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At least 37 records · Page 2Linked to original sources

Management of vaginal erosion of polypropylene mesh slings.

PURPOSE: The SPARC (American Medical Systems, Minneapolis, Minnesota) polypropylene sling has recently been introduced as an alternative delivery system to TVT (Ethicon, New Brunswick, New Jersey) tension-free vaginal tape for placement of a tension-free mid urethral sling. Erosion must always be considered a risk of synthetic materials. We present 4 cases of vaginal erosion of polypropylene mesh placed with this system and the successful conservative management done. MATERIALS AND METHODS: A total of 90 patients received a SPARC polypropylene pubovaginal sling at our institution between October 1, 2001 and October 1, 2002. During followup 3 of our patients and 1 patient with tension-free vaginal tape who was referred from elsewhere presented with vaginal exposure of the mesh. RESULTS: Two patients described persistent vaginal discharge 6 weeks postoperatively, including 1 who complained primarily of partner discomfort during sexual intercourse. Two patients were completely asymptomatic and mesh erosion was discovered at routine physical examination 6 weeks postoperatively. Pelvic examination demonstrated vaginal exposure of the mesh in all cases. Each patient was observed conservatively and 3 months postoperatively all 4 had complete spontaneous epithelialization over the mesh. None had stress incontinence, urgency or urge incontinence, all emptied the bladder to completion and all patients were completely satisfied with the procedure. CONCLUSIONS: The recent literature suggests that polypropylene mesh erosion should be treated with complete removal of the sling material. We present 4 cases of vaginal erosion of polypropylene slings that were managed conservatively with observation and resulted in complete spontaneous healing. Sling preservation with continued patient continence and satisfaction is a feasible option in those with vaginal exposure of polypropylene mesh.

Device Removal↗

Herniorrhaphy with polypropylene mesh causing inguinal vasal obstruction: a preventable cause of obstructive azoospermia.

OBJECTIVE: To report a multiinstitutional experience of men presenting with infertility secondary to inguinal hernia repair using polypropylene mesh. SUMMARY BACKGROUND DATA: An estimated 80% of inguinal hernia operations involve placement of a knitted polypropylene mesh to form a "tension-free" herniorrhaphy. The prosthetic mesh induces a chronic foreign-body fibroblastic response creating scar tissue that imparts strength to the floor and leads to fewer recurrences. However, little is known about the long-term effects of the polypropylene mesh on the vas deferens, especially with regard to fertility. METHODS: Eight institutions in the United States reported a total of 14 cases of azoospermia secondary to inguinal vasal obstruction related to previous polypropylene mesh herniorrhaphy. Patient characteristics and operative findings were forwarded to 1 center for tabulation of data. RESULTS: Mean patient age was 35.5 years with an average duration of infertility of 1.8 years. Mean number of years between urologic evaluation and herniorrhaphy was 6.3 years. Types of inguinal hernia repair previously performed were: open (10), laparoscopic (2), or both (2). Nine patients had bilateral obstruction and 5 patients had unilateral obstruction with contralateral testicular atrophy or epididymal obstruction. Surgical exploration revealed a dense fibroblastic response encompassing the polypropylene mesh with either trapped or obliterated vas in all patients. Surgical reconstruction was performed in 8 of 14 men (57%). CONCLUSION: Reconstruction to restore fertility can be difficult secondary to fibrotic reaction. Before undergoing polypropylene mesh herniorrhaphy, men, especially of young reproductive age or with a solitary testicle, need to be carefully advised of potential obstruction and compromise to future fertility.

Adult↗

Replacement of the medial collateral ligament with polypropylene mesh or a polyester suture in dogs.

The medial collateral ligament of one stifle in 20 adult dogs was excised and replaced with polypropylene mesh or a polyester suture. After 26 weeks, the fibrous tissue-prosthesis composites were evaluated clinically, morphologically, and biomechanically. Clinical lameness was not significantly different after 10 days. The polypropylene mesh reconstructions consistently had more fibrous tissue and greater collagenous ingrowth than the polyester suture reconstructions. There were four complications related to fixation of the polypropylene mesh prosthesis and one to the polyester suture. The polypropylene mesh reconstructions had greater stability and were biomechanically more similar to the natural ligaments than the polyester suture reconstructions. Although the results with polypropylene mesh were favorable, more challenging biomechanical testing and alternative anchoring techniques are required before polypropylene mesh can be recommended as a collateral ligament replacement in dogs.

Animals↗

[Peritoneostomy with latex coated polypropylene: experimental study in rats].

PURPOSE: To evaluate if latex coated polypropylene mesh leads to less adhesions formation. METHODS: 90 rats were distributed in three groups. Group I (control) was submitted to median laparotomy and posterior synthesis; Group II (polypropylene) was submitted to a segment resection of the abdominal wall, and the defect was corrected with a polypropylene mesh; Group III using the new material (latex coated polypropylene). After 45 days the euthanasia procedure was done and the adhesions were evaluated in 2 ways: 1) classification in a grading system; 2) evaluation of the adhesion area, which was calculated by resection of the adhesions after dying with Indian blue ink. RESULTS: The classification in a grading system showed that Group III animals had less adhesions formation (P<0.05), but the evaluation of the adhesion area did not show any difference (P>0.05). The severe complications (fistula, evisceration and obstruction), which were lethal, were not reduced by the latex coated material. CONCLUSION: Latex coated polypropylene causes fewer adhesion formations than polypropylene alone, although it does not diminish the severe early complications.

Abdominal Wall↗

The use of bicomponent fabrics for bonding polypropylene sockets in prostheses.

A technique has been established for bonding polypropylene sockets to the structural components of prostheses based on the use of bicomponent knitted fabrics which adhere to the surface of polypropylene sockets during thermoforming. The strength of adhesion of fabric bonded polypropylene with polyester resin based microballoon for instance is increased by more than 10 times relative to uncoated polypropylene. This procedure has been approved by the United Kingdom Department of Health for incorporating polypropylene sockets in conventional, laminated plastic patellar tendon bearing (PTB) prostheses. The bonding technique described should find general application for bonding polypropylene during the manufacture of both prosthetic and orthotic devices.

Artificial Limbs↗

De novo liver tissue formation in rats using a novel collagen-polypropylene scaffold.

In experimental and clinical settings hepatocyte transplantation has provided limited benefit to patients with chronic liver disease because the transplanted hepatocytes were short-lived and were merely maintained for a brief period within the body. Except for whole-liver transplantation, creation of de novo liver tissue is necessary to treat this condition on a long-term basis. The aim of this study was to facilitate the formation of new tissue by actual self-regeneration, rather than by compensatory hypertrophy, or scar formation, with our collagen-polypropylene composite scaffold. Collagen-polypropylene composite scaffolds, not containing hepatocytes, were implanted into the median liver lobe and the dynamics of new liver tissue formation was analyzed immunohistochemically over a 6-month period. Control scaffolds consisted of polypropylene scaffolds without collagen matrix. The control scaffold implants remained hollow throughout the study period and became encapsulated with a hard connective tissue capsule 1 week after implantation. In contrast, the collagen-polypropylene composite scaffold was filled with regenerating tissue structures 3 weeks after implantation. At this time, the predominant cell type within the scaffold was sesmin-positive stellate cells. A week earlier, oval cells were identified using monoclonal antibody staining (OV-6). Subsequently, these cells differentiated into alpha-fetoprotein-positive immature hepatocytes. After 6 months, mature liver tissue, juxtaposed with bile ducts and blood vessels, was seen within the polypropylene scaffolds. We report the first evidence of de novo formation of liver tissue within a polypropylene scaffold, following implantation in the liver. This scaffold may play a role in treating chronic liver diseases requiring organ replacement therapy.

Animals↗

Catalytic hydroxylation of polypropylenes.

The regioselective functionalization of both model and commercial polypropylenes of varying tacticity has been conducted by a rhodium-catalyzed functionalization of the methyl C-H bonds of the polymer with diboron reagents. Rhodium-catalyzed borylation of the polypropylenes, followed by oxidation of the boron-containing material, produced polymers containing 0.2-1.5% hydroxymethyl side chains. Both the number-average molecular weights and molecular weight distributions of the polypropylenes were essentially unchanged after the catalytic and oxidative functionalization process. The efficiency of the borylation process was affected by the molecular weight of the polymer, the steric hindrance around the methyl groups, and the ratio of the diboron reagent to the monomer repeat unit. The hydroxylated derivative of the commercial isotactic polypropylene was used as macroinitiator for the aluminum-mediated ring-opening polymerization of epsilon-caprolactone to prepare polypropylene-graft-polycaprolactone. This graft copolymer was an effective compatibilizer for melt blends of polypropylene and polycaprolactone.

Journal Article↗

Subcutaneous implants of polypropylene filaments.

Extruded filaments of unmodified polypropylene (PP) with and without antioxidant were implanted subcutaneously in hamsters in order to determine their rate of degradation. Specimens were removed periodically during a 5 month test period and analyzed by infrared spectroscopy and dynamic mechanical testing. The analyses show that degradation beigns to occur after only a few days. Although the reaction sequence is not known, several factors suggest that the in vivo degradation process is similar to autoxidation which occurs in air or oxygen. The infrared data indicate that the hydroxyl content of the implants increases at a rate of 0.061 mg/g polypropylene per day during the initiation phase of the reaction. An induction time of 108 days was extablished. Carbonyl bonds appear after an implantation time of 50--90 days and increase therafter. Mechanical tests indicate a decrease in the dynamic loss tangent, tan delta, during the first month of implantation for unmodified polypropylene. No change in the infrared spectra or tan delta was observed, however, for implants containing an antioxidant. Thus, it is apparent that polypropylene filaments implanted subcutaneously in hamsters degrade by an oxidation process which is retarded effectively by using an antioxidant. While the findings reported are specific to subcutaneous polypropylene implants, they suggest that degradation of other systems may involve similar processes. This notion suggests directions for further research on increasing the in vivo stability of synthetic polymers. Long-term effects of polymer implantation upon tissue were not studied in this work.

Animals↗

Comparison of nylon and polypropylene sutures in a microvenous thrombosis model.

Thrombosis rates of femoral end-to-end microvenous anastomoses with nylon and polypropylene sutures (9-0 suture, 70 mu needle) were compared in a microvenous thrombosis model. The vessel injuries were produced during anastomosis by using a suture with a knot 1 cm from the needle. Anastomotic thrombosis rates were assessed by visual inspection and strip test at 24 hr postoperatively. Low thrombosis rates (0% and 20%, respectively) of anastomoses with both unknotted nylon and unknotted polypropylene sutures were obtained. Anastomoses with knotted nylon and polypropylene sutures resulted in 65% and 45% thrombosis rates, respectively. Statistical analyses showed that there were no significant differences between thrombosis rates, both in anastomosis performance with unknotted nylon and polypropylene sutures (P > 0.05) and with knotted nylon and polypropylene sutures (P > 0.05), while there were significant differences between the thrombosis rate using unknotted sutures and knotted sutures (P < 0.01). It was concluded that vascular injury, not suture material, is the main factor leading to thrombosis in this model.

Anastomosis, Surgical↗

Chronic loading of polypropylene sutures: implications for breakage after carotid endarterectomy.

This study compared the breaking force of acutely and chronically loaded 6-O and 5-O polypropylene sutures. It also examined the effect of graded injuries on those sutures. Studies were performed on 134 6-O and 5-O polypropylene sutures subjected to acute loads, 312 6-O and 5-O sutures subjected to chronic loads, and 377 6-O sutures subjected to quantitative "pinches" with DeBakey forceps to produce graded injuries before chronic loading. The lowest acute breaking force for 6-O polypropylene was 192 g. This occurred in 1.3% of acutely loaded sutures. The single lowest chronic breaking force for 6-O sutures was between 150 and 175 g, occurring in 5% of chronically loaded sutures. Thus, chronically loaded sutures are more likely to break than are acutely loaded ones. All of the chronically loaded sutures broke within the first 48 hr of loading, resembling the time of breakage in patients. The lowest chronic breaking force for 5-O sutures was 300 g, 71% greater than the 175 g for 6-O sutures. Graded pinches of 6-O sutures with DeBakey forceps increased the risk of breakage with chronic loads even more. All of the above data were related to the forces imposed upon a suture when it is used to close a carotid arteriotomy. Safety ratios were lower for chronically loaded 6-O sutures than for acutely loaded 6-O sutures or for chronically loaded 5-O sutures. When used to close a carotid arteriotomy, 6-O polypropylene has an acceptable safety ratio with respect to acute loads, but this is markedly reduced with chronic loading, producing a small but finite risk of breakage. The safety ratio may be reduced to dangerously low levels if the suture is handled improperly. Use of 5-O sutures would greatly increase the safety ratio of the suture line, both acutely and chronically, when polypropylene is used to close a carotid arteriotomy.

Carotid Arteries↗

[Urological symptoms after laparoscopic hernia repair. Reduction with a variant of polypropylene mesh].

In the context of a prospective, randomized, controlled double-blind study concerning a reduction of postoperative, urogenital affections after laparoscopic hernia repair using a polypropylene mesh, laparoscopic polypropylene implantation was performed in 40 male patients. Twenty patients received a heavyweight, rigid polypropylene mesh (group A) and the remainder a heavyweight, but softer polypropylene mesh (group B). Questionnaires were used to assess the severity of pain, impairment of sexual life, appearance of urogenital affections, and general condition. On the 3rd postoperative day, testicle blood circulation and testicle volumes were documented by ultrasound, and a congestion of the plexus pampiniformis was excluded by ultrasound with 5 MHz. Starting in the 1st postoperative week, a prevalence of affections such as testicular sensitivity to touch, pain upon ejaculation, and a pulling sensation during urination became apparent in group A. In the 12th postoperative week, 20% in group A still described testicular sensitivity to touch and 10% pain upon ejaculation and a pulling sensation during urination but only 5% in group B. It is essential to reduce urogenital affections after laparoscopic hernia repair by strict indications and appropriately adapted polypropylene meshes.

Aged↗

Incisional hernia repair after orthotopic liver transplantation: a technique employing an inlay/onlay polypropylene mesh.

BACKGROUND: The literature provides no data on the incidence and operative management of incisional hernias developing after orthotopic liver transplantation. The use of high-dose immunosuppressive agents results in an appreciable delay in wound healing. There is thus a need for a procedure for the reconstruction of the abdominal wall for patients on immunosuppression. The aim of this retrospective study was to establish the incidence of incisional hernias and an analysis of the results after implantation of a polypropylene mesh in inlay-onlay technique after liver transplantation is given. METHODS: The basis for the present retrospective investigations was a total of 207 liver transplantations carried out in 192 patients (15 re-transplantations). After performing tensiometry, a polypropylene mesh (Marlex) was implanted to close the hernias using the inlay/onlay technique or a direct closure of the fascia was done. All treated hernias were followed up for a median of 18 months. RESULTS: Among 184 patients, 17 developed incisional hernias after primary direct closure of the abdominal wall, giving an incidence of 9%. In an additional 8 patients an incisional hernia was seen where an absorbable mesh was used to close the abdominal wall after liver transplantation. In addition, there were 25 incisional hernias after 207 liver transplantations (12%). One of 15 (7%) of the surgically repaired hernias with implantation of a polypropylene mesh (Marlex) developed a recurrence. All the 3 patients after direct apposition of the fascia without using a polypropylene mesh suffered a recurrence (3 of 3; 100%). Significant risk factors for developing an incisional hernia were the amount of ascites and the stay in the ICU after transplantation. Neither severe deep nor superficial wound infection nor bowel fistulas were observed after implantation of a inlay/onlay mesh. CONCLUSION: In patients after liver transplantation, the implantation of a polypropylene mesh proved to be an efficient and safe method of treating incisional hernias. Implantation of a mesh was not associated with an increased infection rate, despite the use of immunosuppression. In view of the high recurrence rate associated with primary closure, mesh implantation should be given preference.

Female↗

Chronic loading and extension increases the acute breaking strength of polypropylene sutures.

Polypropylene sutures provide satisfactory strength for construction of vascular anastomoses, but occasionally they break. Experimental studies show that they break at reduced forces when they are subjected to chronic loads. Moreover, in patients, sutures are subject to acute loads superimposed on chronic loads. For example, an episode of hypertension applies acute load that is added to the baseline chronic load in a suture that has been used to close an arteriotomy. The purpose of the present study was to examine the breaking force of 6-0 polypropylene sutures subjected to acute loads after they had been loaded with chronic loads. One hundred sixty-five 6-0 polypropylene sutures were subjected to 50-175 g chronic loads in vitro. After 38 days they were subjected to additional increasing acute loads until they broke. Five hundred ninety other sutures were subjected to "injuries" of manipulation before chronic loading. A stray knot was simulated by placing a knot in the center of 90 sutures. Nurse's tugs used to straighten folded sutures in the operating room were simulated by applying brief loads of 75-275 g to 452 other sutures. Intraoperative injuries were simulated in 48 other sutures by pinching them with DeBakey forceps. Surprisingly, chronic loading of polypropylene sutures increased their acute breaking force. It is suggested that this may have resulted from increased orientation of crystals in the core of the filaments. By contrast, disturbing the outer surface of the filament by placing a stray knot, or pinching with forceps decreased acute breaking strength. These data suggest that if polypropylene sutures do not break soon after they have been placed in a patient, they may gain strength over time.

Materials Testing↗

Selective removal of polyethylene or polypropylene from their blends based on difference in their adsorption behaviour.

The adsorption of polyethylene and polypropylene on zeolites depends on the nature of zeolite, the solvent as well as the molar mass of the polymer sample. For example, linear polyethylene is strongly retained on zeolite SH-300 from decalin, while isotactic, syndiotactic or atactic polypropylene is fully eluted in this system. On the other hand, polypropylene is retained on zeolite CBV-780 from diphenylether, while linear polyethylene is eluted. These differences in the elution behaviour have been utilised for selective removal of either linear polyethylene or polypropylene from blends of both polymers. The desorption of the retained polymer is difficult, or at times impossible. However, the selected adsorption systems have complimentary character, i.e. either one or second component is eluted or fully retained. Thus these sorbent/solvent systems, identified herein, are the first isocratic chromatographic systems, which enable selectively to remove polyethylene or polypropylene from their mixture. Moreover, decalin/SH-300 enables the removal of both linear and branched polyethylene from mixtures with random ethylene/propylene copolymers (polyethylene fully retained, ethylene/propylene copolymers eluted).

Adsorption↗

Anatomical conditions for pelvic floor reconstruction with polypropylene implant and its application for the treatment of vaginal prolapse.

OBJECTIVE: The purpose of the surgical treatment of vaginal prolapse is not only the restoration of the anatomy but also of the visceral functioning. To maintain the quality of life for patients with recurrent vaginal prolapse, to reduce the failure rates of operations and to avoid a colpectomy or a colpocleisis at the same time, synthetic materials have been introduced in transvaginal reconstructive surgery of the pelvic floor. The TVM Group from France described the reconstruction of the pelvic floor with polypropylene implants in 2004. The aim of this study is to determine the anatomical position of the polypropylene implants after reconstruction of each compartment of the pelvic floor and to determine the relation of the implants to the major neighbouring neurovascular structures on the basis of corpse dissections. STUDY DESIGN: Following the technique of the TVM Group from France we present the pelvic floor reconstruction using Gynecare Prolift* (Ethicon, Sommerville, NJ, USA). To reach the aims of the study, anatomical dissections of the pelvic floor on three specially preserved anatomical specimens are performed after the placement of the implants. RESULTS: The anatomical dissections show that every defect in all three compartments of the pelvic floor can be repaired by using polypropylene implants. Between the implants and the major neighbouring neurovascular structures a safe distance exists with slight individual differences. CONCLUSION: The pelvic floor reconstruction using polypropylene implants is a treatment option especially for the surgical correction of the recurrent vaginal prolapse. If the surgeon has thorough anatomical knowledge and performs the surgical technique in the recommended manner, injuries of the major neighbouring neurovascular structures will be avoided. Clinical studies will analyze the long-term results after pelvic floor reconstruction using polypropylene implants.

Female↗

Prevention of adhesions to polypropylene mesh.

BACKGROUND: Polypropylene mesh used to repair abdominal wall hernias routinely induces dense adhesions if there is direct contact between the mesh and the viscera. Adhesions may lead later to difficult reoperation, intestinal obstruction, or enteric fistula. STUDY DESIGN: A 2.5-cm square defect was surgically created in the rat abdominal wall and replaced with: 1) polypropylene mesh, 2) Sepramesh (SM), or 3) SM plus Seprafilm. Each group included 20 animals. Adhesion area as a percent of the mesh surface was subjectively quantitated by means of laparoscopy and at sacrifice. Evaluations varied from 7 to 28 days after mesh placement. Tissues were harvested at intervals for scanning electron microscopy. RESULTS: Adhesions were complete by day 7, with no change in area thereafter. Adhesion-free mesh surfaces were found on scanning electron microscopy to be carpeted with mesothelial cells from day 5 on. Polypropylene mesh alone induced adhesions in all rats (20/20). The mean area involved was 92%. With SM, 9 of 20 were adhesion-free. The mean area was 15%. When Seprafilm was added to SM, minimal adhesions developed in 5 of 20 rats, the mean area being 2%. Four of the five were single point omental attachments. CONCLUSIONS: 1) Sepramesh alone reduces polypropylene mesh adhesions by roughly three-quarters. 2) Sepramesh plus Seprafilm nearly eliminates such visceral adhesions. 3) Mesothelial cell coverage of polypropylene mesh confers adhesion resistance.

Abdominal Wall↗

Is parastomal hernia repair with polypropylene mesh safe?

BACKGROUND: Concern over the safety of polypropylene mesh in parastomal hernia repairs has led some to avoid its use. We reviewed our rate of complications and outcomes with polypropylene mesh. METHODS: From January 1988 through May 2002, 58 patients underwent parastomal hernia repair with polypropylene mesh. After closure of the fascia, the stoma was pulled through the center of the mesh, which was placed either above or below the fascia. Multivariate analysis was performed to determine independent predictors for the development of complications. RESULTS: There were 31 end colostomies, 24 end ileostomies, and 3 loop transverse colostomies. Mean follow-up with 50.6 months. Overall complications related to the polypropylene mesh was 36% (recurrence 26%, surgical bowel obstruction 9%, prolapse 3%, wound infection 3%, fistula 3%, and mesh erosion 2%). None of the patients had extirpation of their mesh. Complications were significantly associated with younger age (59.6 versus 67 years, P = 0.04). Cancer patients with stomas had fewer complications (P = 0.02, odds ratio 0.34). Inflammatory bowel disease, stomal type, mesh location, urgent procedures, steroid use, and surgical approaches were not significantly associated with an increased complication rate. Of the 15 patients with recurrence, 7 underwent successful repair for an overall success rate of 86%. CONCLUSIONS: Parastomal hernia repair with polypropylene mesh is safe and effective.

Adult↗

Influence of polyglactin-coating on functional and morphological parameters of polypropylene-mesh modifications for abdominal wall repair.

Regarding oversized mechanical properties of most of the currently available materials a new mesh was developed (ETHICON, Norderstedt, Germany) and exactly adopted to the physiology of the human abdominal wall by reducing the amount of polypropylene (weight of <30 g/m2; mesh A). The consecutive increase of pores size as well as the use of multifilaments led to a pronounced increase of flexibility. To improve the handling during operation the initial stiffness of this low-weight large pores mesh was increased by strengthening with different amounts of absorbable polyglactin (combination of glycolide and lactide) in various forms: by coating (mesh B), adding multifilament polyglactin filaments (mesh C, Vypro) or both (mesh D), respectively. To test the consequences of the different supplementary techniques all mesh variants are implanted in a rat model. Over implantation intervals of 3, 7, 14, 21 and 90 days we measured the tensile strength, the resulting stiffness and surveyed the tissue response, particularly in regard to the extent of inflammation and to the induced fibrosis. The results proved a sufficient mechanical stability of the material reduced and pure polypropylene mesh A without restriction of the mobility of the abdominal wall compared with a group that had simple laparotomy and closure. The histological analysis of the interface showed a minor inflammatory reaction and a dense vascularisation. The addition of polyglactin multifilaments (mesh C) reduces the number of macrophages and granulocytes as indicators for acute inflammation, showing generally a scar formation limited merely to the perifilamentary region. The abdominal wall compliance remained unchanged compared with mesh A. The coating of the polypropylene with polyglactin (mesh B and D) appeared to change the tissue reaction remarkably, favouring the formation of a connective tissue capsule around the whole mesh. The mechanical testing revealed an apparent protrusion with an increase of curvature of the artificial abdominal wall at rising intraabdominal pressures. The entire coating of the polypropylene surface with polyglactin induces an all embedding scar plate, filling out the pores and forming a tissue capsule. The complex interaction of tissue and implanted biomaterials with their distinct alterations of the tissue response confirms the necessity of in vivo experiments even after 'minor' modifications. Whereas the addition of polyglactin filaments appears to be favourable, the coating of polypropylene with polyglactin seems to hinder the incorporation of the mesh.

Abdominal Muscles↗