[Mechanical properties of biological or synthetic implants used to treat genital prolapse and stress incontinence in women : what is the ideal material?]. / Propriétés mécaniques des implants biologiques ou synthétiques utilisés dans les cures de prolapsus et d'incontinence urinaire de la femme: quel est le matériau idéal?

INTRODUCTION: Many surgical techniques proposed for genital prolapse or stress incontinence use prosthetic material to reinforce native tissues. Most of the synthetic meshes used have been designed for hernia repair. MATERIAL AND METHOD: We study the biomechanical properties of human Alloderm or animals tissues like Pelvicol and of synthetic resorbable and permanent meshes. We report the results from the literature. We report the results of a personal study of the biomechanical properties of synthetic meshes. RESULTS: The literature on biomechanical properties of biological or synthetic meshes and their evolution after implantation is sparse. Biogyn ITY or Prolène are the only meshes without spatial orientation. Their resistance to rupture and mechanical properties are variable and seem poor for Biogyn W8 et Mersuture. DISCUSSION: Reviewing the literature we discuss the ideal properties for synthetic meshes used for cure of genital prolapse.

[Biomechanics of stress distribution and resistance of biological tissues: why use prostheses for the treatment of genital prolapse?]. / Biomécanique de la réparation et résistance des tissus biologiques dans les cures de prolapsus: pourquoi utiliser des prothèses?

BACKGROUND: Solidity and elasticity are the two main biomechanical properties of pelvic tissues involved in surgical cure of genital prolapse-prevertebral, pectinate, and sacrospinal ligaments, tendinous arcs of the pelvic fascia, vaginal tissue. We report data in the literature and personal studies concerning these autologous biological tissues. MATERIAL AND METHODS: The resistance of pelvic tissues was tested on 29 cadavers. Measurements were also made on two 2-cm samples of vaginal tissue obtained during vaginal route surgery for prolapse cure in 20 menopaused women. Stress tests were conducted to determine resistance and level of rupture. RESULTS: There was a wide variability in ligament resistance, ranging from a minimum of 22 Newtons to a maximum to the order of 200 Newtons. Results varied greatly from one woman to another and also between the two sides in the same woman. The prevertebral ligament exhibited the greatest resistance. The pectinate ligament was significantly more resistant than the sacrospinal ligaments and the tendinous arcs of the pelvic fascia. There was a significant relationship between the subjective assessment of ligament quality and objective measurements of resistance. For vaginal tissues, resistance varied greatly from 12 Newtons to a maximum to the order of 76 Newtons. Flexion values ranged from 14 to 130 Newtons. CONCLUSION: Our findings illustrate pelvic tissue failure observed in patients with genital prolapse. Individual maximal resistance of the pelvic ligaments is vary variable, between ligaments and between subjects, and even between sides in a given subject. Pelvic ligaments used for cure of genital prolapse are moderately resistant with wide interindividual variability. The mechanical properties of vaginal tissue are also very variable, illustrating why these tissues may exhibit a certain resistance against dissociation when exposed to loading but much less resistance when exposed to traction by a surgical suture. These findings suggest a revision of classical surgical procedures.

[Surgical humanitarian missions. An experience over 18 years]. / Missions humanitaires chirurgicales. Une expérience de dix-huit ans.

One hundred and fourteen Surgical Humanitarian Assignments carried out in 18 years in three African countries allowed performing 17,036 operations, including 72.42% for abdominopelvic surgery, 17.38% for traumatology and 10.22 for various illnesses. Basic gynecological surgery and the cure of hernias made up 81.68% of all operations. 40.25% of all surgery was performed in emergency. The general mortality rate is 3.3% with extreme values of 73.80% for multiple injuries and 1.07% for the cure of hernias.