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Morbid obesity is a burgeoning health crisis. Significant morbidity is associated with the current gastric bypass, and, therefore, alternative surgical modalities are desired. A novel minimally invasive surgical technique, endoluminal gastric partitioning, is presented. Ten mongrel dogs underwent endolaparoscopic placement of intragastric mesh. Each circular prosthesis (Surgisis® or prolene mesh) was 8 cm in diameter with a 1.5 cm central aperture. The mesh was passed transorally into the gastric lumen and secured with a laparoscopic, intragastric suturing resulting in a 30 to 50 mL proximal gastric reservoir. The operation was successfully completed in all 10 animals. Nine of 10 animals were healthy at the scheduled sacrifice date. In 2 dogs, the intragastric mesh was 100% adherent to the gastric mucosa after 7 days. Four of the final 5 dogs demonstrated some degree of mucosal adherence after 1 week. Endoluminal placement of intragastric mesh appears feasible and safe. Long-term studies are necessary to demonstrate the efficacy and long-term weight loss of this, or alternate intraluminal gastric partitioning techniques.

Alloplastic meshes are potential alternatives for reconstruction of irreparable rotator cuff tears. This study evaluates the biomechanical suitability at the tendon mesh interface of five different meshes. Twenty-five ovine infraspinatus tendons were repaired in five experimental groups (n 5) with an alloplastic mesh. The control group was repaired with sutures (n 5). Group 1 was repaired with a polypropylene mesh (Prolene), group 2 with a polypropylene/polyglactin mesh (Vypro), group 3 with a 1-mm thick ePTFE mesh, group 4 with a 2-mm ePTFE mesh (Gore-Tex), and group 5 with a 2.87-mm PTFE felt (Bard). The tendon–mesh interface was tested by a tensile testing machine until failure occurred. The control group failed at a mean (± SD) ultimate tensile strength of 98 ± 14 N with the sutures cutting out of the tendon. The Prolene mesh failed at 72 ± 12 N with the sutures cutting through the mesh. In the Vypro group, the repair failed at 75 ± 14 N. The 1-mm ePTFE mesh failed at 78 ± 9 N. The 2-mm ePTFE mesh failed at 109 ± 12 N and the PTFE felt at 111 ± 16 N with the sutures cutting through the tendon. There was a statistical significant difference (P < 0.01) between the 2-mm ePTFE mesh and the PTFE felt when compared with the other tested meshes. The ideal rotator cuff repair should possess high initial fixation strength and maintain mechanical stability over time. The 2-mm ePTFE mesh and the PTFE felt demonstrated significantly superior initial fixation strength at the mesh tendon interface when compared with the other tested meshes. INTRODUCTION

OBJECTIVE: To compare the effectiveness of two transperitoneal laparoscopic Burch procedures. METHODS: The sample size required was 30 subjects per group to detect a statistically significant estimated difference of 15% between two surgical procedures with an α = 0.05 and a power of 0.7. Sixty women affected by genuine stress incontinence (GSI) were enrolled and randomly assigned to two groups of 30 women each. All women were treated with the transperitoneal laparoscopic Burch procedure using nonabsorbable sutures (group A) or Prolene mesh (Ethicon, Somerville, NJ) fixed with tacks or staples (group B). The failure rate was defined subjectively and objectively. The subjective evaluation was performed by asking the women to rate their urine loss on a visual analog scale. The objective evaluation was a clinical evaluation using multichannel urodynamic studies. RESULTS: The subjective failure rate was not significantly different between the two groups at 3 months (0% for both groups), 6 months (3.7% versus 3.8% for groups A and B, respectively), and 12 months (7.4% versus 15.4% for groups A and B, respectively) after surgery. At 3 months (3.7% versus 3.8% for groups A and B, respectively) and 6 months (7.4% versus 15.4% for groups A and B, respectively) follow-up, the objective failure rate was not significantly different between the two groups. However, at 12 months after the surgical procedure, the objective failure rate was significantly lower in group A than in group B (11.1% versus 26.9%, respectively; P CONCLUSION: Transperitoneal laparoscopic Burch colposuspension performed using sutures was more effective than the mesh technique.

Conventional repair of large incisional hernias is often associated with a painful postoperative recovery and a delayed return to normal activities. We describe here a technique of laparoscopic incisional hernia repair and review our experience with 30 cases. Hernias ranging in size from 10 to 420 cm2 (mean, 104 cm2) were repaired using a polytetrafluoroethylene patch (16 cases) and a Prolene mesh (14 cases). Operating room time ranged from 45 mins to 190 min (mean 108 mins). Postop stay ranged from 1 to 17 days (mean, 4.3 days; median, 3 days). Follow-up extends beyond 18 months. Postoperative complications included ileus (three cases) trocar site infection (one case) and urinary retention (two cases). There has been one hernia recurrence to date. Our experience with the laparoscopic repair of incisional hernias reveals it to be technically feasible with minimal morbidity, allowing patients prompt resumption of regular activities. Prospective comparison with conventional repair and longer follow-up are needed.

Introduction: The repair of pelvic organ prolapse (POP) with or without stress urinary incontinence (SUI) has evolved over time. The increasing prevalence of POP and SUI has led to the development of many commercial kits (CK). The downside of CK is their high cost. Off-the-shelf Prolene mesh can be tailored to any clinical need and has robust long-term outcomes.1,2 Surgeon-tailored Prolene mesh (STPM) for the treatment of SUI with or without POP has recently been found to be more cost effective than CK.3 We aim to describe the repair of POP with SUI using STPM in a step-wise fashion in an 8-min video. Also, we compare the operative costs associated with the use of CK, with or without biomaterials, with STPM in the treatment of SUI with or without POP. Methods: The video shows our operative technique using STPM for the treatment of a patient with POP along with SUI. The technique entails a single vaginal incision, tailoring the mesh to a patient-specific defect, tension-free retropubic support of ...

A prolene mesh used during laproscopic sacral colpopexy protrubed into the rectum and presented as foreing body

Fifty consecutive patients with radiation-related problems of the chest wall were treated between 1976 and 1984. There were 40 women and 10 men with an average age of 54 years (range 26 to 78 years). Twenty-three patients had radiation ulcers alone, 20 had recurrent cancer, and 7 had infected median sternotomy wounds. Thirty-six had skeletal resections and 44 had soft-tissue resections. The skeleton was reconstructed with Prolene mesh in 12 patients and with autogenous rib in 3. Sixty-three muscles were transposed in 43 patients. Twelve omental transpositions were performed (8 for primary treatment and 4 for salvage of a failed muscle flap). Hospitalization averaged 20.2 days. There was one operative death (at 29 days). Partial flap necrosis occurred in 10 patients. Mesh was removed in three patients. There were 14 late deaths, most from recurrent tumor. The remaining patients had well-healed wounds and a generally improved quality of life. We conclude that aggressive resection and reliable reconstruction are critical considerations in the surgical management of this perplexing clinical problem.

Experience with 100 consecutive chest wall reconstructions during the past 7 years was reviewed. There were 52 female and 48 male patients with ages ranging from 13 to 78 years (average 53). Of the 100 patients, 42 had tumors of the chest wall, 19 had radiation necrosis, 24 had infected median sternotomies , and 15 had combinations of the three. Seventy-six patients underwent skeletal resection of the chest wall. An average of 5.7 ribs were resected in 63 patients. Total or partial sternectomies were performed in 29. Ninety-two patients underwent 142 muscle flaps: 77 pectoralis major, 29 latissimus dorsi, and 36 other muscles, including serratus anterior, rectus abdominis, and external oblique muscles. The omentum was transposed in ten patients. Chest wall skeletal defects were closed with Prolene mesh in 29 patients and with autogenous ribs in 11. Eighty-nine patients underwent primary closure of the skin. The 100 patients underwent an average of 2.1 operations. Hospitalization averaged 17.5 days. There was one perioperative death (29 days). Two patients required tracheostomy. Follow-up averaged 21.6 months. There were 24 late deaths. All 99 patients who were alive 30 days after operation had excellent results at the time of death or last follow-up.