Int UrogynecolJ (1997) 8:105-115 © 1997 Springer-VerlagLondon Ltd International Urogynecology Journal Review Article The Use of Mesh in Gynecologic Surgery C. B. Iglesia, D. E. Fenner, and L. Brubaker Rush-Presbyterian-St. Luke's Medical Center, Chicago, USA Abstract: The aim of this review was to compare properties of the most commonly used synthetic meshes and describe their use in gynecologic procedures. An Ovid search of the English literature from 1966 to the present was carried out, together with a hand search of Index Medicus from 1950 to 1965. Articles involving the use of mesh in surgical procedures or comparative studies of the different mechanical properties of mesh are included. Overviews from urogynecologic texts and surgical texts are also included. All studies in this review consisted of retrospective case series (21 suburethral sling articles, 15 sacrocolpopexy articles, and five pelvic sling articles). No randomized prospective trials were available. Outcome variables, including cure rates and mesh-related complications, are reviewed and com- pared. Conclusions show that long-term success of the suburethral sling with synthetic mesh ranges from 61% to 100%, and the success rate of the abdominal sacrocol- popexies using mesh ranges from 68% to 100%. Mesh- related complications rates are frequent, with up to a 35% removal rate and 10% sinus tract formation for suburethral slings and 9% erosion rate for sacrocolpo- pexy. The ideal synthetic mesh material for pelvic surgery, one that induces minimal foreign-body reaction with minimal risk of infection, rejection and erosion, has yet to be developed. Keywords: Gore-tex; Marlex; Mersilene; Sacrocolpo- pexy; Suburethral sling Correspondence and offprint requests to: Dr Cheryl B, Iglesia, Department of Obstetrics and Gynecology, Rush-Presbyterian-St. Luke's Medical Center, 1725 West Harrison, Suite 818, Chicago, IL 60612, USA. Introduction The use of synthetic biocompatible materials has become more common in gynecologic surgery over the past three decades. These materials may be used when the surgeon wishes to avoid an additional fascial- harvesting procedure or to use materials that are stronger than the patient's own fascial tissue. Prepared strips reduce operative time, simplify the procedure, and theoretically decreased patient soreness and risk of subsequent hernia formation. This paper will review the properties of the most commonly used synthetic bio- compatible materials and their use in gynecologic pro- cedures. Much of the initial data on synthetic mesh were derived from general surgery research for repair of abdominal wall hernias [1,2]. In general, synthetic mesh is useful as a reinforcement of herniations. In gyneco- logy, the two most common procedures involving the use of synthetic mesh are the abdominal sacrocolpopexy and the suburethrat sling. A variety of other anecdotally described uses include laparoscopic retropubic urethro- pexy, intraperitoneal placement for adhesion preven- tion, and rare pelvic floor hernias [3-5]. Selected case series comprise the majority of mesh reports in gyneco- logic surgery. General Properties of Synthetic Mesh The search for the ideal synthetic biocompatible material dates back to the mid 1950s, when Cumberland [6] and Scales [7] studied materials used in ventral hernia repair and orthopedic prostheses. They sought a material which was both chemically and physically inert, non-carcinogenic, mechanically strong and easily fabri- cated and sterilizable. Some of these properties have