Mechanical behavior of surgical meshes for abdominal wall repair: In vivo versus biaxial characterization

Abstract

Despite the widespread use of synthetic meshes in the surgical treatment of the hernia pathology, the election criteria of a suitable mesh for specific patient continues to be uncertain. Thus, in this work, we propose a methodology to determine in advance potential disadvantages on the use of certain meshes based on the patient-specific abdominal geometry and the mechanical features of the certain meshes. To that purpose, we have first characterized the mechanical behavior of four synthetic meshes through biaxial tests. Secondly, two of these meshes were implanted in several New Zealand rabbits with a total defect previously created on the center of the abdominal wall. After the surgical procedure, specimen were subjected to in vivo pneumoperitoneum tests to determine the immediate post-surgical response of those meshes after implanted in a healthy specimen. Experimental performance was recorded by a stereo rig with the aim of obtaining quantitative information about the pressure-displacement relation of the abdominal wall. Finally, following the procedure presented in prior works (Simón-Allué et al., 2015, 2017), a finite element model was reconstructed from the experimental measurements and tests were computationally reproduced for the healthy and herniated cases. Simulations were compared and validated with the in vivo behavior and results were given along the abdominal wall in terms of displacements, stresses and strain. Mechanical characterization of the meshes revealed Surgipro as the most rigid implant and Neomesh SuperSoft® as the softer, while other two meshes (Neomesh Soft®, Neopore®) remained in between. These two meshes were employed in the experimental study and resulted in similar effect in the abdominal wall cavity and both were close to the healthy case. Simulations confirmed this result while showed potential objections in the case of the other two meshes, due to high values in stresses or elongation that may led to discomfort in real tissue. The use of this methodology on human surgery may provide the surgeons with reliable and useful information to avoid certain meshes on specific-patient treatment.

Preparation and Characterization of Functionalized Surgical Meshes for Early Detection of Bacterial Infections

“…Meshes for abdominal surgical procedures are flexible medical devices used to treat hernias, abdominal or inguinal, by adding tension-free reinforcement that results in improved tissue integration and reparation. , Meshes have also been used as prosthetic devices for the treatment of vaginal prolapse , and urinary incontinence . In the last decade, many fundamental research has been performed on tissue compatibility, bio-integration, and mechanical properties of surgical meshes. − Also, their chemical surface functionalization has resulted in significant improvements, for example, prevention of unwanted tissue adhesion, cell adhesion/de-adhesion control features, and thermosensitive and shape memory properties.…”

A novel in vivo approach to assess strains of the human abdominal wall under known intraabdominal pressure

“…the model of Tuset et al, 2019). Simón-Allué et al (2015) developed the idea of measurements carried out during laparoscopic repair on an animal model to identify parameters of a hyperelastic isotropic material law and their spatial distribution in the rabbit abdominal wall (Simón-Allué et al, 2017), additionally, to study the effects of implanting surgical meshes on an animal model (Simón-Allué et al, 2018). The in vivo performance of a surgical mesh implanted in abdominal wall became another research issue.…”

In vivo performance of intraperitoneal onlay mesh after ventral hernia repair

“…However, He et al (2020) reported that validation of the model of a repaired abdominal wall with an implant is currently missing due to a lack of sufficient data. Simón-Allué et al (2018) proposed a combined numerical in vivo and ex vivo study, but the study concerned open repair in rabbits. Podwojewski et al (2014) investigated ex vivo strains in the human abdominal wall subjected to pressure loading in the following states: healthy (intact) and incised and repaired with an intraperitoneal implant.…”