Biomechanics applied to incisional hernia repair – Considering the critical and the gained resistance towards impacts related to pressure

Kallinowski, F.; Ludwig, Yannique; Löffler, Thorsten; Vollmer, Matthias; Lösel, Philipp; Voß, Samuel; Görich, Johannes; Heuveline, Vincent; Nessel, Regine

doi:10.1016/j.clinbiomech.2020.105253

Cited by 20 publications

(49 citation statements)

References 38 publications

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“…Commercially available hernia meshes and fixation systems such as sutures, tacks, and glue were tested on a self-built bench test (3). Two different tissues were investigated with differences in their elasticity: beef flank was found to be more distensible and to bear more load compared with pig belly (5,7).…”

Section: Description Of the Bench Testmentioning

confidence: 99%

“…The fixation coefficients were calculated per suture knot loop, per tack, per fixation point or per gluing area of half a square centimeter. For the individual surgical unit, the material preferentially used should be tested before coefficients are applied (3).…”

Section: Consideration For the Clinical Application Of The Grip Conceptmentioning

confidence: 99%

“…The calculations with the coefficients are given in formulas (1) and (1a) and return the gained resistance to impacts related to pressure (GRIP) in relative numbers (3). The gained resistance of a reconstruction toward impacts delivered by pressure was shortened to the acronym GRIP as detailed previously (8).…”

Section: Consideration For the Clinical Application Of The Grip Conceptmentioning

confidence: 99%

“…Please note that the coefficients for the various factors have to be determined for each condition with a bench test several times before the factors can be used to plan a reconstruction. For a given mesh, it is possible to describe conditions of 100% stability in a DIS test as a critical resistance of impacts delivered by pressure shortened to the acronym CRIP (3).…”

Section: Consideration For the Clinical Application Of The Grip Conceptmentioning

confidence: 99%

“…Dynamic intermittent strain (DIS) resembling coughs can characterize any influence numerically with relative figures (1,2). The results can be summed up to indicate the critically needed (CRIP) and the gained resistances to impacts delivered by pressure (GRIP) before and during surgery (3). The CRIP gives a threshold for the reconstruction to survive 425 repeated impacts within a period of 4 h on the bench test.…”

Section: Introductionmentioning

confidence: 99%

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The Grip Concept of Incisional Hernia Repair—Dynamic Bench Test, CT Abdomen With Valsalva and 1-Year Clinical Results

et al. 2021

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Incisional hernia is a frequent consequence of major surgery. Most repairs augment the abdominal wall with artificial meshes fixed to the tissues with sutures, tacks, or glue. Pain and recurrences plague at least 10–20% of the patients after repair of the abdominal defect. How should a repair of incisional hernias be constructed to achieve durability? Incisional hernia repair can be regarded as a compound technique. The biomechanical properties of a compound made of tissue, textile, and linking materials vary to a large extent. Tissues differ in age, exercise levels, and comorbidities. Textiles are currently optimized for tensile strength, but frequently fail to provide tackiness, dynamic stiction, and strain resistance to pulse impacts. Linking strength with and without fixation devices depends on the retention forces between surfaces to sustain stiction under dynamic load. Impacts such a coughing or sharp bending can easily overburden clinically applied composite structures and can lead to a breakdown of incisional hernia repair. Our group developed a bench test with tissues, fixation, and textiles using dynamic intermittent strain (DIS), which resembles coughing. Tissue elasticity, the size of the hernia under pressure, and the area of instability of the abdominal wall of the individual patient was assessed with low-dose computed tomography of the abdomen preoperatively. A surgical concept was developed based on biomechanical considerations. Observations in a clinical registry based on consecutive patients from four hospitals demonstrate low failure rates and low pain levels after 1 year. Here, results from the bench test, the application of CT abdomen with Valsalva's maneuver, considerations of the surgical concept, and the clinical application of our approach are outlined.

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Section: Description Of the Bench Testmentioning

confidence: 99%

Section: Consideration For the Clinical Application Of The Grip Conceptmentioning

confidence: 99%

Section: Consideration For the Clinical Application Of The Grip Conceptmentioning

confidence: 99%

Section: Consideration For the Clinical Application Of The Grip Conceptmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Grip Concept of Incisional Hernia Repair—Dynamic Bench Test, CT Abdomen With Valsalva and 1-Year Clinical Results

et al. 2021

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Stapled fascial suture: ex vivo modeling and clinical implications

et al. 2022

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Background Recently, in the field of abdominal wall repair surgery, some minimally invasive procedures introduced the use of staplers to provide a retromuscular prosthetic repair. However, to the knowledge of the authors, there are little data in the literature about the outcomes of stapled sutures adoption for midline reconstruction. This study aims to investigate the biomechanics of stapled sutures, simple (stapled), or oversewn (hybrid), in comparison with handsewn suture. From the results obtained, we tried to draw indications for their use in a clinical context. Methods Human cadaver fascia lata specimens, sutured (handsewn, stapled, or hybrid) or not, underwent tensile tests. The data on strength (maximal stress), ultimate strain (deformability), Young's modulus (rigidity), and dissipated specific energy (ability to absorb mechanical energy up to the breaking point) were recorded for each type of specimens and analyzed. Results Stapled and hybrid suture showed a significantly higher strength (handsewn 0.83 MPa, stapled 2.10 MPa, hybrid 2.68 MPa) and a trend toward a lower ultimate strain as compared to manual sutures (handsewn 344%, stapled 249%, hybrid 280%). Stapled and hybrid sutures had fourfold higher Young's modulus as compared to handsewn sutures (handsewn 1.779 MPa, stapled 7.374 MPa, hybrid 6.964 MPa). Handsewn and hybrid sutures showed significantly higher dissipated specific energy (handsewn 0.99 mJ-mm 3 , stapled 0.73 mJ-mm 3 , hybrid 1.35 mJ-mm 3 ). Conclusion Stapled sutures can resist high loads, but are less deformable and rigid than handsewn suture. This suggests a safer employment in case of small defects or diastasis (< W1 in accord to EHS classification), where the presumed tissutal displacement is minimal. Oversewing a stapled suture improves its efficiency, becoming crucial in case of larger defects (> W1 in accord to EHS classification) where the expected tissutal displacement is maximal. Hybrid sutures seem to be a good compromise. Keywords Diastasis recti • Stapled repair • Tensile test • Anterior rectus sheath plication • Laparo-endoscopic • Minimally invasiveIn the field of abdominal wall repair surgery, the minimally invasive techniques are gaining an increasing interest. In

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Prospective cohort study on mesh shrinkage measured with MRI after robot-assisted minimal invasive retrorectus ventral hernia repair using an iron-oxide-loaded polyvinylidene fluoride mesh

et al. 2023

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Background Mesh-reinforced ventral hernia repair is considered the gold standard treatment for all but the smallest of hernias. Human data on mesh shrinkage in the retrorectus mesh position is lacking. A prospective observational cohort study was performed to measure mesh shrinkage in robot-assisted minimal invasive retrorectus repair of ventral hernias. Methods A cohort of 20 patients underwent a robot-assisted minimal invasive retrorectus repair of their ventral hernia. Magnetic resonance imaging (MRI) imaging was performed one month and thirteen months after implantation of an iron-oxide-impregnated polyvinylidene fluoride (PVDF) mesh to assess the decrease in mesh surface area. Inter-rater reliability among three radiologists regarding measurement of the mesh dimensions was analyzed. Quality of Life scoring was evaluated. Results The inter-rater reliability between the radiologists reported as the intra-class correlations proved to be excellent for mesh width (ICC 0.95), length (ICC 0.98) and surface area (ICC 0.99). Between MRI measurements at one month and thirteen months postoperatively, there was a significant increase in mesh surface area (+ 12.0 cm2, p = 0.0013) and mesh width (+ 0.8 cm, p < 0.001), while the length of the mesh remained unchanged (−0.1 cm, p = 0.754). Quality of Life Scoring showed a significant improvement in Quality of Life after one month and a further improvement at thirteen months (p < 0.001). Conclusion There was an excellent inter-rater reliability between three radiologists when measuring width, length, and surface area of an iron-oxide-impregnated PVDF mesh using MRI visualization. Mesh shrinkage was not observed, instead the effective mesh surface area and width of the mesh increased.

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Biomechanics applied to incisional hernia repair – Considering the critical and the gained resistance towards impacts related to pressure

Cited by 20 publications

References 38 publications

The Grip Concept of Incisional Hernia Repair—Dynamic Bench Test, CT Abdomen With Valsalva and 1-Year Clinical Results

The Grip Concept of Incisional Hernia Repair—Dynamic Bench Test, CT Abdomen With Valsalva and 1-Year Clinical Results

Stapled fascial suture: ex vivo modeling and clinical implications

Prospective cohort study on mesh shrinkage measured with MRI after robot-assisted minimal invasive retrorectus ventral hernia repair using an iron-oxide-loaded polyvinylidene fluoride mesh

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