scholarly journals P054 REDUCTION OF FAILURE RATES AFTER INCISIONAL HERNIA REPAIR BY ADDING A PROPHYLACTIC MESH

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Carolin Lesch ◽  
Friedrich Kallinowski ◽  
Katharina Uhr ◽  
Matthias Vollmer ◽  
Christian Gerhard ◽  
...  
Keyword(s):  
Incisional Hernia ◽  
Abdominal Wall ◽  
Mesh Size ◽  
Incisional Hernia Repair ◽  
Bench Test ◽  
Failure Rates ◽  
Defect Closure ◽  
Prophylactic Mesh ◽  
Linea Alba ◽  
Class A

Abstract Aim “Can a mesh reduce failure rates after closure of a hernia defect?” Material and Methods “Porcine abdominal walls and bovine flanks were used as model tissues. After preparation, a 15 cm long incision was placed in the linea alba of the porcine abdominal wall. An additional round 5 cm defect was punched in the middle of the incision. The bovine flank was prepared in a similar manner. The incisions with the defects were closed with running sutures in a small stitch, small bite technique. Monomax® 2-0 sutures were used with suture to wound lengths above 4:1. Dynamesh® CiCAT meshes of three different sizes were placed in the sublay position. The mesh-tissue compounds were investigated on our self-built hydraulic bench test simulating coughs. Dynamic intermitted strain (DIS) was repeatedly delivered with impacts around 210 mmHg. Each of ten preparation was loaded 425 times by the pressure peaks.” Results “Small stitch, small bite sutures using 2-0 Monomax® with a suture-incision-ratio of 4.5:1 can provide a durable defect closure. Under other conditions, suture lines can reopen. A mesh reduces the recurrence of incisional hernia depending on the mesh size.” Conclusions “An additional DIS-class A mesh in sublay position can provide sufficient support for a suture closing the defect of the abdominal wall. It can prevent a tear-out of the suture from the tissue. On average, a mesh-augmented defect closure reduces the recurrence rate of incisional hernia.”

scholarly journals P024 BIOMECHANICAL INFLUENCES TO BE CONSIDERED FOR A DURABLE INCISIONAL HERNIA REPAIR

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Friedrich Kallinowski ◽  
Yannique Ludwig ◽  
Dominik Gutjahr ◽  
Christian Gerhard ◽  
Hannah Schulte-Hörmann ◽  
...  
Keyword(s):  
Incisional Hernia ◽  
Hernia Repair ◽  
Abdominal Wall ◽  
Computerized Tomography ◽  
Peak Load ◽  
Incisional Hernia Repair ◽  
Bench Test ◽  
Failure Rates ◽  
Tissue Quality ◽  
The Individual

Abstract Aim Recurrence indicates a failed repair. Which biomechanical factors have to be considered to reduce failure rates? How can surgeons enhance the interface between mesh and tissue? Material and Methods The strength of the mesh-tissue interface was evaluated by cyclic loading. A self-made bench test was used to apply dynamic intermittent strain (DIS) to model preparations in order to evaluate the tissue quality and the material properties of hernia meshes and fixation devices. The influences and the properties were condensed in coefficients representing their relative strengths. The strain of the individual human abdominal wall were determined with computerized tomography at rest and during Valsalva’s maneuver. Results The strain observed in porcine, bovine and human tissue was in the same range. Tissue samples exhibited both brittle and ductile failure patterns. Both the load duration and the peak load increased destruction. Stress concentration elevated failure rates. Regional areas of distorsions increase stress concentrations. Hernia repair has to counteract individual strain levels. Measures to improve hernia repair include closure of the defect, use of higher DIS class meshes, increased mesh overlap and additional fixation. In the clinical routine, all measures must be adapted to the individual tissue quality. Conclusions Using the conception of GRIP as the gained resistance towards pressure related impacts, a durable hernia repair can be designed from coefficients determined with a bench test or with computerized tomography of the human abdominal wall. Pain levels and hernia recurrence rates can be reduced in incisional hernia repair when biomechanical principles are considered.

scholarly journals Biomechanical Influences on Mesh-Related Complications in Incisional Hernia Repair

2021 ◽  
Vol 8 ◽  
Author(s):  
Friedrich Kallinowski ◽  
Yannique Ludwig ◽  
Dominik Gutjahr ◽  
Christian Gerhard ◽  
Hannah Schulte-Hörmann ◽  
...  
Keyword(s):  
Incisional Hernia ◽  
Hernia Repair ◽  
Abdominal Wall ◽  
Peak Load ◽  
Incisional Hernia Repair ◽  
Bench Test ◽  
Stress Concentrations ◽  
Tissue Quality ◽  
Tissue Interface ◽  
The Individual

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.

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

2021 ◽  
Vol 8 ◽  
Author(s):  
Friedrich Kallinowski ◽  
Dominik Gutjahr ◽  
Felix Harder ◽  
Mohammad Sabagh ◽  
Yannique Ludwig ◽  
...  
Keyword(s):  
Incisional Hernia ◽  
Hernia Repair ◽  
Abdominal Wall ◽  
Composite Structures ◽  
Incisional Hernia Repair ◽  
Clinical Results ◽  
Major Surgery ◽  
Bench Test ◽  
Tissue Elasticity ◽  
Clinical Registry

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.

scholarly journals OV09 ROBOTIC REPAIR OF SUBXIPHOID INCISIONAL HERNIA POST CABG

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Moamena El-Matbouly ◽  
Yaser Janahi ◽  
Ahmed Suliman ◽  
Hany Atalah ◽  
Ahmed Albahrani
Keyword(s):  
Incisional Hernia ◽  
Abdominal Wall ◽  
Complex Structure ◽  
Median Sternotomy ◽  
Wound Dehiscence ◽  
High Recurrence Rate ◽  
Linea Alba ◽  
Prolonged Intubation ◽  
Sternal Wound Dehiscence ◽  
Upper Abdominal

Abstract Aim A median sternotomy that extends toward the epigastric area can weaken the upper abdominal wall and result in the development of subxiphoid incisional hernia. We aim to assess the efficacy and the feasibility of repair of subxiphoid incisional hernia post CABG robotically. In this video; we will also review the surgical technique and the steps for robotic repair of subxiphoid incisional hernia Material and Methods 57-year-old female presented with subxiphoid swelling post CABG in 2019. Her surgery was complicated with sternotomy wound infection with VAC dressing application and ARDS with prolonged intubation. She had 5x7 cm hernia defect that showed on the CT thorax along with sternal wound dehiscence. She underwent robotic repair of her hernia with phasix mesh and recovered well after surgery. Results The subxiphoid hernia is known for its repair complexities and high recurrence rate because the subxiphoid area is a complex structure consisting of boney structures, the rectus abdominis muscles, linea alba, and the diaphragm. The Da Vinci platform allows for accessing hard-to reach area with enhanced precision in dissection and superior dexterity compared to laparoscopy. The Robotic platform allows for manipulation of the camera to assess and operate on the abdominal wall with ease as compared to laparoscopy. Conclusions robotic repair of subxiphoid incisional hernia with mesh is safe and effective method of repair. There are no short-term or long- term side effects of the procedure with no recurrence at 6 months follow up.

scholarly journals SILS Incisional Hernia Repair: Is It Feasible in Giant Hernias? A Report of Three Cases

2011 ◽  
Vol 2011 ◽  
pp. 1-3 ◽  
Author(s):  
Umut Barbaros ◽  
Tugrul Demirel ◽  
Aziz Sumer ◽  
Ugur Deveci ◽  
Mustafa Tukenmez ◽  
...  
Keyword(s):  
Incisional Hernia ◽  
Abdominal Wall ◽  
Single Incision ◽  
Anterior Abdominal Wall ◽  
Oral Intake ◽  
Operation Time ◽  
Incisional Hernia Repair ◽  
Composite Mesh ◽  
First Case ◽  
The Mean

Aim. Three incisional ventral abdominal wall hernias were repaired by placing a 20 × 30 cm composite mesh via single incision of 2 cm. Methods. All three cases had previous operations and presented with giant incisional defects clinically. The defects were repaired laparoscopically via single incision with the placement of a composite mesh of 20 × 30 cm. Nonabsorbable sutures were needed to hang and fix the mesh only in the first case. Double-crown technique was used in all of the cases to secure the mesh to the anterior abdominal wall. Results. The mean operation time was 120 minutes. The patients were mobilized and led for oral intake at the first postoperative day. No morbidity occurred. Conclusion. Abdominal incisional hernias can be repaired via single incision with a mesh application in experienced centers.

scholarly journals Evaluation of a new suture material (Duramesh™) by measuring suture tension in small and large bites techniques for laparotomy closure in a porcine model

Hernia ◽  
2020 ◽  
Vol 24 (6) ◽  
pp. 1317-1324
Author(s):  
Y. Yurtkap ◽  
F. P. J. den Hartog ◽  
W. van Weteringen ◽  
J. Jeekel ◽  
G. J. Kleinrensink ◽  
...  
Keyword(s):  
Incisional Hernia ◽  
Abdominal Wall ◽  
Suture Material ◽  
Abdominal Pressure ◽  
Postoperative Phase ◽  
Burst Abdomen ◽  
Linea Alba ◽  
Custom Made ◽  
Suture Tension ◽  
Significant Difference

Abstract Purpose After closure of laparotomies, sutures may pull through tissue due to too high intra-abdominal pressure or suture tension, resulting in burst abdomen and incisional hernia. The objective of this study was to measure the suture tension in small and large bites with a new suture material. Methods Closure of the linea alba was performed with small bites (i.e., 5 mm between two consecutive stitches and 5 mm distance from the incision) and large bites (i.e., 10 mm × 10 mm) with Duramesh™ size 0 (2 mm) and PDS II 2-0 in 24 experiments on six porcine abdominal walls. The abdominal wall was fixated on an artificial computer-controlled insufflatable abdomen, known as the ‘AbdoMan’. A custom-made suture tension sensor was placed in the middle of the incision. Results The suture tension was significantly lower with the small bites technique and Duramesh™ when compared with large bites (small bites 0.12 N (IQR 0.07–0.19) vs. large bites 0.57 N (IQR 0.23–0.92), p  < 0.025). This significant difference was also found in favour of the small bites with PDS II 2-0 (p  < 0.038). No macroscopic tissue failure was seen during or after the experiments. Conclusion Closure of the abdominal wall with the small bites technique and Duramesh™ was more efficient in dividing suture tension across the incision when compared to large bites. However, suture tension compared to a conventional suture material was not significantly different, contradicting an advantage of the new suture material in the prevention of burst abdomen and incisional hernia during the acute, postoperative phase.

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