Surgical mesh

SURGICAL MESH

1. Surgical mesh RIYA SANJAY BAGHELE - NAGPUR.

2. DEFINITION … Surgical mesh is a sterile woven piece of netting that is used in surgical procedures to help repair sites of surgical incision, tissue herniation, or to provide support to internal parts of the body. Surgical mesh is used in many different types of surgical procedures. Hernia repair is one of the most frequently performed general surgeries world wide, and usually involves the use of surgical mesh. Mesh is also used to assist in surgical correction of urinary incontinence, uterine suspension, vertebral reconstruction, tissue reconstruction, vaginal prolapse, etc. In tissue repair application, the mesh serves to mechanically strengthen the weakened area while simultaneously promoting long term stability by acting as a scaffold for new tissue growth.

3. Indication… Surgical mesh can be permanently implanted to reinforce the vaginal wall for POP repair, or support the urethra or bladder neck for the repair of SUI. In pelvic organ prolapse , the pelvic organ may shift downwards and bulge out of the vagina. This occurs in women whose pelvic floor muscles and tissue are too weak to hold the organs in place. Stress urinary incontinence (SUI) is a leakage of urine during moments of physical activity that increases abdominal pressure, such as coughing, sneezing, laughing, or exercise. SUI is the most common type of urinary incontinence in women. Biodegradable surgical mesh are used in the treatment of hernias where the connective tissue has ruptured or Transvaginal insertion mesh to treat (POP) as a sling material to support the repositioning and support of the bladder neck for female urinary incontinence.

4. The use of surgical mesh slings to treat SUI provides a less invasive approach than non-mesh repairs, which require a larger incision in the abdominal wall. The multi-incision sling procedure can be performed using three incisions, in two ways: with one vaginal incision and two lower abdominal incisions, called retropubic; or with one vaginal incision and two groin/thigh incisions, called transobturator . There is also a "mini-sling" procedure that utilizes a shorter piece of surgical mesh, which may be done with only one incision.

5. Materials used for surgical mesh include: Non-absorbable synthetic polymers : 1. Polyprophylene(Prolene). The mesh is pliable but at the same time sufficiently mechanically resistant. Fully transparent to allow secure fixation. Monofilament. Can be used in presence of infection. Good elasticity and high tensile strength. Non absorbable. Used for hernia repair and abdominal wall construction. Sterilized by gamma radiation. Fixed with prolene sutures. .

6. 3. PTFE (Teflon/Gordex) Soft, flexible non absorbable. Impervious to fluids. Should not be used in presence of infection. 4.Stainless steel mesh Rigid and difficult to work with it. Causes discomfort to patient Absorbable synthetic polymers: -Polyglycolic acid; used for wound closure and organ support. Biological Mesh: - Surgisis ( Porcine submucosa) -Alloderm (Cadaveric human dermis) Composite mesh: -A combination of any of 3 previous materials . Composite mesh Biological Mesh

7. MESH USED IN HERNIA SURGERY STAINLESS STEEL MESH

8. Physical or mechanical properties of mesh materials… Weight-  Measurement of the “heaviness” or “heft” of the material, weight /unit area. Shrinkage-Dimensional decrease in length or width of a material. Strain-  Deformation of a material in response to an applied force, force/unit area. Tensile strength- Maximum stress that a material subject to a stretching load can withstand without tearing or breaking. Burst strength- The maximum uniformly distributed pressure applied at right angle to its surface that a material will withstand under standardized conditions pressure/unit area  Elasticity -  Property of a material whereby it changes its shape and size under the action of opposing forces, but recovers its original configuration when the forces are removed .

9. Stiffness- Ratio of steadily increasing or decreasing force acting on a deformable elastic material to the resulting displacement or deformation. Isotropy- When a material do not exhibit differences in properties based on the direction of the applied load, the material is said to be isotropic . Multifilament Types of mesh Monofilament Types of mesh

10. Ideal properties of surgical mesh… Ideal properties of synthetic biomaterials have been established in the 50´s of the last century, the material should ideally be: Physically stable after implantation Chemically inert Non allergic Non carcinogenic Mechanically resistant Sterilizable Cheap

11. Properties of the surgical meshes Relative Weight of Meshes Shrinkage Porosity, Bridging Elasticity of Abdominal Wall and Mesh Elasticity Stability of Mesh.

12. Complications of meshes … Chronic pain. Tissue or mesh erosion into organs. Most complications are merely a reflection of the properties already described. Thus, when choosing a mesh, the surgeon must decide which properties are the most important for the specific situation. For example, materials such as ePTFE have a good profile for adhesion risk but a high risk of infection. Incontrast, Polypropylene meshes are durable and have a low infection risk but they have little flexibility and a high adhesion risk. Bowel obstruction. Mesh degradation.

13. INFECTION RISK  The risk of infection is mainly determined by the type of filament used and pore size. Microporous meshes (for example, ePTFE) are at higher risk of infection because macrophages and neutrophils are unable to enter small pores (< 10 μm). This allows bacteria (< 1 μm) to survive unchallenged within the pores. A similar problem applies to multifilament meshes. The meshes at lowest risk of infection are, therefore, those made with monofilament and containing pores greater than 75 μm. Eradication of infection in such meshes can be achieved without their removal .

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