Biomechanical Influences on Mesh-Related Complications in Incisional Hernia Repair
Aim: Hernia repair strengthens the abdominal wall with a textile mesh. Recurrence and pain indicate weak bonds between mesh and tissue. It remains a question which biomechanical factors strengthen the mesh-tissue interface, and whether surgeons can enhance the bond between mesh and tissue.Material a...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2021-10-01
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| Series: | Frontiers in Surgery |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fsurg.2021.763957/full |
| _version_ | 1818927657160540160 |
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| author | Friedrich Kallinowski Yannique Ludwig Dominik Gutjahr Christian Gerhard Hannah Schulte-Hörmann Lena Krimmel Carolin Lesch Katharina Uhr Philipp Lösel Samuel Voß Vincent Heuveline Matthias Vollmer Johannes Görich Regine Nessel |
| author_facet | Friedrich Kallinowski Yannique Ludwig Dominik Gutjahr Christian Gerhard Hannah Schulte-Hörmann Lena Krimmel Carolin Lesch Katharina Uhr Philipp Lösel Samuel Voß Vincent Heuveline Matthias Vollmer Johannes Görich Regine Nessel |
| author_sort | Friedrich Kallinowski |
| collection | DOAJ |
| description | Aim: Hernia repair strengthens the abdominal wall with a textile mesh. Recurrence and pain indicate weak bonds between mesh and tissue. It remains a question which biomechanical factors strengthen the mesh-tissue interface, and whether surgeons can enhance the bond between mesh and tissue.Material and Methods: This study assessed the strength of the mesh-tissue interface by dynamic loads. A self-built bench test delivered dynamic impacts. The test simulated coughing. Porcine and bovine tissue were used for the bench test. Tissue quality, mesh adhesiveness, and fixation intensity influenced the retention power. The influences were condensed in a formula to assess the durability of the repair. The formula was applied to clinical work. The relative strength of reconstruction was related to the individual human abdominal wall. From computerized tomography at rest and during Valsalva's Maneuver, the tissue quality of the individual patient was determined before surgery.Results: The results showed that biomechanical parameters observed in porcine, bovine, and human tissue were in the same range. Tissues failed in distinct patterns. Sutures slackened or burst at vulnerable points. Both the load duration and the peak load increased destruction. Stress concentrations elevated failure rates. Regional areas of force contortions increased stress concentrations. Hernia repair improved strain levels. Measures for improvement included the closure of the defect, use of higher dynamic intermittent strain (DIS) class meshes, increased mesh overlap, and additional fixation. Surgeons chose the safety margin of the reconstruction as desired.Conclusion: The tissue quality has now been introduced into the concept of a critical and a gained resistance toward pressure-related impacts. A durable hernia repair could be designed from available coefficients. Using biomechanical principles, surgeons could minimize pain levels. Mesh-related complications such as hernia recurrence can potentially be avoided in incisional hernia repair. |
| first_indexed | 2024-12-20T03:16:30Z |
| format | Article |
| id | doaj.art-626bbacc5529493ca1eb70128b24bae7 |
| institution | Directory Open Access Journal |
| issn | 2296-875X |
| language | English |
| last_indexed | 2024-12-20T03:16:30Z |
| publishDate | 2021-10-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Surgery |
| spelling | doaj.art-626bbacc5529493ca1eb70128b24bae72022-12-21T19:55:20ZengFrontiers Media S.A.Frontiers in Surgery2296-875X2021-10-01810.3389/fsurg.2021.763957763957Biomechanical Influences on Mesh-Related Complications in Incisional Hernia RepairFriedrich Kallinowski0Yannique Ludwig1Dominik Gutjahr2Christian Gerhard3Hannah Schulte-Hörmann4Lena Krimmel5Carolin Lesch6Katharina Uhr7Philipp Lösel8Samuel Voß9Vincent Heuveline10Matthias Vollmer11Johannes Görich12Regine Nessel13General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, GermanyGeneral, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, GermanyGeneral, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, GermanyGeneral, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, GermanyGeneral, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, GermanyGeneral, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, GermanyGeneral, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, GermanyGeneral, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, GermanyEngineering Mathematics and Computing Lab (EMCL), Interdisciplinary Center for Scientific Computing, Heidelberg, GermanyLaboratory of Fluid Dynamics and Technical Flows, Otto-von-Guericke University Magdeburg, Magdeburg, GermanyEngineering Mathematics and Computing Lab (EMCL), Interdisciplinary Center for Scientific Computing, Heidelberg, GermanyBiomechanics, Hamburg University of Technology, Hamburg, GermanyRadiological Center, Eberbach, GermanyGeneral, Visceral and Pediatric Surgery, Klinikum Am Gesundbrunnen, Heilbronn, GermanyAim: Hernia repair strengthens the abdominal wall with a textile mesh. Recurrence and pain indicate weak bonds between mesh and tissue. It remains a question which biomechanical factors strengthen the mesh-tissue interface, and whether surgeons can enhance the bond between mesh and tissue.Material and Methods: This study assessed the strength of the mesh-tissue interface by dynamic loads. A self-built bench test delivered dynamic impacts. The test simulated coughing. Porcine and bovine tissue were used for the bench test. Tissue quality, mesh adhesiveness, and fixation intensity influenced the retention power. The influences were condensed in a formula to assess the durability of the repair. The formula was applied to clinical work. The relative strength of reconstruction was related to the individual human abdominal wall. From computerized tomography at rest and during Valsalva's Maneuver, the tissue quality of the individual patient was determined before surgery.Results: The results showed that biomechanical parameters observed in porcine, bovine, and human tissue were in the same range. Tissues failed in distinct patterns. Sutures slackened or burst at vulnerable points. Both the load duration and the peak load increased destruction. Stress concentrations elevated failure rates. Regional areas of force contortions increased stress concentrations. Hernia repair improved strain levels. Measures for improvement included the closure of the defect, use of higher dynamic intermittent strain (DIS) class meshes, increased mesh overlap, and additional fixation. Surgeons chose the safety margin of the reconstruction as desired.Conclusion: The tissue quality has now been introduced into the concept of a critical and a gained resistance toward pressure-related impacts. A durable hernia repair could be designed from available coefficients. Using biomechanical principles, surgeons could minimize pain levels. Mesh-related complications such as hernia recurrence can potentially be avoided in incisional hernia repair.https://www.frontiersin.org/articles/10.3389/fsurg.2021.763957/fullbench testcomputerized tomographyincisional herniaGRIPCRIPhernia repair |
| spellingShingle | Friedrich Kallinowski Yannique Ludwig Dominik Gutjahr Christian Gerhard Hannah Schulte-Hörmann Lena Krimmel Carolin Lesch Katharina Uhr Philipp Lösel Samuel Voß Vincent Heuveline Matthias Vollmer Johannes Görich Regine Nessel Biomechanical Influences on Mesh-Related Complications in Incisional Hernia Repair Frontiers in Surgery bench test computerized tomography incisional hernia GRIP CRIP hernia repair |
| title | Biomechanical Influences on Mesh-Related Complications in Incisional Hernia Repair |
| title_full | Biomechanical Influences on Mesh-Related Complications in Incisional Hernia Repair |
| title_fullStr | Biomechanical Influences on Mesh-Related Complications in Incisional Hernia Repair |
| title_full_unstemmed | Biomechanical Influences on Mesh-Related Complications in Incisional Hernia Repair |
| title_short | Biomechanical Influences on Mesh-Related Complications in Incisional Hernia Repair |
| title_sort | biomechanical influences on mesh related complications in incisional hernia repair |
| topic | bench test computerized tomography incisional hernia GRIP CRIP hernia repair |
| url | https://www.frontiersin.org/articles/10.3389/fsurg.2021.763957/full |
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