European Journal of Obstetrics & Gynecology and Reproductive Biology
Study of the biomechanical properties of synthetic mesh implanted in vivo
Introduction
Classic pelvic floor repair is carried out via the abdominal or vaginal route [1], [2], [3], [4], [5], [6]. Prosthetic material that was first used to cure abdominal hernia [7], [8] changed attitudes and promoted synthetic prostheses to replace altered tissues and fascias [9], [10], [11]. New techniques used Velcro-like adherence of prosthetic arms through tissues, without fixation (tension-free) [12], [13], [14]. Clinical studies promote the use of synthetic material in pelvic floor repair. Many non-validated prostheses are surgically used without fundamental studies. There are so many of these prostheses that objective clinical study of each type is difficult. The surgeon may often choose the easiest technique, according to his own experience, or rely on clinical studies. Before being used surgically, new prostheses must be thoroughly tested. There are few previous works on the biomechanical study of synthetic materials before and after implantation [15], [16], [17]. They do exist, but only investigate the tolerance of the strands and some of the mechanical properties of the non-implanted meshes. First of all, we wanted to study feasibility; we thus studied the mechanical properties of the different types of prostheses and their changes in vivo after cicatrization.
Section snippets
Materials and methods
The animal model was the 3-month-old female Landrace Large white pig. This animal has a large parietal wall and distribution of intra-abdominal pressure. Twelve animals were included in the study. We strictly followed the guidelines of the animal research ethics committee and animals were brought up and fed according to the ethics laws of our institution.
We studied five prostheses: three were non-absorbable, one was absorbable, and one semi-absorbable (Table 1). A sterile sample (60 mm × 40 mm) of
Results
Samples were taken from 12 sows. One of the animals died, on day 10, from evisceration and traumatic hemorrhage caused by another pig in the same box. Therefore, we had 11 mechanical studies of the two orientations of the sample.
Discussion
Our work does not reopen the question of what prosthetic material is used to treat pelvic floor dysfunction for stress incontinence or prolapse. Clinical studies have shown good results, but erosions and recurrence remain asignificant problem [13], [14]. To go on using this material, it must be tested and validated. We ought to try and standardize our techniques, and use to the utmost the results of fundamental research. We would then be able to give our patients the best treatment with less
Conclusion
We do not yet have a perfect prosthesis that is easy to implant, with good mechanical properties and which is well-tolerated. Results of clinical studies show granulomas, recurrence, infections, expulsion, and exposition with the use of prostheses. Therefore, we must specifically evaluate each new type of prosthesis. Objective and standardized studies must try and evaluate the material used and its structure. It would seem nonsense to replace “altered” connective tissue with prostheses that
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