-
Journal of Orthopaedics Jun 2024Various reconstruction methods have been described in medical literature on scapular tumor resection depending on the type of resection and other factors. However the... (Review)
Review
Is polypropylene mesh reconstruction functionally superior to non reconstructive group following total scapular resection? A retrospective analysis of 16 patients and a systematic review of the literature.
BACKGROUND
Various reconstruction methods have been described in medical literature on scapular tumor resection depending on the type of resection and other factors. However the ideal method of reconstructions has been still debatable. The purpose of the current study was to assess whether polypropylene mesh reconstruction is superior as compared to non reconstructive group following total scapular resection.We also evaluated how our method of reconstruction fare as compared to reported reconstruction methods in the published literature.
METHODS
During 2014 to 2019; Total scapulectomy (Type III scapular resection) was performed in 16 patients for malignant tumor involving scapula bone. Reconstruction with polyprolene mesh(Group I) was performed in 56 % patient and non reconstruction technique (Group II) was observed in 44 % patient. The mean follow-up duration of current study was 28.3 months (range 13-67 months). The search method of PubMed and Cochrane databases provided 121 articles; of which 5 studies having 144 cases were utilised for final analysis. The reconstruction method used were dynamic humeral suspension (39.5%), non reconstruction method (35 %), scapular prosthesis (18 %) and static humeral suspension (5.5%).
RESULTS
The mean Musculoskeletal tumor society score (MSTS) of the study cohort was 19.8(0-23); and that in polyprolene mesh or static suspension method (Group I) and non reconstructive technique (Group II) was 67 % and 61% respectively. The emotional acceptance score in group I was 4.5 and that in group II was 4.2 points. There was no difference in the shoulder movements in both the groups. The mean surgical durations in group I and group II was was 186 min and 140 min respectively. The systematic review showed the mean Musculoskeletal tumor society score (MSTS) of dynamic suspension and non reconstruction method were 63 % and 63.5% respectively. The mean Musculoskeletal tumor society score (MSTS) of scapula prosthesis tended to be higher than those with dynamic suspension (77 % vs 65 %).
CONCLUSIONS
The reconstruction with polypropylene mesh had better functional outcome and emotional acceptance as compared to non-reconstructive group in patients with total scapular resection surgery. The findings of systematic review suggest that; patients treated by reconstruction with polypropylene mesh and non-reconstructive group as compared to scapular prosthesis had limited shoulder movements with no difference in hand position, manual dexterity and lifting ability.
PubMed: 38404696
DOI: 10.1016/j.jor.2024.02.019 -
International Urogynecology Journal Mar 2021The aim of this study is to systematically compare rates of erosion and chronic pain after mesh insertion for pelvic organ prolapse (POP) and stress urinary incontinence... (Review)
Review
BACKGROUND
The aim of this study is to systematically compare rates of erosion and chronic pain after mesh insertion for pelvic organ prolapse (POP) and stress urinary incontinence (SUI) surgery.
METHODS
A systematic electronic search was performed on studies that evaluated the incidence of erosion and chronic pain after mesh insertion for POP or SUI. The primary outcome measurement was to compare mesh erosion rates for POP and SUI surgery. Secondary outcome measurements were incidence of de novo pain and a comparison of patient demographics for both surgeries.
RESULTS
Twenty-six studies on 292,606 patients (n = 9077 for POP surgery and n = 283,529 for SUI surgery) met the inclusion criteria. Median follow-up was 26.38 ± 22.17 months for POP surgery and 39.33 ± 27.68 months for SUI surgery. Overall, the POP group were older (p < 0.0001) and had a lower BMI (p < 0.0001). Mesh erosion rates were significantly greater in the POP group compared to the SUI group (4% versus 1.9%) (OR 2.13; 95% CI 1.91-2.37; p < 0.0001). The duration from surgery to onset of mesh erosion was 306.84 ± 183.98 days. There was no difference in erosion rates between abdominal and transvaginal mesh for POP. There was no difference in erosion rates between the transobturator and retropubic approach for SUI. The incidence of chronic pain was significantly greater in the POP group compared to the SUI group (6.7% versus 0.6%) (OR 11.02; 95% CI 8.15-14.9; p < 0.0001). The duration from surgery to onset of chronic pain was 325.88 ± 226.31 days.
CONCLUSIONS
The risk of mesh erosion and chronic pain is significantly higher after surgery for POP compared to SUI. These significant complications occur within the first year after surgery.
Topics: Chronic Pain; Humans; Pelvic Organ Prolapse; Suburethral Slings; Surgical Mesh; Urinary Incontinence, Stress
PubMed: 33237357
DOI: 10.1007/s00192-020-04612-x -
Hernia : the Journal of Hernias and... Aug 2023There is an increasing number of patients following hernia surgery with implanted mesh reporting symptoms that could indicate autoimmune or allergic reactions to mesh.... (Review)
Review
BACKGROUND
There is an increasing number of patients following hernia surgery with implanted mesh reporting symptoms that could indicate autoimmune or allergic reactions to mesh. 'Allergy' to metals, various drugs, and chemicals is well recognised. However, hypersensitivity, allergy or autoimmunity caused by surgical mesh has not been proven by a scientific method to date. The aim of this study was twofold: to describe the pathophysiology of autoimmunity and foreign body reaction and to undertake a systematic review of surgical mesh implanted at the time of hernia repair and the subsequent development of autoimmune disease.
METHODS
A systematic review using the PRISMA guidelines was undertaken. Pubmed (Medline), Google Scholar and Cochrane databases were searched for all English-written peer-reviewed articles published between 2000 and 2021. The search was performed using the keywords "hernia", "mesh", "autoimmunity", "ASIA", "immune response", "autoimmune response".
RESULTS
Seven papers were included in the final analysis-three systematic reviews, three cohort studies and one case report. Much of the current data regarding the association of hernia mesh and autoimmunity relies on retrospective cohort studies and/or case reports with limited availability of cofounding factor data linked to autoimmune disease such as smoking status or indeed a detailed medical history of patients. Three systematic reviews have discussed this topic, each with a slightly different approach and none of them has identified causality between the use of mesh and the subsequent development of autoimmune disease.
CONCLUSION
There is little evidence that the use of polypropylene mesh can lead to autoimmunity. A large number of potential triggers of autoimmunity along with the genetic predisposition to autoimmune disease and the commonality of hernia, make a cause and effect difficult to unravel at present. Biomaterials cause foreign body reactions, but a chronic foreign body reaction does not indicate autoimmunity, a common misunderstanding in the literature.
Topics: Humans; Retrospective Studies; Herniorrhaphy; Hernia, Inguinal; Foreign-Body Reaction; Surgical Mesh; Autoimmune Diseases
PubMed: 36739352
DOI: 10.1007/s10029-023-02749-4 -
Journal of Obstetrics and Gynaecology... Jan 2024Surgical site infections (SSI) are common causes of postoperative morbidity at cesarean delivery (CD). The objective of this study was to compare the risk of SSI and... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Surgical site infections (SSI) are common causes of postoperative morbidity at cesarean delivery (CD). The objective of this study was to compare the risk of SSI and other wound complications associated with different suture materials for subcuticular skin closure at CD.
DATA SOURCES
We searched Cochrane Library, MEDLINE, Embase, and Clinicaltrials.gov from inception to June 3, 2021, and limited our search to English, peer-reviewed, randomized controlled trials and cohort studies.
STUDY SELECTION
Of 1541 titles identified, 4 studies met the selection criteria and were included. Studies were included if the population was pregnant individuals undergoing transverse incision primary or repeat, elective or emergent CD with subcuticular skin closure, and if outcomes related to SSI, wound seroma, hematoma, or dehiscence were reported. We completed the assessment using Covidence review management software.
DATA EXTRACTION AND SYNTHESIS
Two authors independently reviewed studies and assessed the risk of bias using the Cochrane 'Risk of bias' tool for randomized trials (RoB 2.0) and the Cochrane Risk of Bias in Non-Randomized Studies-of Interventions (ROBINS-I) tools for cohort studies. We compared SSI risk and secondary outcomes of hematoma, seroma, and dehiscence between skin closure with monofilament (poliglecaprone 25 or polypropylene) versus multifilament (polyglactin 910) sutures using a fixed-effects meta-analysis. Statistical heterogeneity was estimated using the I statistic. Monofilament sutures were associated with a reduced risk of SSI (RR = 0.71, 95% CI 0.52-0.98, I = 0%) compared to multifilament sutures. There was no difference in the risk of secondary outcomes.
CONCLUSION
Monofilament suture for subcuticular skin closure at CD was associated with decreased risk of SSI compared to multifilament suture.
Topics: Female; Pregnancy; Humans; Surgical Wound Dehiscence; Seroma; Surgical Wound Infection; Polyglactin 910; Sutures; Hematoma; Suture Techniques
PubMed: 37595945
DOI: 10.1016/j.jogc.2023.07.010 -
Water Environment Research : a Research... May 2024Microplastics (MPs) pollution has wreaked havoc on biodiversity and food safety globally. The false ingestion of MPs causes harmful effects on organisms, resulting in a... (Review)
Review
A systematic review on microplastic contamination in marine Crustacea and Mollusca of Asia: Current scenario, concentration, characterization, polymeric risk assessment, and future Prospectives.
Microplastics (MPs) pollution has wreaked havoc on biodiversity and food safety globally. The false ingestion of MPs causes harmful effects on organisms, resulting in a decline in biodiversity. The present review comprehended the current knowledge of MP contamination in Crustacea and Mollusca from 75 peer-reviewed articles published in Asia between 2015 and 2023. A total of 79 species (27 Crustacea and 52 Mollusca) have been recorded to be contaminated with MPs. Out of the total 27 species of Crustacea, Metopograpsus quadridentatus (327.56 MPs/individual) and Balanus albicostatus (0.42 MPs/individual) showed the highest and lowest contamination, respectively. Out of the total 52 species of Mollusca, Dolabella auricularia (2325 MPs/individual) and Crassostrea gigas and Mytilus edulis (0.2 MPs/individual) showed the highest and lowest contamination, respectively. In terms of country-wise MP contamination, China has the highest number of contaminated species in both phylums among Asia. Findings of pollution indices revealed a very high risk of MP contamination in all the countries. Fiber was reported predominantly in both groups. Blue and black-colored MPs having <500 μm and <500 μm-1 mm size were found dominantly in Crustacea and Mollusca, respectively. Polypropylene was recorded as the dominant plastic polymer in both Crustacea and Mollusca. In essence, this review has provided a comprehensive insight into MP concentration in Crustacea and Mollusca of Asia, highlighting variations among species and geographic locations. This understanding is crucial for tackling urgent environmental challenges, safeguarding human health, and promoting global sustainability initiatives amid the escalating issue of plastic pollution. PRACTITIONER POINTS: Microplastic pollution has created havoc on biodiversity and food safety. A total of 27 and 52 species of crustaceans and Mollusca have been recorded to be contaminated with MPs. Metopograpsus quadridentate and Dolabella auricularia have shown higher MPs contamination. Polypropylene was recorded as the dominant plastic polymer in both crustacean and Mollusca. Findings of pollution indices revealed a very high risk of MP contamination in all the countries.
Topics: Animals; Mollusca; Water Pollutants, Chemical; Risk Assessment; Asia; Microplastics; Crustacea; Environmental Monitoring
PubMed: 38708452
DOI: 10.1002/wer.11029 -
American Journal of Surgery Oct 2016Prophylactic mesh during laparotomy has been shown to be effective in preventing postoperative incisional hernia (IH) in high-risk patients. Since obesity is a risk... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Prophylactic mesh during laparotomy has been shown to be effective in preventing postoperative incisional hernia (IH) in high-risk patients. Since obesity is a risk factor for IH, we wished to determine whether mesh prevents IH in open and laparoscopic bariatric surgery patients.
METHODS
We conducted a systematic review of the literature with meta-analysis. Seven studies met inclusion criteria. We abstracted data regarding postoperative IH development, surgical site infection, and seroma or wound leakage and performed meta-analysis.
RESULTS
The prophylactic mesh group had significantly decreased odds of developing IH than the standard closure group (odds ratio, .30, 95% CI, .13 to .68, P = .004). No included studies evaluated outcomes after prophylactic mesh during laparoscopic bariatric surgery.
CONCLUSIONS
Prophylactic mesh during open bariatric surgery appears to be beneficial in reducing postoperative IH without significant increasing the odds of surgical site infection or seroma or wound leakage. Higher quality studies, including those in laparoscopic patients, and cost-utility analysis, are needed to support routine use of this intervention.
Topics: Bariatric Surgery; Humans; Incisional Hernia; Polyglactin 910; Polypropylenes; Postoperative Complications; Seroma; Surgical Mesh; Surgical Wound Infection
PubMed: 27659158
DOI: 10.1016/j.amjsurg.2016.06.004 -
Journal of Abdominal Wall Surgery : JAWS 2023Groin hernia literature often uses the terms light- and heavyweight and small or large pores to describe meshes. There is no universal definition of these terms, and... (Review)
Review
Groin hernia literature often uses the terms light- and heavyweight and small or large pores to describe meshes. There is no universal definition of these terms, and the aim of this scoping review was to assess how mesh weight and pore sizes are defined in the groin hernia literature. In this systematic scoping review, we searched PubMed, Embase, and Cochrane CENTRAL. We included randomised controlled trials with adults undergoing groin hernia repair with the Lichtenstein or laparoscopic techniques using a flat permanent polypropylene or polyester mesh. Studies had to use the terms lightweight, mediumweight, or heavyweight to be included, and the outcome was to report how researchers defined these terms as well as pore sizes. We included 48 studies with unique populations. The weight of lightweight meshes ranged from 28 to 60 g/m with a median of 39 g/m, and the pore size ranged from 1.0 to 4.0 mm with a median of 1.6 mm. The weight of heavyweight meshes ranged from 72 to 116 g/m with a median of 88 g/m, and the pore size ranged from 0.08 to 1.8 mm with a median of 1.0 mm. Only one mediumweight mesh was used weighing 55 g/m with a pore size of 0.75 mm. There seems to be a consensus that meshes weighing less than 60 g/m are defined as lightweight and meshes weighing more than 70 g/m are defined as heavyweight. The weight terms were used independently of pore sizes, which slightly overlapped between lightweight and heavyweight meshes.
PubMed: 38312405
DOI: 10.3389/jaws.2023.11179 -
Journal of Pharmacy & Bioallied Sciences Feb 2024This systematic review examines the efficacy and biocompatibility of orthodontic clear aligner tooth aligners constructed from polyethylene terephthalate glycol (PeT-G),...
Effectiveness and Biocompatibility of Tooth Aligners Made from Polyethylene Terephthalate Glycol (PeT-G), Polypropylene (PP), Polycarbonate (PC), Thermoplastic Polyurethanes (TPUs), and Ethylene-Vinyl Acetate (EVA): A Systematic Review.
OBJECTIVE
This systematic review examines the efficacy and biocompatibility of orthodontic clear aligner tooth aligners constructed from polyethylene terephthalate glycol (PeT-G), polypropylene (PP), polycarbonate (PC), thermoplastic polyurethanes (TPUs), and ethylene-vinyl acetate (EVA).
MATERIALS AND METHODS
To find relevant papers published through September 2021, PubMed was searched extensively. Randomized clinical trials (RCTs) and observational studies assessing the effectiveness and biocompatibility of the aligner materials were included. Data were extracted independently, and the quality of included research was appraised using relevant procedures. The research variability necessitated a narrative synthesis.
RESULTS
Five studies were included for comparison. All materials were biocompatible; however, PeT-G and EVA aligners caused the least tissue irritation. Patients preferred TPU aligners for initial comfort and PeT-G aligners for transparency and endurance.
CONCLUSION
Biocompatible PeT-G, PP, PC, TPU, and EVA tooth aligners fix malocclusions. Aligner materials should be chosen based on patient preferences, treatment goals, and material qualities. For stronger proof, a longer-term study is needed.
PubMed: 38595485
DOI: 10.4103/jpbs.jpbs_883_23 -
Surgery Apr 2017Operative intervention to correct incisional hernia affects 150,000 patients annually, with 1 in 3 repairs recurring within 9 years. The aim of this study was to... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Operative intervention to correct incisional hernia affects 150,000 patients annually, with 1 in 3 repairs recurring within 9 years. The aim of this study was to compare the incidence of incisional hernia and postoperative complications in elective midline laparotomy patients after the use of prophylactic mesh placement and primary suture closure.
METHODS
A systematic review was performed to identify studies comparing prophylactic mesh placement to primary suture closure in elective, midline laparotomy at index abdominal aponeurosis closure. The primary outcome was incisional hernia. Secondary outcomes included postoperative complications.
RESULTS
Fourteen studies were included (2,114 patients), with 1,152 receiving prophylactic mesh placement. Prophylactic mesh placement decreased the risk of incisional hernia overall when compared to primary suture closure (relative risk = 0.15; P < .00001) and in trials using only polypropylene mesh versus 4:1 primary suture closure (relative risk = 0.15; P = .003). Prophylactic mesh placement reduced the risk of incisional hernia regardless of mesh location or composition: onlay (relative risk = 0.07; P < .0001), retrorectus (relative risk = 0.04; P = .002), and preperitoneal (relative risk = 0.18; P = .02). Prophylactic mesh placement increased risk of seroma overall (relative risk = 1.95; P < .0001), onlay (relative risk = 2.43; P = .01) and preperitoneal (relative risk = 1.47; P = .01) but not retrorectus plane (relative risk = 1.55; P = .26). Polypropylene mesh increased seroma risk only in the onlay position (relative risk = 2.77; P = .04). Prophylactic mesh placement patients are at increased risk for chronic wound pain compared to primary suture closure (relative risk = 1.70; P = .03).
CONCLUSION
Prophylactic mesh placement is associated with an 85% postoperative incisional hernia risk reduction when compared to primary suture closure in at-risk patients undergoing elective, midline laparotomy closure. This technique appears to be safe with comparable complication profiles, barring an increased risk of seroma, especially with the onlay technique, and the possibility for an increased risk of chronic pain. Despite this verification, evidence from large domestic trials that sufficiently addresses major knowledge gaps is simply lacking.
Topics: Adult; Aged; Elective Surgical Procedures; Female; Humans; Incisional Hernia; Laparotomy; Male; Middle Aged; Primary Prevention; Prognosis; Randomized Controlled Trials as Topic; Risk Assessment; Surgical Mesh; Suture Techniques; Treatment Outcome; Wound Healing
PubMed: 28040255
DOI: 10.1016/j.surg.2016.09.036 -
Hernia : the Journal of Hernias and... Aug 2014Despite the vast selection of brands available, nearly all synthetic meshes for hernia surgery continue to use one or other of three basic materials: polypropylene,... (Review)
Review
PURPOSE
Despite the vast selection of brands available, nearly all synthetic meshes for hernia surgery continue to use one or other of three basic materials: polypropylene, polyester and ePTFE. These are used in combination with each other or with a range of additional materials such as titanium, omega 3, monocryl, PVDF and hyaluronate. This systematic review of all experimental and clinical studies is aimed at investigating whether titanized meshes confer advantages over other synthetic meshes in hernia surgery.
MATERIALS AND METHODS
A search of the medical literature from 2002 to 2012, as indexed by Medline, was performed, using the PubMed search engine (http://www.pubmed.gov). The search terms were: hernia mesh, titanium coating, lightweight mesh, TiMesh, mesh complications. All papers were graded according to the Oxford hierarchy of evidence.
RESULTS
Patients operated on with the Lichtenstein technique performed using the lightweight titanium-coated mesh have a shorter convalescence than those with the heavy-weight mesh Prolene. For inguinal hernias operated on with the TAPP technique and using a lightweight titanium-coated mesh in comparison to a heavy-weight Prolene mesh, the early postoperative convalescence seems to improve. Titanized meshes do exhibit a negative effect on sperm motility 1 year after a TEP operation, but not after 3 years. The laparoscopic IPOM technique with a titanium-coated polypropylene mesh was associated with less postoperative pain in the short term, lower analgesic consumption and a quicker return to everyday activities compared with the Parietex composite mesh.
CONCLUSION
In clinical studies, the titanium-coated polypropylene mesh shows in inguinal hernia repair certain benefits compared with the use of older heavy-weight meshes.
Topics: Biocompatible Materials; Hernia, Inguinal; Herniorrhaphy; Humans; Polypropylenes; Surgical Mesh; Titanium
PubMed: 24253381
DOI: 10.1007/s10029-013-1187-3