vláčil, J; Engels, A; Schmidt, B; De, D; Feola, A; Deprest, J
• Is Part Of: BJOG. Volume 120:Issue 2(2013:Feb.)
• Page Start: 244
• Page End: 250
• Publication Date: 2012-12-14
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1111/1471-0528.12081
• Languages: English
• ISSNs: 1470-0328

Abstract

<abstract abstract-type="main" id="bjo12081-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bjo12081-sec-0001" sec-type="section"> <title>Objective</title> <p>To compare the occurrence of graft‐related complications (GRCs) and biomechanical properties of meshes implanted vaginally and abdominally.</p> </sec> <sec id="bjo12081-sec-0002" sec-type="section"> <title>Design</title> <p> <italic>In vivo</italic> animal experiment.</p> </sec> <sec id="bjo12081-sec-0003" sec-type="section"> <title>Setting</title> <p>Centre for Surgical Technologies, Medical Faculty, KU Leuven, Belgium.</p> </sec> <sec id="bjo12081-sec-0004" sec-type="section"> <title>Population</title> <p>Twenty adult parous Texel ewes.</p> </sec> <sec id="bjo12081-sec-0005" sec-type="section"> <title>Methods</title> <p>Sheep were implanted with Gynemesh M, a 28‐g/m² polypropylene mesh reinforced with polyglecaprone fibres, under general anaesthesia. Dissection into the rectovaginal septum was performed to accommodate a flat 50 × 50 mm (<italic>n</italic> = 10) or 35 × 35 mm (<italic>n</italic> = 10) mesh, which was sutured to the underlying tissues. A 50 × 50 mm mesh was laid over a primarily sutured, full‐thickness, 40‐mm longitudinal abdominal wall incision. Sacrifice was at 60 days (<italic>n</italic> = 10) or 90 days (<italic>n</italic> = 5).</p> </sec> <sec id="bjo12081-sec-0006" sec-type="section"> <title>Main outcome measures</title> <p>The occurrence of exposure, the degree of contraction and examination of the biomechanical properties of explants with a minimum radius of 32 mm via biaxial tensiometry.</p> </sec> <sec id="bjo12081-sec-0007" sec-type="section"> <title>Results</title> <p>Insertion of a 50 × 50 mm mesh led to exposures in 30% (3/10) of cases, and the average contraction rate was 52 ± 14%. In the 35 × 35 mm implants, there were no exposures, and the contraction rate was 25 ± 26.3%. Vaginal explants with no GRCs and of sufficient size had biomechanical properties that were comparable with those of abdominal explants.</p> </sec> <sec id="bjo12081-sec-0008" sec-type="section"> <title>Conclusion</title> <p>Vaginal mesh insertion is associated with GRCs, such as exposure and contraction. Although other factors probably play a role, this study illustrates that mesh size may also induce these complications. In a vaginal surgery model, clinically occurring GRCs can be reproduced. In addition, biomechanics of uncomplicated vaginal explants are comparable with those measured on abdominal explants.</p> </sec> </abstract>