Mesh removal explant study from 2013

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    • #33213
      Good intentions
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      I just came across this paper from 2013 when I was searching for mesh removal surgeons in Europe. It surprised me. It implies that mesh removal was much more common in the early 2000’s than I had thought.

      The paper studies the tissue that was found around the explanted mesh and describes possible reasons for recurrence in terms of collagen quality and inflammation. It makes some firm statements, but seemed to be looking forward to the European Hernia Society’s plan to create Guidelines. Generating data for its use. Of course, the Guidelines turned in to a document promoting the use of mesh over pure tissue repairs and studies like this were ignored.

      “Retrieval study at 623 human mesh explants made of
      polypropylene – impact of mesh class and indication for mesh removal on tissue reaction

      B. Klosterhalfen (1), U. Klinge (2)
      (1) Institute for Pathology, Duren Hospital, 52351 D € uren, Germany
      (2) Department for General, Visceral and Transplant Surgery, University Hospital of the RWTH Aachen, 52074 Aachen, Germany

      Received December 3, 2012; revised March 4, 2013; accepted March 27, 2013

      Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/jbmb.32958”

      https://ec.europa.eu/health/scientific_committees/emerging/docs/surgical_co_klosterhalfen2.pdf

      Some excerpts –

      “Abstract:

      Textile meshes frequently are implanted in the abdominal wall to reinforce a hernia repair. However, revisions for mesh associated complications confirm that these devices are not completely free of risk. Explanted devices offer an opportunity to define the impact of mesh structure on tissue response. This retrieval study analyses the tissue reaction to 623 polypropylene mesh samples (170 class 1 with large pores, and 453 class 2 with small pores) explanted for pain, infection, or recurrence. Histopathological assessment included morphometry of inflammatory infiltrate (IF) and connective tissue (CT), and of collagen 1/3 ratio. Half of the meshes were removed after more than 23 month. …”

      “MATERIAL METHODS

      Between 2003 and 2010, explanted meshes from human patients have been submitted to the institute for pathology, Duren, mainly from Germany, but additionally from many other parts of the world…”

      “DISCUSSION

      Tissue response to meshes is defined by lots of confounders, as by any present local complication, the type of procedure and location of the mesh, and last not least the kind of material (i.e., mesh class used). In this retrieval study of explanted hernia meshes, to our knowledge the biggest in literature, we can demonstrate that 75% of the mesh explants were performed within 3years after implantation. …

      … In some cases, explantation may be the final result after several failing attempts of conservative therapies. However, 25% of explants were done more than 3 years after implantation, which means a permanent risk as long as a foreign body stays in the tissue! Interestingly, the explantation for chronic pain similarly was also done after a median of 22 month with a latest explantation 96 month after implantation. Chronic pain was reported in 170 of the 623 patients, from which 75% had their mesh placed into the groin area and only 27% in the anterior abdominal wall. Thus, sometimes chronic pain may develop late over time, mainly if placed in the groin. …

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