Understanding Dimensional Stability of Polymer Surgical Mesh

Polymer surgical mesh is a biomedical implant that has revolutionized the repair of the abdominal wall and pelvic floor. Each year, over 1.6 million Americans undergo surgical procedures using polymer surgical mesh to treat conditions where internal organs protrude through weakened tissues. This material is used in approximately 90% of hernia repairs, 80% of stress urinary incontinence procedures, and 30% of pelvic organ prolapse surgeries. Despite this widespread use of polymer surgical mesh, post-implantation complications have prompted regulatory investigation and scrutiny. These complications stem from the mesh's behavior within the human body, including wrinkling, contraction, and loss of fixation, which can impair the mesh's intended function and potentially result in additional surgical procedures. Such complications are primarily determined by the clinical performance of surgical mesh, which depends mainly on proper mesh-tissue integration and is directly influenced by the mesh's structural characteristics and dimensional stability. While researchers recognize that appropriate structural characteristics and dimensional stability are essential for successful outcomes, accurately measuring mesh dimensional changes in vivo remains difficult. This challenge creates a critical need to advance the understanding of mesh dimensional behavior under physiological conditions to improve patient outcomes and reduce complications. In response to this need, the broad objective of this dissertation was to characterize dimensional changes in polymer surgical mesh using in vitro and in vivo approaches. This dissertation was completed in three aims. Aim 1 evaluated the accuracy and precision of ultrasound imaging in both in vitro and in vivo settings to measure changes in mesh dimensions. Aim 2 used a systematic approach to characterize and analyze pore structures using photogrammetric and image processing methods. Aim 3 explored structural behavior that could contribute to mesh dimensional change. This dissertation addresses gaps in understanding surgical mesh behavior in physiological conditions. It provides novel methods for assessing mesh dimensional stability and structural characteristics that affect mesh design and surgical techniques. This dissertation fills the need for quantitative data on mesh performance under realistic conditions, with implications for addressing patient safety and improving surgical outcomes in hernia repair and pelvic floor reconstruction procedures.