Transmural Mesh Migration From the Abdominal Wall to the Rectum After Hernia Repair Using a Prolene Mesh: A Case Report

이유진,배병노 대한대장항문학회 2021 Annals of Coloproctolgy Vol.37 No.S

Mesh erosion or migration is a rare and late complication after hernia repair. Its incidence is increasing as the utilization of prosthetic mesh gains popularity for abdominal hernia repair. However, mesh migration is exceedingly rare and its clinical presentation is atypical and diverse. Therefore, the management of mesh migration should be individualized to each patient. This research reports the case of a 94-year-old man with transmural migration of Prolene mesh (Ethicon) from the abdominal wall to the rectum 14 years after incisional hernia repair. He presented with only chronic abdominal pain and constipation. Migration of the mesh and a fistula between the right abdominal wall and transverse colon was observed on computed tomography. The mesh was evacuated manually from the anus without any sequelae. These findings made this case atypical, since complete transluminal migration of mesh is exceedingly rare and mesh erosion or migration requires surgical treatment in many cases.

흉·요추 불안정성 척추 손상 환자에서 전방 감압술과 전방기기 및 Surgical Titanium Mesh를 이용한 내고정술 (장기적 추적 검사 결과)

박환민,이승명,조하영,신호,정성헌,송진규,장석정,Park, Hwan Min,Lee, Seung Myung,Cho, Ha Young,Shin, Ho,Jeong, Seong Heon,Song, Jin Kyu,Jang, Seok Jeong 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.1

Objective : Thoracolumbar junction is second most common level of injury next to cervical spine. The object of this study is to study the usefulness of surgical titanium mesh instead of bone graft, as well as to evaluate the correction of spinal deformity and safety of early ambulation in patients with injury at thoracolumbar junction. Patients and Methods : This review included 51 patients who were operated from July 1994 to December 1997. The injured spine is considered to be unstable, if it shows involvement of two or more columns, translatory displacement more than 3.5mm, decrease more than 35% in height of vertebral body and progression of malalignment in serial X-ray. The decision to operate was determined by (1) compression of spinal cord or cauda eguina, (2) unstable fracture, (3) malalignment and (4) fracture dislocation. The procedure consisted of anterior decompression through corpectomy and internal fixation with anterior instrument and surgical titanium mesh which was impacted with gathered bone chip from corpectomy. Results : Fifty-one patients were followed up for at least 12 months. The main causes of injury were fall and vehicle accident. The twelfth thoracic and the first and the second lumbar vertebrae were frequently involved. Complete neural decompression was possible under direct vision in all cases. Kyphotic angulation occurred in a patient. Radiologic evaluation showed correction of deformity and no distortion or loosening of surgical titanium mesh with satisfactory fixation postoperatively. Conclusions : We could obtain neurological improvement, relief of pain, immediate stabilization and early return to normal activities postoperatively. Based on these results, authors recommend anterior decompression and internal fixation with surgical titanium mesh in thoracolumbar unstable spine injuries.

ProliftTM System을 이용한 여성 골반장기탈출증의 치료 경험

한지연,이규성,주명수 대한비뇨의학회 2008 Investigative and Clinical Urology Vol.49 No.8

Purpose: In the surgical treatment of pelvic organ prolapse(POP), treatment failure and re-operation rates are relatively high when conventional mesh-free surgical methods are employed. Recently, a transvaginal prolapse repair method using surgical mesh has come into broad usage. The principal objective of this study was to report on the clinical efficacy and safety of transvaginal mesh repair of genital prolapses using the ProliftTM system. Materials and Methods: We included 31(mean age 61.1 years) patients who had undergone pelvic organ prolapsed treatment with the ProliftTM system. The evaluation included a medical history, physical examination including Pelvic Organ Prolapse staging system(POP-Q), a urodynamic study, and a Pelvic Floor Distress Inventory(PFDI). An anatomic cure after intervention was defined as stage 0 and an improvement was defined as stage I. Anatomic failures were defined as stage II or higher. The patients were monitored at 4, 12 and 52 weeks postoperatively, and the mean follow-up period was 13.7 months. Results: Preoperative anterior vaginal wall prolapse to the POP-Q was stage II in 13, III in 14, IV in 4, uterine or vaginal vault prolapse stage II in 3, III in 6, IV in 1 and posterior vaginal wall prolapse stage II in 3, and stage III in 7. Anterior, posterior and total repair were performed in 21(67.8%), 1(3.2%), and 9(29.0%) patients, respectively. 90.3%(28/31) of the patients had been anatomically cured upon follow-up examination, and 93.5%(29/31) reported being satisfied with the result of the operation. Pre-and postoperative urinary symptoms, as well as prolapse symptoms as evaluated by PFDI, were improved significantly. Conclusions: Pelvic floor surgery using the ProliftTM system appears to be both effective and safe. Purpose: In the surgical treatment of pelvic organ prolapse(POP), treatment failure and re-operation rates are relatively high when conventional mesh-free surgical methods are employed. Recently, a transvaginal prolapse repair method using surgical mesh has come into broad usage. The principal objective of this study was to report on the clinical efficacy and safety of transvaginal mesh repair of genital prolapses using the ProliftTM system. Materials and Methods: We included 31(mean age 61.1 years) patients who had undergone pelvic organ prolapsed treatment with the ProliftTM system. The evaluation included a medical history, physical examination including Pelvic Organ Prolapse staging system(POP-Q), a urodynamic study, and a Pelvic Floor Distress Inventory(PFDI). An anatomic cure after intervention was defined as stage 0 and an improvement was defined as stage I. Anatomic failures were defined as stage II or higher. The patients were monitored at 4, 12 and 52 weeks postoperatively, and the mean follow-up period was 13.7 months. Results: Preoperative anterior vaginal wall prolapse to the POP-Q was stage II in 13, III in 14, IV in 4, uterine or vaginal vault prolapse stage II in 3, III in 6, IV in 1 and posterior vaginal wall prolapse stage II in 3, and stage III in 7. Anterior, posterior and total repair were performed in 21(67.8%), 1(3.2%), and 9(29.0%) patients, respectively. 90.3%(28/31) of the patients had been anatomically cured upon follow-up examination, and 93.5%(29/31) reported being satisfied with the result of the operation. Pre-and postoperative urinary symptoms, as well as prolapse symptoms as evaluated by PFDI, were improved significantly. Conclusions: Pelvic floor surgery using the ProliftTM system appears to be both effective and safe.

Short-term outcomes of the transvaginal minimal mesh procedure for pelvic organ prolapse

Naoko Takazawa,Akiko Fujisaki,Yasukuni Yoshimura,Akira Tsujimura,Shigeo Horie 대한비뇨의학회 2018 Investigative and Clinical Urology Vol.59 No.3

Purpose: This study aimed to evaluate the clinical outcomes and complications of transvaginal minimal mesh repair without using commercially available kits for treatment of pelvic organ prolapse (POP). Materials and Methods: This retrospective cohort study involved 91 women who underwent surgical management of POP with originally designed small mesh between July 2014 and August 2015. This mesh is 56% smaller than the mesh widely used in Japan, and it has only two arms delivered into each right and left sacrospinous ligament. The main study outcome was the anatomic cure rate defined as recurrence of POP quantification (POP-Q) stage II or more. We also assessed changes in the overactive bladder symptom score (OABSS) and prolapse quality of life questionnaire (P-QOL) and evaluated adverse events. Finally, we compared patient backgrounds between the patients with and without recurrence. Results: Prolapse recurred in 10 of 91 patients (11.0%), and all patients with recurrence were diagnosed as POP-Q stage II. As adverse events, only mesh erosion occurred in two (2.2%) and pelvic pain in one (1.1%) of the 91 patients. The OABSS and P-QOL were significantly improved by the operation. When we compared patient backgrounds between the patients with and without recurrence, body mass index was the only factor influencing affecting recurrence. Conclusions: Transvaginal minimal mesh repair resulted in successful outcomes with low mesh-related complications and anatomic recurrence at one year. Furthermore, significant improvement in QOL was offered by this procedure. Our minimal mesh technique should be considered as one treatment option for the management of POP.

복강경 창상탈장 교정술 후 발생한 Mesh 감염의 치료

이길재,정민 대한내시경복강경외과학회 2012 Journal of Minimally Invasive Surgery Vol.15 No.4

Laparoscopic repair using mesh is a standard technique for ventral hernia repair. Complications of laparoscopic ventral hernia repair increase according to the increment of laparoscopic repair. Subcutaneous emphysema and mesh infection are major complications of laparoscopic repair of ventral hernia. The principle of management of infection is removal of a foreign body. However, in the case of repair with mesh,removal of infected mesh induces recurrence of hernia. Preservation of mesh is the best option for treatment of infected mesh. We have experienced treatment without removal of mesh in a case of infected subcutaneous emphysema after laparoscopic ventral hernia repair. The infection spread slowly to mesh and seroma. Drainage and debridement of infected tissue and evacuation of infected seroma resulted in healing of the infection without removal of mesh.

Computed Tomography-Based Preoperative Simulation System for Pedicle Screw Fixation in Spinal Surgery

Woochan Wi,박상민,신병석 대한의학회 2020 Journal of Korean medical science Vol.35 No.18

Background: A preoperative planning system facilitates improving surgical outcomes that depend on the experience of the surgeons, thanks to real-time interaction between the system and surgeons. It visualizes intermediate surgical planning results to help surgeons discuss the planning. The purpose of this study was to demonstrate the use of a newly- developed preoperative planning system for surgeons less experienced in pedicle-screw fixation in spinal surgery, especially on patients with anatomical variations. Methods: The marching cubes algorithm, a typical surface extraction technique, was applied to computed tomography (CT) images of vertebrae to enable three-dimensional (3D) reconstruction of a spinal mesh. Real-time processing of such data is difficult, as the surface mesh extracted from high-resolution CT data is rough, and the size of the mesh is large. To mitigate these factors, Laplacian smoothing was applied, followed by application of a quadric error metric-based mesh simplification to reduce the mesh size for the level-of-detail (LOD) image. Taubin smoothing was applied to smooth out the rough surface. On a multiplanar reconstruction (MPR) cross-sectional image or a 3D model view, the insertion position and orientation of the pedicle screw were manipulated using a mouse. The results after insertion were then visualized in each image. Results: The system was used for pre-planning pedicle-screw fixation in spinal surgery. Using any pointing device such as a mouse, surgeons can manipulate the position and angle of the screws. The pedicle screws were easy to manipulate intuitively on the MPR images, and the accuracy of screw fixation was confirmed on a trajectory view and 3D images. After surgery, CT scans were performed again, and the CT images were checked to ensure that the screws were inserted properly. Conclusion: The preoperative planning system allows surgeons and students who are not familiar with pedicle-screw fixation to safely undertake surgery following preoperative planning. It also provides opportunities for screw-fixation training and simulation.

생리활성이 향상된 수술용 메시

이가현,이성준,최진현,김한도,최교창,박홍수,이세근 한국생체재료학회 2009 생체재료학회지 Vol.13 No.2

Polypropylene (PP) mesh has been widely used for surgical treatment of urinary incontinence. Despite of the undisputed advantages of the PP meshes currently available, there have been number of reports about complications after these surgeries such as inflammation and infection around implanted area. Anti-oxidant agents including caffeic acid, quercetin, morin, and curcumin were incorporated to the surface of PP films to depress an initial excessive inflammatory reaction through quenching reactive oxygen species(ROS) released from macrophages. The depression of the inflammation could be evaluated through measuring various cytokines produced by LPS-stimulated macrophages, and quercetin-coated PP film which had the highest ROS scavenging activity among other anti-oxidants showed decreases in IL-1β and IL-6 by 68% and 77% compared to control, respectively. Furthermore, the viabilities of fibroblasts cultured on the anti-oxidant-coated PP films were increased and abundant spreading of cell were observed in SEM micrographs. From these results, it could be suggested that the incorporation of anti-oxidant would be one of the promising methods to enhance anti-inflammation and cell-affinity of surgical meshes.

The Use of Absorbable Surgical Mesh after Partial Mastectomy for Improving the Cosmetic Outcome

김형욱,Sang Il Hwang,Cha Kyong Yom,박용래,Won Gil Bae 한국유방암학회 2009 Journal of breast cancer Vol.12 No.3

Purpose: Partial mastectomy without immediate volume replacement can be associated with cosmetic failure. The aim of the present study was to assess cosmesis achieved in patients who underwent partial mastectomy and reconstruction using absorbable surgical mesh. Methods: We used absorbable surgical mesh (Polyglactin 910, Vicryl®) to repair defects after performing partial mastectomy in 25 patients. Endoscopy-assisted partial mastectomy was performed with conservation of the whole skin of the breast and areola. A tailored fan-shape mesh was inserted into the postoperative defect. The cosmetic appearance was evaluated using a simplified five-grade for five-items scoring system at 3 and 6 months after the operation. Results: An excellent or good cosmetic result was obtained in 82.6% of the patients (19/23) after 3 and 6 months, and no major complications were noted. Conclusion: This procedure can be easily performed by general surgeons. Insertion of an absorbable surgical mesh into the postoperative defect could be an effective modality for reconstructing a defect after breast surgery.

Vaginal Mucosal Flap as a Sling Preservation for the Treatment of Vaginal Exposure of Mesh

김세영,박종연,김한권,박창후,김성진,성기택,박창면 대한비뇨의학회 2010 Investigative and Clinical Urology Vol.51 No.6

Purpose: Tension-free vaginal tape (TVT) procedures are used for the treatment of stress urinary incontinence in women. The procedures with synthetic materials can have a risk of vaginal erosion. We experienced transobturator suburethral sling (TOT) tape-induced vaginal erosion and report the efficacy of a vaginal mucosal covering technique. Materials and Methods: A total of 560 female patients diagnosed with stress urinary incontinence underwent TOT procedures at our hospital between January 2005 and August 2009. All patients succeeded in follow-ups, among which 8 patients (mean age: 50.5 years) presented with vaginal exposure of the mesh. A vaginal mucosal covering technique was performed under local anesthesia after administration of antibiotics and vaginal wound dressings for 3-4 days. Results: Seven of the 8 patients complained of persistent vaginal discharge postoperatively. Two of the 8 patients complained of dyspareunia of their male partners. The one remaining patient was otherwise asymptomatic, but mesh erosion was discovered at the routine follow-up visit. Six of the 8 patients showed complete mucosal covering of the mesh after the operation (mean follow-up period: 16 moths). Vaginal mucosal erosion recurred in 2 patients, and the mesh was then partially removed. One patient had recurrent stress urinary incontinence. Conclusions: Vaginal mucosal covering as a sling preservation with continued patient continence may be a feasible and effective option for the treatment of vaginal exposure of mesh after TOT tape procedures.

Preliminary evaluation of a three-dimensional, customized, and preformed titanium mesh in peri-implant alveolar bone regeneration

Gyu-Un Jung,Jae-Yun Jeon,Kyung-Gyun Hwang,Chang-Joo Park 대한구강악안면외과학회 2014 대한구강악안면외과학회지 Vol.40 No.4

ectives: The purpose of this preliminary study is to evaluate the effectiveness of a customized, three-dimensional, preformed titanium mesh as a barrier membrane for peri-implant alveolar bone regeneration. Materials and Methods: Ten patients were recruited for this study. At the time of implant placement, all patients had fenestration or a dehiscence defect around the implant fixture. A mixture of particulate intraoral autologous bone and freeze-dried bone allograft was applied to the defect in a 1 : 1 volume ratio and covered by the preformed titanium mesh. A core biopsy specimen was taken from the regenerated bone four months postoperatively. Patients were followed for 12 months after the definitive prosthesis was placed. Results: Satisfactory bone regeneration with limited fibrous tissue was detected beneath the preformed titanium mesh. Histologic findings revealed that newly formed bones were well-incorporated into the allografts and connective tissue. New growth was composed of approximately 80% vital bone, 5% fibrous marrow tissue, and 15% remaining allograft. All implants were functional without any significant complications. Conclusion: The use of preformed titanium mesh may support bone regeneration by maintaining space for new bone growth through its macro-pores. This preliminary study presents the efficacy of a preformed titanium mesh as a ready-to-use barrier membrane around peri-implant alveolar bone defect. This preformed mesh is also convenient to apply and to remove.