El Diario de Pontevedra : periódico liberal: Ano XIV Número 3910 - 1897 xullo 14

Synthetic mesh surgery for both abdominal and urogenital hernia repair is often unsatisfactory in the long-term due to postoperative complications. We hypothesized that a semi-degradable mesh hybrid may provide more appropriate biocompatibility with comparable mechanical properties. The aim was to compare its in vivo biocompatibility with a commercial polypropylene (PP) mesh.72 rats were randomly allocated to either our new composite mesh (monofilament PP mesh knitted with polylactic-acid-fibers (PLA)) or to a commercially available PP mesh that was used as a control. 15, 90, and 180 days after implantation into the rat abdomen mesh tissue complexes were analysed for erosion, contraction, foreign body reaction, tissue integration and biomechanical properties.No differences were seen in regard to clinical parameters including erosion, contraction or infection rates between the two groups. Biomechanical properties including breaking load, stiffness and deformation did not show any significant differences between the different materials at any timepoint. Macrophage staining did not reveal any significant differences between the two groups or between timepoints either. In regard to collagen I there was significantly less collagen I in the PP group compared to the PP/ PLA group at day 180. Collagen III did not show any significant differences at any timepoint between the two groups.A PP/PLA hybrid mesh, leaving a low amount of PP after PLA degradation seems to have comparable biomechanical properties like PP at 180 days due to enhanced collagen production without significant differences in erosion, contraction, herniation or infection rates

A new bioabsorbable polymer film to prevent peritoneal adhesions validated in a post-surgical animal model

International audienceBACKGROUND: Peritoneal adhesions are a serious surgical postoperative complication. The aim of this study is to investigate, in a rat model, the anti-adhesive effects of a bioabsorbable film of polymer combining polyethylene glycol and polylactic acid. MATERIALS AND METHODS: Sixty-three animals were randomized into five groups according to the anti-adhesion treatment: Hyalobarrier\textregistered, Seprafilm\textregistered, Polymer A (PA), Polymer B (PB), and control. The rats were euthanized on days 5 and 12 to evaluate the extent, severity and degree of adhesions and histopathological changes. Three animals were euthanized at day 2 in PA, PB and control groups to observe the in vivo elimination. RESULTS: Macroscopic adhesion formation was significantly lower in the PA group than in the control group at day 5 (median adhesion score 0\textpm0 vs 9.6 \textpm0.5 p = 0.002) and at day 12 (0\textpm0 vs 7.3\textpm4 p = 0.02). Furthermore, median adhesion score at day 5 was significantly lower in the PA group than in the Seprafilm group (0\textpm0 vs 4.2\textpm 3.9 p = 0.03). Residence time of PA seems longer than PB. CONCLUSION: The PA bioabsorbable film seems efficient in preventing the formation of peritoneal adhesions

Perioperative morbi-mortality after pelvic organ prolapse surgery in a large French national database from gynecologist surgeons

International audienceObjective To assess morbidity and mortality following pelvic organ prolapse surgery in France, irrespective of the surgical technique, using a broad national database. Materials and methods: This descriptive multicenter retrospective study was conducted using a database populated via an application run by a professional association. Results 286 gynecologists contributed data to the database. Of the 4322 surgeries analyzed, an abdominal approach was used in 975 of cases (22.5%), a vaginal approach in 3277 (75.9%), and a combined approach in 68 (1.6%). After one year, abdominal surgery was associated with higher rates of de novo urinary incontinence, constipation, and intestinal obstruction, whereas vaginal surgery was associated with higher rates of urinary retention, hematoma, de novo chronic pain, and vaginal mesh extrusion. There was no significant difference between the groups in the incidence of severe complications. After one year, vaginal mesh-augmented cystocele repair was associated with higher rates of de novo urinary incontinence, de novo chronic pain, and reoperation than native tissue repair. Mesh repair was also associated with higher rates of severe complications at one year. Conclusion After pelvic organ prolapse surgery, the perioperative morbidity and mortality associated with transabdominal and transvaginal approaches are similar. However, transvaginal mesh repair is associated with greater perioperative morbidity than transvaginal native tissue repair

Histological properties in rats implanted with PP and PP/PLA.

<p>A. CD68 staining percentage after 15, 90 and 180 days. B. Collagen I staining percentage after 15, 90 and 180 days. C. Collagen III staining percentage after 15, 90 and 180 days. D. Collagen ratio (%) after 15, 90 and 180 days of implantation. Data are mean ± SD of n = 6 animals/ group *: p< 0.05.</p

Macrophage staining in explanted meshes.

<p>A PP mesh with CD68 staining after 15 days. B. PP/PLA mesh with CD68 staining after 15 days. C. PP mesh with CD68 staining after 180 days. D. PP/PLA mesh with CD68 staining after 15, 90 and 180 days. Scale bars are 100 µm.</p

Biomechanical properties in rats implanted with PP and PP/PLA.

<p>A. Breaking load after 15, 90 and 180 days. B. Stiffness after 15, 90 and 180 days. C Deformation after 15, 90 and 180 days of implantation. Data are mean ± SD of n = 6 animals/ group *: p< 0.05.</p

Images of the abdominal hernia model.

<p>1A. Schematic showing the different layers of the abdominal wall and mesh placement. 1B. Photograph of implantation of the PP/PLA mesh. 1C. Schematic of full thickness defect and mesh placement.</p

A preclinical evaluation of polypropylene/polylacticacid hybrid meshes for fascial defect repair using a rat abdominal hernia model - Fig 2

<p>Images taken at euthanization (180 days) frontal view showing normal wound healing of PP mesh with skin (Fig 2A) and without skin (Fig 2B); frontal view showing mesh erosion in a PP mesh (Figs 2C and D). Fig 2 D (sagittal view) and F (frontal view) showing herniation of a PLA mesh.</p

Response to first line platinum-based chemotherapy in mismatch repair deficient (MMRd)/ microsatellite instability high (MSI-high) endometrial carcinoma

International audienceBackground: Around 15% of metastatic endometrial carcinoma (EC) are MMRd/MSI-H improving response to immune checkpoint inhibitors (ICI). So far, few data existed considering the chemotherapy (CT) sensitivity in MMRd/MSI-H EC, especially response to first-line platinum-based treatment. Patients and methods: We performed a multicentric retrospective analysis reporting the response to first line platinum CT in MMRd/MSI-H EC patients. The primary endpoints were objective response rate (ORR) and progression-free survival (PFS) with first line platinum-based CT. Results: A total of 112 patients MMRd/MSI-H EC from 8 centers were identified. Median overall survival was 58.0 months (95% CI: 45.3–95.1). Among them, 78 patients received first line platinum CT in recurrent/metastatic setting. With a median follow up of 32.6 months (min: 0.03; max: 135.0), ORR and DCR (disease control rate) were 50% (95% CI: 38.5–61.5) and 68% (95% CI: 56.4–78.1), respectively. Median PFS and OS from first line platinum-based CT was 7.8 months (95% CI: 6.0–9.0) and 51.9 months (95% CI: 28.0-NE), respectively. Median PFS with ICI in second line (n = 48) was 10.7 months (95% CI: 3.4-NE) from ICI initiation. Conclusion: ORR in first line metastatic MMRd/MSI-H EC is consistent with efficacy in an all comer metastatic EC population