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 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 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 EP.TH.108A Descriptive Case Series of Incisional Hernia Repair Using Dual Mesh Technique

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Chloe Theodorou ◽  
Zia Moinuddin ◽  
David Van Dellen
Keyword(s):  
Incisional Hernia ◽  
Hernia Repair ◽  
Abdominal Wall ◽  
Abdominal Wall Reconstruction ◽  
Surgical Techniques ◽  
Case Series ◽  
Incisional Hernia Repair ◽  
Fistula Formation ◽  
Mesh Technique ◽  
Dual Mesh

Abstract Aims Incisional hernias are a common complication after surgery that cause significant patient morbidity. Symptomatic patients are offered repair but many surgical techniques exist, with abdominal wall reconstruction becoming preferable for large complex defects. This paper describes our experience of abdominal wall reconstruction using a dual mesh technique. Method 22 patients underwent incisional hernia repair between March 2019 and September 2020. All patients received dual mesh, placed in retrorectus or transversalis fascial/retromuscular space. Absorbable BIO-A GORE mesh was used with a polypropylene mesh above. All patients were followed up to assess for complications and recurrence. Results No patients experienced fistula formation, long-term pain or obstructive symptoms. We report one true hernia recurrence (4.5%) and one case of infected mesh (4.5%), these both await further treatment. One patient had a proven wound infection which resolved with conservative treatment. 4 patients (18.2%) experienced seromas, 3 of these resolved spontaneously, one requiring image-guided drainage. Conclusion Incisional hernia repair using combination polypropylene and bio-absorbable mesh provides a safe and effective repair with low recurrence and incidence of surgical site occurrences in the short term. Longer follow up and further studies are needed to evaluate this mesh technique to support ongoing use of absorbable meshes in complex hernia repair.

scholarly journals Mesh Migration into the Neobladder and Ileum with Complicated Fistula Formation following Incisional Hernia Repair

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Masatsugu Kuroiwa ◽  
Masato Kitazawa ◽  
Yusuke Miyagawa ◽  
Futoshi Muranaka ◽  
Shigeo Tokumaru ◽  
...  
Keyword(s):  
Incisional Hernia ◽  
Hernia Repair ◽  
Abdominal Wall ◽  
Rare Case ◽  
Intestinal Tract ◽  
Incisional Hernia Repair ◽  
Small Bowel Resection ◽  
Fistula Formation ◽  
Mesh Migration ◽  
Incisional Surgical Site Infection

Background. Tension-free repair using mesh has become the standard treatment for abdominal wall incisional hernias. However, its postoperative complications reportedly include mesh infection, adhesions, and fistula formation in other organs. Here, we report an extremely rare case of mesh migration into the neobladder and ileum with entero-neobladder and neobladder-cutaneous fistulas. Case Presentation. An 80-year-old male who had undergone radical cystectomy 5 years ago and abdominal wall incisional hernia repair 3 years ago presented with fever and abdominal pain. Computed tomography (CT) scan revealed mesh migration into the neobladder and ileum. He was treated conservatively with antibiotics for a month but did not show improvement; hence, he was transferred to our hospital. He was diagnosed with mesh migration into the neobladder and ileum with complicated fistula formation. He underwent mesh removal, partial neobladder resection, and partial small bowel resection. He developed superficial incisional surgical site infection, which improved with drainage and antibiotics, and he was discharged 40 days after the surgery. Conclusions. We reported a rare case of mesh migration into the neobladder and ileum with fistula formation. Successful conservative treatment cannot be expected for this condition because mesh migration into the intestinal tract causes infection and fistula formation. Hernia repair requires careful placement of the mesh such that it does not come into contact with the intestinal tract. Early surgical intervention is important if migration into the intestinal tract is observed.

Sign in / Sign up

Export Citation Format

Share Document