DOCSLIB.ORG

Insertion and Removal of Vaginal Mesh for Pelvic Organ Prolapse

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Insertion and Removal of Vaginal Mesh for Pelvic Organ Prolapse CLINICAL OBSTETRICS AND GYNECOLOGY Volume 53, Number 1, 99–114 r 2010, Lippincott Williams & Wilkins Insertion and Removal of Vaginal Mesh for Pelvic Organ Prolapse TYLER M. MUFFLY, MD and MATTHEW D. BARBER MD, MHS Department of Obstetrics and Gynecology, Center for Urogynecology and Pelvic Reconstructive Surgery, Obstetrics, Gynecology and Women’s Health Institute, Cleveland Clinic, Cleveland, Ohio Abstract: A variety of surgical meshes are available A woman’s risk of requiring surgery for to correct pelvic organ prolapse. This article discusses prolapse is approximately 7% by the age benefits and risks of vaginal mesh use. Emphasis is 1 placed on the appropriate surgical technique to im- of 80 years. Of those who receive surgery, prove outcomes and minimize mesh complications. an estimated 13% will require a repeat Placement options are reviewed with the discussion operation within 5 years and as many of self-tailored mesh, trocar-based mesh kits, and non- as 29% will undergo another surgery trocar mesh kits. This article also reviews the manage- for prolapse or a related condition at ment of mesh complications including the technique 1,2 for mesh removal. some point during their life. Given the Key words: pelvic organ prolapse, surgical mesh, mesh rates of prolapse recurrence after surgery, kits, mesh erosion many pelvic reconstructive surgeons have incorporated the use of synthetic or bio- logic graft materials into their repairs in an attempt to improve outcomes. The concept of using mesh or grafts to im- Introduction prove native tissue repairs is not novel. Pelvic organ prolapse is one of the most The use of synthetic mesh for inguinal and common indications for surgery in wo- ventral hernia repair is well supported men with approximately 200,000 inpati- in the general surgery literature and is ent surgical procedures performed for this currently considered the ‘‘gold standard’’ indication in the United States annually.1 approach.3 The use of synthetic mesh during sacral colpopexy to suspend the Correspondence: Matthew D. Barber, MD, MHS, vaginal apex from abdominal or laparo- Section of Urogynecology and Pelvic Reconstructive scopic approach is well established and Surgery, Obstetrics, Gynecology and Women’s Health 4 Institute, Cleveland Clinic, Desk A81, Cleveland, OH. supported by level I evidence. In the last E-mail: [email protected] 5 years, there has been an increase in the The authors have no potential conflicts of interest. use of synthetic and biologic mesh to CLINICAL OBSTETRICS AND GYNECOLOGY / VOLUME 53 / NUMBER 1 / MARCH 2010 www.clinicalobgyn.com | 99 100 Muffly and Barber augment transvaginal prolapse surgery. Nonabsorbable synthetic graft use may This has largely been driven by the recent improve anatomic outcomes of the anterior availability and marketing of commer- vaginal wall, but there are trade-offs in cially available pre-packed mesh delivery regard to additional risks systems or ‘‘mesh kits.’’ Despite a paucity There are no comparative studies to guide of consistent data, the use of new syn- any recommendation on the use of nonab- thetic materials, including mesh kits, is sorbable synthetic mesh in the posterior or apical compartments when compared with rapidly expanding. In this chapter, we will native tissue repair. summarize the potential benefits and risks They noted, however, that no high or associated with vaginal mesh use, describe even moderate quality evidence existed to the currently available synthetic and bio- guide their recommendations and that logic graft materials, review the various in some cases evidence was so limited that surgical approaches for vaginal mesh no recommendation could be offered. As placement, and provide a step-wise ap- such, they emphasized that future re- proach for managing postoperative mesh search was likely to have an important complications. effect on their estimates and may even change them.7 Similar to the SGS review, Benefits and Risks of the Cochrane Collaboration completed a Vaginal Mesh Use systematic review and concluded that the Current data is sparse, but suggests that use of mesh or graft inlays at the time the use of mesh or graft to augment of anterior vaginal wall repair may reduce vaginal prolapse surgery is associated the risk of recurrent cystocele, but that with both potential benefits and risks. there was insufficient evidence to make The pelvic surgeon must carefully consid- recommendations for posterior vaginal 8 er the balance of these benefits and risks wall or apical repair. when considering the use of mesh for Potential complications related to graft transvaginal prolapse repair. Most data and mesh include erosion, infection, on the outcomes and complications after dyspareunia, fistula, and chronic pain.9 transvaginal mesh placement has con- Rates of these complications vary greatly sisted of retrospective or uncontrolled and have not always been consistently case series. More recently, a few random- reported. Erosion of mesh varies after vagi- ized, controlled trials have been published nal prolapse repair varies widely from 3% which demonstrate improved anatomic to 17% 3 to 12 months after placement outcomes, but similar subjective out- with synthetic mesh carrying a greater risk comes and higher complication rates after than biologic grafts.5,10 Multifilament mesh placement when compared with tra- mesh has a higher rate of erosion and com- ditional vaginal repairs.5,6 In 2008, the plication than wide pore monofilament Society of Gynecologic Surgery (SGS) mesh. Additional risk factors include con- systematically reviewed the literature current hysterectomy and tobacco use. and published clinical practice guidelines Although some experienced surgeons have on vaginal graft use.7 In this statement, reported erosion rates as low as 2% to the authors made the following conclu- 3%, the largest series describing short- sions based on the literature available at term complications in 289 women noted the time of their review: an erosion rate of 10% with transvaginal placement of loosely woven polypropy- Native tissue repair remains appropriate lene mesh.11 when compared with biologic graft use or absorbable synthetic graft use for all com- Other complications such as fistula, partments de novo dyspareunia, and chronic pain www.clinicalobgyn.com Mesh for Pelvic Organ Prolapse 101 have also been reported but mostly in was noted in 94% and 93%, respectively case reports and small series. In October (P = 0.90), the proportion with stage 3 2008, the Food and Drug Administra- or 4 prolapse was similar 3% versus 0% tion (FDA) issued a public health noti- (P = 0.11) and the rate of reoperations fication (http://www.fda.gov/cdrh/safety/ for prolapse recurrence was only 1% in 102008-surgicalmesh.html) and made re- each group. Moreover, the women whose commendations regarding the serious surgery was augmented with mesh had a complications associated with transvagi- higher rate of new onset stress urinary nal placement of surgical mesh for the incontinence (22% vs. 10%, P<0.02) repair of pelvic organ prolapse and stress and mesh exposure (17% vs. 0%).5 This urinary incontinence in which they de- trial illustrates the balance of risks and scribe receiving 1000 reports of compli- benefits that the surgeon and patient cations over 3 years (Table 1). The most must consider before considering the use frequent complications noted in the FDA of vaginal mesh or graft for the treatment public health notification included ero- of pelvic organ prolapse. sion through vaginal epithelium, infection, To summarize, the current evidence pain, urinary problems, and recurrence of would support the use of synthetic mesh prolapse and/or incontinence. Also noted to augment repairs of anterior vaginal was vaginal scarring, which in some cases prolapse but at the expense of an increased led to a significant decrease in patient rate of complications, particularly mesh quality of life due to discomfort and pain, exposure. More data is needed to deter- including dyspareunia. mine the role of synthetic vaginal mesh A recent randomized trial by Hiltunen use for posterior vaginal wall and apical et al5 that compared anterior colporraphy prolapse and to determine the role of with and without polypropylene mesh biologic grafts in vaginal prolapse repairs augmentation provides a good example for all segments. of both the benefits and risks of vaginal mesh use. In this trial, the cure rate 12 months after surgery (defined as pelvic Indications and Preoperative organ prolapse quantification stage 0 or 1) Preparation was significantly higher after the mesh- Given the current state of the literature, augmented repair compared with standard clinical judgment must be relied upon to anterior colporraphy (61.5% vs. 93.3%, determine the indications for using trans- P<0.001). However, symptomatic cure vaginal mesh use at this time. Surgeons’ (absence of vaginal bulge symptoms) views differ as to when using mesh for this TABLE 1. FDA Administration Public Health Notification Recommendations: Serious Com- plications Associated with Transvaginal Placement of Surgical Mesh in Repair of Pelvic Organ Prolapse and Stress Urinary Incontinence Obtain specialized training for each mesh placement technique and be aware of its risks Be vigilant for potential adverse events from the mesh, especially erosion and infection Watch for complications associated with the tools used in transvaginal placement, especially bowel, bladder, and blood vessel perforations Inform patients that implantation of
Load more

Recommended publications
  • Stephen Tabiri
    Surgical Mesh should be available inguinal hernia repair in Low and Middle Income Countries Presenter: Stephen Tabiri 1University for Development Studies-School of Medicine and Health Sciences 2University of Utah Center for Global Surgery 3 Holy Family Hospital Declaration • Nothing to disclose ~ 5 billion Meara JM et al. Global surgery 2030: evidence and solutions for achieving health, welfare, and economic development. The Lancet 2010; 386 (9993); 569-624. Debas et al. Disease Control Priorities in Developing Countries. 2nd ed. Washington, DC: World Bank and Oxford University Press; 2006: 1245-1259. Intervention Cost per DALY averted (in $US) Inguinal hernia repair (Ghana) $14.66 Cataract surgery $50 Vitamin A supplementation $10 Oral rehydration solution $1000 Antiretroviral therapy for $900 HIV/AIDS Insecticide treated bednets $29 Shillcut et al., Cost-effectiveness of groin hernia surgery in the Western Region of Ghana. Archives of Surgery 2010; 145: 954. Chao et al., Cost-effectiveness of surgery and its policy implications for global health: a systematic review and analysis. Lancet Global Health 2014; 2: e334-e345. Traditional methods and results vs 1.4-7.9% 3.15%! Ohene-Yeboah M, Beard JH, Frimpong-Twumasi B, Koranteng A, Mensah S. Prevalence of inguinal hernia in adult men in the Ashanti Region of Ghana. World Journal of Surgery 2015; 40: 806-812. Beard J, Oresanya LB, Ohene-Yeboah M, Dicker R, Harris HW. Characterizing the global burden of surgical disease: a method to estimate inguinal hernia epidemiology in Ghana. World Journal of Surgery 2013; 37: 498. • Purpose: assess the current state of inguinal hernia repair in northern Ghana.
    [Show full text]
  • Regenerative Surgery for Inguinal Hernia Repair
    Clinical Research and Trials ` Research Article ISSN: 2059-0377 Regenerative surgery for inguinal hernia repair Valerio Di Nicola1,2* and Mauro Di Pietrantonio3 1West Sussex Hospitals NHS Foundation Trust, Worthing Hospital, BN112DH, UK 2Regenerative Surgery Unit, Villa Aurora Hospital-Foligno, Italy 3Clinic of Regenerative Surgery, Rome, Italy Abstract Inguinal hernia repair is the most frequently performed operation in General Surgery. Complications such as chronic inguinal pain (12%) and recurrence rate (11%) significantly influence the surgical results. The 4 main impacting factors affecting hernia repair results are: mesh material and integration biology; mesh fixation; tissue healing and regeneration and, the surgical technique. All these factors have been analysed in this article. Then a new procedure, L-PRF-Open Mesh Repair, has been introduced with the aim of improving both short and long term results. We are presenting in a case report the feasibility of the technique. Introduction Only 57% of all inguinal hernia recurrences occurred within 10 years after the hernia operation. Some of the remaining 43% of all Statistics show that the most common hernia site is inguinal (70- recurrences happened only much later, even after more than 50 years [7]. 75% cases) [1]. A further complication after inguinal hernia repair is chronic groin Hernia symptoms include local discomfort, numbness and pain pain lasting more than 3 months, occurring in 10-12% of all patients. which, sometimes can be severe and worsen during bowel straining, Approximately 1-6% of patients have severe chronic pain with long- urination and heavy lifting [2]. Occasionally, complications such as term disability, thus requiring treatment [5,8].
    [Show full text]
  • Surgical Mesh Repair of Inguinal Hernia in Men
    Plain Language Summary January 2020 Surgical mesh repair of inguinal hernia in men What is an inguinal hernia? An inguinal hernia is a type of groin hernia. Inguinal hernias occur when a piece of bowel or fatty tissue bulges out through the abdominal wall causing a swelling in the groin. Inguinal hernias are much more common in men than women: nine hernias in men to every one hernia in women. What is surgical mesh hernia repair? Operations to repair an inguinal hernia can either use a piece of surgical mesh to reinforce the body tissues or surgical stitches to pull the body’s tissues together. Surgical mesh is a loosely woven sheet of polypropylene (a type of plastic). The ‘thread’ used to stitch tissues together for hernia repair is also made of polypropylene. Why is this important? Use of surgical mesh has become an important topic in the last few years following women’s experiences of severe chronic pain after an operation using surgical mesh to treat pelvic organ prolapse. In Scotland there are around 5,000 inguinal hernia repairs each year that use surgical mesh. Following the issues raised about surgical mesh for pelvic organ prolapse, there is an awareness that similar issues need to be considered in relation to using surgical mesh for repair of inguinal hernias. What we did We assessed whether inguinal hernia repair using surgical mesh was effective, safe and good value for money. We also explored patient experiences and views about using surgical mesh for inguinal hernia repair. What we found Men who had an inguinal hernia repaired using surgical mesh were less likely to have their hernia return compared with men who had their hernia repaired using surgical stitches.
    [Show full text]
  • TIGR® Matrix Surgical Mesh Launched in the United States
    ® SURGICAL MESH CORPORATE - timeline The history of Novus Scientic - a journey of innovation RadiPlast founded Radi Medical Systems AB founded. PressureWire® methodology ‘Fractional Flow Reserve’ (FFR) conceived. on the basis of using Novus Scientific founded. intelligent plastic Radi grows it’s international presence globally with nine regional offices. TIGR® mouldings to avoid RadiPlast becomes RadiPlast sold to to CR Bard. available injuries to children. agent for ACS (Advanced Employees around the world swell to 350. in EU. Catheter Systems). Radi acquired by St Jude Medical Inc. Later the company First PressureWire® sold. TIGR® turns its’ hand to available PressureWire® (Radi Sensor) First FemoStop® sold. First Femoseal® sold. selling catheter kits. in USA. concept conceived. Work starts on TIGR™ project. Polymer research starts in earnest at the Radi research facility in Uppsala. 03 011 1978 2004 1979 2005 1980 2006 RadiPlast 1981 MEDICAL SYSTEMS 2007 1982 2008 1983 2009 1984 1978 1985 Engstrom runs radiology product company 1986RadiPlast AB. 1987 1982 1988 Engstrom secures distribution rights to Advanced Cardiovascular 1989 Systems Inc. (ACS > Guidant Inc). 1990 1988 1991 Engstrom sells RadiPlast AB to CR Bard Inc. and founds Radi Medical Systems 1992 AB. 1993 1988 – 2008 1994 1995 Radi pioneers some of the world’s leading devices for interventional cardiology, hemostasis 1996 management, and radiology. 1999 1997 1998 Engstrom sets up a resorbable biomaterials R&D department in Sweden. 1999 2003 2000 2001 Engstrom invests heavily in clean room production facilities on the island of Phuket. 2002 2004 20 ® Resorbable polymer matrix project group established - 1st patent filed for what would become TIGR Matrix Surgical Mesh.
    [Show full text]
  • The Role of Mesh Implants in Surgical Treatment of Parastomal Hernia
    materials Review The Role of Mesh Implants in Surgical Treatment of Parastomal Hernia Karolina Turlakiewicz 1,2,* , Michał Puchalski 1 , Izabella Kruci ´nska 1 and Witold Sujka 2 1 Institute of Material Science of Textiles and Polymer Composites, Lodz University of Technology, Zeromskiego˙ 116, 90-924 Lodz, Poland; [email protected] (M.P.); [email protected] (I.K.) 2 Tricomed S.A., Swi˛etoja´nska5/9,´ 93-493 Lodz, Poland; [email protected] * Correspondence: [email protected] Abstract: A parastomal hernia is a common complication following stoma surgery. Due to the large number of hernial relapses and other complications, such as infections, adhesion to the intestines, or the formation of adhesions, the treatment of hernias is still a surgical challenge. The current standard for the preventive and causal treatment of parastomal hernias is to perform a procedure with the use of a mesh implant. Researchers are currently focusing on the analysis of many relevant options, including the type of mesh (synthetic, composite, or biological), the available surgical techniques (Sugarbaker’s, “keyhole”, or “sandwich”), the surgical approach used (open or laparoscopic), and the implant position (onlay, sublay, or intraperitoneal onlay mesh). Current surface modification methods and combinations of different materials are actively explored areas for the creation of biocompatible mesh implants with different properties on the visceral and parietal peritoneal side. It has been shown that placing the implant in the sublay and intraperitoneal onlay mesh positions and the use of a specially developed implant with a 3D structure are associated with a lower frequency of recurrences.
    [Show full text]
  • Surgical Mesh for Inguinal Hernia Repair
    Surgical mesh for inguinal hernia repair March 2019 Acknowledgements This report is authored by Elena Tumasz-Jordan, Liza Mastikhina, Brenlea Farkas, Diane Lorenzetti, Joyce Li, and Fiona Clement on behalf of the HTA Unit at the University of Calgary. The authors declare no conflict of interests. This research was supported by the Health Technology Assessment Office, Province of BC. The views expressed herein do not necessarily represent those of the Government of British Columbia. Table of Contents Abbreviations .................................................................................................................................. 9 Executive Summary ...................................................................................................................... 10 Purpose of this Health Technology Assessment ................................................................... 13 Research Question and Research Objectives ........................................................................ 13 Overview of Approach .......................................................................................................... 13 Background ........................................................................................................................... 14 4.1 Surgical Mesh ................................................................................................................. 14 4.1.1 Description of Mesh ................................................................................................ 14 4.1.2
    [Show full text]
  • Surgical Mesh for Transvaginal Repair of Pelvic Organ Prolapse in the Anterior Vaginal Compartment
    Surgical Mesh for Transvaginal Repair of Pelvic Organ Prolapse in the Anterior Vaginal Compartment FDA Executive Summary Obstetrics and Gynecology Devices Panel February 12, 2019 Table of Contents I. Introduction .......................................................................................................................................... 4 II. Clinical Background on Pelvic Organ Prolapse .................................................................................... 5 A. Overview of Condition ..................................................................................................................... 5 B. Prevalence ........................................................................................................................................ 7 C. Risk Factors ....................................................................................................................................... 8 D. Treatment ......................................................................................................................................... 8 E. Professional Society Positions ......................................................................................................... 8 F. Professional Society Guidelines Regarding Training ..................................................................... 10 III. Device Description .......................................................................................................................... 10 IV. Regulatory History .........................................................................................................................
    [Show full text]
  • Polymer Hernia Repair Materials: Adapting to Patient Needs and Surgical Techniques
    materials Review Polymer Hernia Repair Materials: Adapting to Patient Needs and Surgical Techniques Marta Rodríguez 1,2,3, Verónica Gómez-Gil 1,2 ,Bárbara Pérez-Köhler 2,3,4 , Gemma Pascual 2,3,4 and Juan Manuel Bellón 1,2,3,* 1 Departamento de Cirugía, Ciencias Médicas y Sociales, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, Alcalá de Henares, 28805 Madrid, Spain; [email protected] (M.R.); [email protected] (V.G.-G.) 2 Biomedical Networking Research Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 28029 Madrid, España; [email protected] (B.P.-K.); [email protected] (G.P.) 3 Ramón y Cajal Health Research Institute (IRYCIS), Colmenar Viejo, 28034 Madrid, Spain 4 Departamento de Medicina y Especialidades Médicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, Alcalá de Henares, 28805 Madrid, Spain * Correspondence: [email protected] Abstract: Biomaterials and their applications are perhaps among the most dynamic areas of research within the field of biomedicine. Any advance in this topic translates to an improved quality of life for recipient patients. One application of a biomaterial is the repair of an abdominal wall defect whether congenital or acquired. In the great majority of cases requiring surgery, the defect takes the form of a hernia. Over the past few years, biomaterials designed with this purpose in mind have been gradually evolving in parallel with new developments in the different surgical techniques. In consequence, the classic polymer prosthetic materials have been the starting point for structural modifications or new prototypes that have always strived to accommodate patients’ needs.
    [Show full text]
  • Biocompatible Properties of Surgical Mesh Using an Animal Model
    Australian and New Zealand Journal of Obstetrics and Gynaecology 2006; 46: 42–45 Blackwell Publishing Asia Original Article Biocompatible properties of surgical mesh Biocompatible properties of surgical mesh using an animal model Hannah G. KRAUSE,1 Stuart J. GALLOWAY,2 Soo K. KHOO,3 Richard LOURIE2 and Judith T. W. GOH1 1Urogynaecology Unit, Gold Coast Hospital, Southport, 2Department of Anatomical Pathology, St Vincent’s Hospital, Melbourne, and 3Department of Gynaecology, Royal Brisbane Women’s Hospital, Brisbane, Australia Abstract Aim: To study the biocompatibility of surgical meshes for use in pelvic reconstructive surgery using an animal model. Methods: Eight different types of mesh: Atrium, Dexon, Gynemesh, IVS tape, Prolene, SPARC tape, TVT tape and Vypro II, were implanted into the abdominal walls of rats for 3 months’ duration. Explanted meshes were assessed, using light microscopy, for parameters of rejection and incorporation. Results: Type 1 (Atrium, Gynemesh, Prolene, SPARC and TVT) and type 3 (Vypro II, Dexon and IVS) meshes demonstrated different biocompatible properties. Inflammatory cellular response and fibrosis at the interface of mesh and host tissue was most marked with Vypro II and IVS. All type 1 meshes displayed similar cellular responses despite markedly different mesh architecture. Conclusions: The inflammatory response and fibrous reaction in the non-absorbable type 3 meshes tested (IVS and Vypro II) was more marked than the type 1 meshes. The increased inflammatory and fibrotic response may be because of the multifilamentous polypropylene components of these meshes. Material and filament composition of mesh is the main factor in determining cellular response. Key words: animal model, biocompatibility, monofilament, multifilament, surgical mesh.
    [Show full text]
  • Meshes for Intraabdominal Placement (Laparoscopic)
    V.- MESHES FOR INTRAABDOMINAL PLACEMENT (LAPAROSCOPIC) PICTURES NAME of the products Soft Tissue Patch MANUFACTURER Gore DESCRIPTION e-PTFE mesh for intraperitoneal placement For reconstruction of hernias or soft tissue deficiencies, surgeons require a prosthesis affording a secure repair with decreased risk of recurrence, increased patient comfort postoperatively, and minimal complications such as adhesions and fistula formation. The GORE-TEX® Soft Tissue Patch has long been the prosthetic patch of choice for soft tissue repairs. Composed of the inert biomaterial expanded polytetrafluoroethylene (ePTFE), it features a microporous structure allowing for host tissue incorporation. GORE-TEX® Soft Tissue Patch meets the unique challenges of laparoscopic hernia repair and inguinal herniorrhaphy, as well as temporary bridging of fascial defects. It is contraindicated for the reconstruction of cardiovascular and orthopedic defects. The GORE-TEX® Soft Tissue Patch has material and suture/staple retention strength greater than the most commonly used meshes. The biological inertness of the prosthesis, combined with softness and conformability in vivo, minimizes foreign-body response, erosion into the bowel, and adhesions to surrounding viscera. The GORE-TEX® Soft Tissue Patch offers ease of handling, including cutting and shaping to size without fraying. Pre-configured patches requiring little or no trimming before implantation are also provided. ADVANTAGES • Composed of the inert biomaterial expanded polytetrafluoroethylene (ePTFE), it features a microporous structure allowing for host tissue incorporation. • Unique challenges of laparoscopic hernia repair and inguinal herniorrhaphy • • http://www.goremedical.com/stp/ PICTURES NAME of the products Dual Mesh Biomaterial MANUFACTURER Gore DESCRIPTION e-PTFE mesh for intraperitoneal placement In certain hernia and soft tissue reconstructions, and in temporary bridging of fascial defects, it is sometimes necessary to encourage host tissue ingrowth along one surface, while minimizing tissue attachment along another surface.
    [Show full text]
  • Hernia Repair
    HERNIA REPAIR What is a Hernia? A hernia is a weakness or tear in the wall of the abdomen resulting in a bulge or tear. The inner lining of the abdomen pushes through the weakened area of the abdominal wall to form a small balloon-like sax. This can allow a loop of intestine or abdominal tissue to push into the sac. A hernia can cause severe pain and potentially serious problems that could require emergency surgery. Hernias may be acquired (caused by wear and tear over the years) or congenital (result from a weakness in the abdominal wall present since birth). Hernias can get worse and grow larger over time. A hernia does not go away over time, nor will it go away by itself. Men, women and children of all ages can have hernias. How do I know I have a hernia? • Common areas to develop a hernia are in the groin (inguinal), belly button (umbilical), the site of a previous operation (incisional), high in the thigh, just below the groin (femoral), and in the groin at the internal ring (indirect inguinal hernia). • Hernias can be on both sides of the groin (bilateral hernias) or may recur at the site of a previous hernia (recurrent hernia). • You may notice a bulge under the skin or feel pain when you lift heavy objects, cough, or strain during urination or bowel movements. You may notice pain during prolonged sitting or standing. • The pain can be sharp and sudden or a dull ache that worsens towards the end of the day.
    [Show full text]
  • Regulatory Warnings and Use of Surgical Mesh in Pelvic Organ
    Letters implementing strategies to promote more judicious use of CT. of pelvic organ prolapse and reported 1503 mesh-related Efforts by policy makers and medical-center leaders to re- events (5-fold increase) in the Manufacturer and User Device align incentives that promote the escalating use of CT remain Experience database from January 1, 2008, through Decem- a societal imperative. ber 31, 2010.2 We sought to determine the extent of use of vaginal mesh in pelvic organ prolapse after the most recent Frank S. Drescher, MD FDA warning and patterns of discontinuation of the use of Brenda E. Sirovich, MD, MS vaginal mesh in New York State. Author Affiliations: Outcomes Group, VA Medical Center, White River Junction, Methods | We used data from the New York Statewide Plan- Vermont (Drescher, Sirovich); Medicine, Geisel School of Medicine at ning and Research Cooperative System, which contains rec- Dartmouth, Hanover, New Hampshire (Drescher, Sirovich); Pulmonary and Critical Care Medicine, Veterans Affairs, White River Junction, Vermont ords of all surgical procedures done in the state. Patients un- (Drescher); The Dartmouth Institute for Health Policy and Clinical Practice, dergoing surgical procedures for pelvic organ prolapse with or Hanover, New Hampshire (Sirovich). without the use of mesh from January 1, 2011, to December 31, Corresponding Author: Frank S. Drescher, MD, Pulmonary and Critical Care 2013, were identified through previously described methods.3 Medicine, Veterans Affairs, 215 N Main St (111), White River Junction, VT 05009 ([email protected]). Patients with previous repairs of prolapse were excluded. The average annual hospital volume of prolapse repair surgery was Published Online: December 28, 2015.
    [Show full text]