Primary and Recurrent Repair of Incisional Hernia Based on Biomechanical Considerations to Avoid Mesh-Related Complications

Abstract

Aim: Mechanical principles successfully guide the construction of polymer material composites in engineering. Since the abdominal wall is a polymer composite augmented with a textile during incisional hernia repair we ask: can incisional hernia be repaired safely and durably based on biomechanical principles?Material and Methods: Repair materials were assessed on a self-built bench test using pulse loads to elude influences on the reconstruction of the abdominal wall. Tissue elasticity was analyzed preoperatively as needed with computed tomography at rest and during Valsalva's maneuver. Preoperatively, the critical retention force of the reconstruction to pulse loads was calculated and a biomechanically durable repair was designed based on the needs of the individual patient. Intraoperatively, the design was adjusted as needed. Hernia meshes with high grip factors (Progrip®, Dahlhausen® Cicat) were used for the repairs. Mesh sizes, fixation elements and reconstructive details were oriented on the biomechanical design. All patients recieved single-shot antibiosis. Patients were discharged after full ambulation was achieved.Results: A total of 163 patients (82 males and 81 females) were treated for incisional hernia in four hospitals by ten surgeons. Primary hernia was repaired in 119 patients. Recurrent hernia was operated on in 44 cases. Recurrent hernia was significantly larger (median 161 cm2 vs. 78 cm2; u-test: p = 0.00714). Re-do surgery took significantly longer (median 229 min vs. 150 min; p < 0.00001) since recurrent disease required more often transversus abdominis release (70% vs. 47%). GRIP tended to be higher in recurrent repair (p = 0.01828). Complication rates (15%) and hospital stay were the same (6 vs. 6 days; p = 0.28462). After 1 year, no recurrence was detected in either group. Pain levels were equally low in both primary and recurrent hernia repairs (median NAS = 0 in both groups at rest and under load, p = 0.88866).Conclusion: Incisional hernia can safely and durably be repaired based on biomechanical principles both in primary and recurrent disease. The GRIP concept provides a base for the application of biomechanical principles in incisional hernia repair.

Standardized suturing can prevent slackening or bursting suture lines in midline abdominal incisions and defects

“…A comparative relative number potentially enables the long-term-strength to be assessed. This has been shown for incisional hernia repair and may be a perspective for abdominal wall closure as well [ 20 ]. We are well aware that our studies are only applicable to about 80% of the human cases.…”

“…The variation of the tissue elasticity in porcine and bovine tissues is lower than in human tissue with a ratio of 1: 4. However, it covers 95% of the variation found in 123 patients [ 20 ]. We cut a median 15 cm long incision into the tissues.…”

Editorial: Mesh Complications in Hernia Surgery

“…Not all meshes or fixation elements are equal (12). Advanced mesh material with well-known biomechanical properties combined with sophisticated techniques can give excellent clinical results (9,13,14). Material science works with coefficients permitting engineers to build skyscrapers, supersonic airplanes or just fitting a balcony to a house in an earthquake area.…”

Construction and properties of the silk fibroin and polypropylene composite biological mesh for abdominal incisional hernia repair

“…Although the use of mesh greatly reduces the recurrence rate of incisional hernia and promotes wound healing, according to a large number of clinical data feedback, the polyester mesh is rarely used due to poor anti-infection ability and heavy foreign body reaction. The polypropylene mesh has good histocompatibility, light inflammatory response, and strong anti-infection ability, but it is easy to adhere to viscera, resulting in intestinal obstruction, intestinal leakage, and other complications ( Aydemir Sezer et al, 2019 ; Yang et al, 2020b ; Nessel et al, 2021 ; Pascual et al, 2022 ). Expanded polytetrafluoroethylene (ePTFE) is not easy to adhere to viscera, but it has poor anti-infection ability and poor firmness.…”

“…The polypropylene mesh has good histocompatibility, light inflammatory response, and strong anti-infection ability, but it is easy to adhere to viscera, resulting in intestinal obstruction, intestinal leakage, and other complications (Aydemir Sezer et al, 2019;Yang et al, 2020b;Nessel et al, 2021;Pascual et al, 2022). Expanded polytetrafluoroethylene (ePTFE) is not easy to adhere to viscera, but it has poor anti-infection ability and poor firmness.…”