@incollection{BhattaraiStaat2018,
  author    = {Bhattarai, Aroj and Staat, Manfred},
  title     = {Mechanics of soft tissue reactions to textile mesh implants},
  series = {Biological, Physical and Technical Basics of Cell Engineering},
  booktitle = {Biological, Physical and Technical Basics of Cell Engineering},
  editor    = {Artmann, Gerhard and Temiz Artmann, Ayseg{\"u}l and Zhubanova, Azhar A. and Digel, Ilya},
  publisher = {Springer},
  address   = {Singapore},
  isbn      = {978-981-10-7904-7},
  doi       = {10.1007/978-981-10-7904-7_11},
  pages     = {251 -- 275},
  year      = {2018},
  abstract  = {For pelvic floor disorders that cannot be treated with non-surgical procedures, minimally invasive surgery has become a more frequent and safer repair procedure. More than 20 million prosthetic meshes are implanted each year worldwide. The simple selection of a single synthetic mesh construction for any level and type of pelvic floor dysfunctions without adopting the design to specific requirements increase the risks for mesh related complications. Adverse events are closely related to chronic foreign body reaction, with enhanced formation of scar tissue around the surgical meshes, manifested as pain, mesh erosion in adjacent structures (with organ tissue cut), mesh shrinkage, mesh rejection and eventually recurrence. Such events, especially scar formation depend on effective porosity of the mesh, which decreases discontinuously at a critical stretch when pore areas decrease making the surgical reconstruction ineffective that further augments the re-operation costs. The extent of fibrotic reaction is increased with higher amount of foreign body material, larger surface, small pore size or with inadequate textile elasticity. Standardized studies of different meshes are essential to evaluate influencing factors for the failure and success of the reconstruction. Measurements of elasticity and tensile strength have to consider the mesh anisotropy as result of the textile structure. An appropriate mesh then should show some integration with limited scar reaction and preserved pores that are filled with local fat tissue. This chapter reviews various tissue reactions to different monofilament mesh implants that are used for incontinence and hernia repairs and study their mechanical behavior. This helps to predict the functional and biological outcomes after tissue reinforcement with meshes and permits further optimization of the meshes for the specific indications to improve the success of the surgical treatment.},
  language  = {en}
}
@inproceedings{BhattaraiStaat2018,
  author    = {Bhattarai, Aroj and Staat, Manfred},
  title     = {Pectopexy to repair vaginal vault prolapse: a finite element approach},
  series = {Proceedings CMBBE 2018},
  booktitle = {Proceedings CMBBE 2018},
  editor    = {Fernandes, P.R. and Tavares, J. M.},
  year      = {2018},
  abstract  = {The vaginal prolapse after hysterectomy (removal of the uterus) is often associated with the prolapse of the vaginal vault, rectum, bladder, urethra or small bowel. Minimally invasive surgery such as laparoscopic sacrocolpopexy and pectopexy are widely performed for the treatment of the vaginal prolapse with weakly supported vaginal vault after hysterectomy using prosthetic mesh implants to support (or strengthen) lax apical ligaments. Implants of different shape, size and polymers are selected depending on the patient's anatomy and the surgeon's preference. In this computational study on pectopexy, DynaMesh®-PRP soft, GYNECARE GYNEMESH® PS Nonabsorbable PROLENE® soft and Ultrapro® are tested in a 3D finite element model of the female pelvic floor. The mesh model is implanted into the extraperitoneal space and sutured to the vaginal stump with a bilateral fixation to the iliopectineal ligament at both sides. Numerical simulations are conducted at rest, after surgery and during Valsalva maneuver with weakened tissues modeled by reduced tissue stiffness. Tissues and prosthetic meshes are modeled as incompressible, isotropic hyperelastic materials. The positions of the organs are calculated with respect to the pubococcygeal line (PCL) for female pelvic floor at rest, after repair and during Valsalva maneuver using the three meshes.},
  language  = {en}
}
@article{BhattaraiStaat2018,
  author    = {Bhattarai, Aroj and Staat, Manfred},
  title     = {Computational comparison of different textile implants to correct apical prolapse in females},
  series = {Current Directions in Biomedical Engineering},
  volume    = {4},
  journal   = {Current Directions in Biomedical Engineering},
  number    = {1},
  publisher = {De Gruyter},
  address   = {Berlin},
  doi       = {10.1515/cdbme-2018-0159},
  pages     = {661 -- 664},
  year      = {2018},
  abstract  = {Prosthetic textile implants of different shapes, sizes and polymers are used to correct the apical prolapse after hysterectomy (removal of the uterus). The selection of the implant before or during minimally invasive surgery depends on the patient's anatomical defect, intended function after reconstruction and most importantly the surgeon's preference. Weakness or damage of the supporting tissues during childbirth, menopause or previous pelvic surgeries may put females in higher risk of prolapse. Numerical simulations of reconstructed pelvic floor with weakened tissues and organ supported by textile product models: DynaMesh®-PRS soft, DynaMesh®-PRP soft and DynaMesh®-CESA from FEG Textiletechnik mbH, Germany are compared.},
  language  = {en}
}
@phdthesis{Bhattarai2018,
  author    = {Bhattarai, Aroj},
  title     = {Constitutive modeling of female pelvic floor dysfunctions and reconstructive surgeries using prosthetic mesh implants},
  isbn      = {978-3-9818074-8-6},
  doi       = {10.17185/duepublico/70340},
  pages     = {192 S.},
  year      = {2018},
  language  = {en}
}