Polypropylene as a reinforcement in pelvic surgery is not inert: comparative analysis of 100 explants.
OBJECTIVE
Currently, most implants used for reinforcement in surgical treatment of pelvic floor disorders are knitted monofilament polypropylene (PP). While previously recognized as inert, PP is associated with high complication rates. Some recent literature suggests polyester prosthetics based on poly(ethylene terephthalate) (PET), which may be more inert in vivo.


METHODS
A sample of 100 implants explanted from patients due to complications was examined to evaluate the relative degradation characteristics of PP and PET prosthetics. Histological, microscopic (scanning electron microscopy, SEM) and chemical analysis (Fourier transform infrared (FTIR) spectroscopy and differential scanning calorimetry (DSC)) were conducted on these explants.


RESULTS
Poly(ethylene terephtahlate) explants appeared to sustain less degradation in vivo than the PP explants observed in this cohort.


CONCLUSIONS
This is the first study to evaluate synthetic implants used in a vaginal approach for pelvic floor reinforcement. The study provides evidence contrary to published literature characterizing PP as inert in such applications. Additionally, the study suggests the need for clinical trials comparatively investigating the performance of new types of monofilament prosthetics, such as those comprising PET.
Clavé
Arnaud
A
Service de Chirurgie (Pr Lefèvre), CHRU Brest Faculté de Médecine, Université de Bretagne Occidentale, Brest, France. clave.henri@wanadoo.fr
Yahi
Hannah
H
Hammou
Jean-Claude
JC
Montanari
Suzelei
S
Gounon
Pierre
P
Clavé
Henri
H
D020878:Device Removal; D005260:Female; D005549:Foreign-Body Reaction / Q000209:etiology*; D006801:Humans; D008855:Microscopy, Electron, Scanning; D056887:Pelvic Organ Prolapse / Q000601:surgery; D011126:Polypropylenes / Q000009:adverse effects*; D011183:Postoperative Complications / Q000209:etiology*; D011446:Prospective Studies; D017550:Spectroscopy, Fourier Transform Infrared; D013526:Surgical Mesh / Q000009:adverse effects*; D014550:Urinary Incontinence, Stress / Q000601:surgery
D011126:Polypropylenes