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Sebastian L, Alina J, Fabinshy T, Dominik R, Axel S, Jens H, Kilian W, Claudia R, Leonidas K, Julia R, Nadja T, Christian E. AbsorbaTack ™ vs. ProTack ™ vs. sutures: a biomechanical analysis of cervical fixation methods for laparoscopic apical fixations in the porcine model. Arch Gynecol Obstet 2023; 307:863-871. [PMID: 36404354 PMCID: PMC9984508 DOI: 10.1007/s00404-022-06827-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/16/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE Treatment of pelvic organ prolapse (POP) often requires the use of synthetic mesh. In case of a novel and standardized bilateral apical fixation, both uterosacral ligaments are replaced by polyvinylidene-fluoride (PVDF) tapes. One of the main problems remains the fixation method, which should be stable, but also simple and quick to use. The current study evaluated biomechanical differences between the cervical tape fixation with sutures (group 1), non-absorbable tacks (group 2) and absorbable tacks (group 3) in an in vitro porcine model. METHODS A total of 28 trials, conducted in three groups, were performed on porcine, fresh cadaver uteri. All trials were performed until mesh, tissue or fixation device failure occurred. Primary endpoints were the biomechanical properties maximum load (N), displacement at failure (mm) and stiffness (N/mm). The failure mode was a secondary endpoint. RESULTS There was a significant difference between all three groups concerning the maximum load. Group 1 (sutures) supported a maximum load of 64 ± 15 N, group 2 (non-absorbable tacks) yielded 41 ± 10 N and group 3 (absorbable tacks) achieved 15 ± 8 N. The most common failure mode was a mesh failure for group 1 and 2 and a fixation device failure for group 3. CONCLUSION The PVDF-tape fixation with sutures supports 1.5 times the load that is supported by non-absorbable tacks and 4.2 times the load that is supported by absorbable tacks. Nevertheless, there was also a stable fixation through tacks. Sutures are the significantly stronger and cheaper fixation device but may prolong the surgical time in contrast to the use of tacks.
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Affiliation(s)
- Ludwig Sebastian
- Department of Gynecology and Obstetrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpenerstrasse 34, 50931, Cologne, Germany.
| | - Jansen Alina
- Department of Gynecology and Obstetrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpenerstrasse 34, 50931, Cologne, Germany
| | - Thangarajah Fabinshy
- Department of Gynecology and Obstetrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpenerstrasse 34, 50931, Cologne, Germany
| | - Ratiu Dominik
- Department of Gynecology and Obstetrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpenerstrasse 34, 50931, Cologne, Germany
| | - Sauerwald Axel
- Department of Gynecology and Obstetrics, St. Marien Hospital Düren, Düren, Germany
| | - Hachenberg Jens
- Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany
| | - Wegmann Kilian
- Department for Trauma, Hand and Elbow Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Rudroff Claudia
- Department of General Surgery, Evangelisches Krankenhaus Köln-Weyertal, Cologne, Germany
| | - Karapanos Leonidas
- Department of Urology, Uro-Oncology, Faculty of Medicine and University Hospital Cologne, Robot- Assisted and Reconstructive Surgery, University of Cologne, Cologne, Germany
| | - Radosa Julia
- Department for Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, Homburg, Germany
| | - Trageser Nadja
- Department of Gynecology and Obstetrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpenerstrasse 34, 50931, Cologne, Germany
| | - Eichler Christian
- Department of Gynecology and Obstetrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpenerstrasse 34, 50931, Cologne, Germany.,Breast Cancer Center, St. Franziskus-Hospital Münster, 48145, Münster, Germany
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Polypropylene Pelvic Mesh: What Went Wrong and What Will Be of the Future? Biomedicines 2023; 11:biomedicines11030741. [PMID: 36979721 PMCID: PMC10045074 DOI: 10.3390/biomedicines11030741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 02/21/2023] [Accepted: 02/23/2023] [Indexed: 03/05/2023] Open
Abstract
Background: Polypropylene (PP) pelvic mesh is a synthetic mesh made of PP polymer used to treat pelvic organ prolapse (POP). Its use has become highly controversial due to reports of serious complications. This research critically reviews the current management options for POP and PP mesh as a viable clinical application for the treatment of POP. The safety and suitability of PP material were rigorously studied and critically evaluated, with consideration to the mechanical and chemical properties of PP. We proposed the ideal properties of the ‘perfect’ synthetic pelvic mesh with emerging advanced materials. Methods: We performed a literature review using PubMed/Medline, Embase, Cochrane Library (Wiley) databases, and ClinicalTrials.gov databases, including the relevant keywords: pelvic organ prolapse (POP), polypropylene mesh, synthetic mesh, and mesh complications. Results: The results of this review found that although PP is nontoxic, its physical properties demonstrate a significant mismatch between its viscoelastic properties compared to the surrounding tissue, which is a likely cause of complications. In addition, a lack of integration of PP mesh into surrounding tissue over longer periods of follow up is another risk factor for irreversible complications. Conclusions: PP mesh has caused a rise in reports of complications involving chronic pain and mesh exposure. This is due to the mechanical and physicochemical properties of PP mesh. As a result, PP mesh for the treatment of POP has been banned in multiple countries, currently with no alternative available. We propose the development of a pelvic mesh using advanced materials including emerging graphene-based nanocomposite materials.
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