A Selection of Hernia Meshes on the Basis of Experimental Results for Abdominal Layers

Kirilova, Miglena; Pashkouleva, Dessislava; Kavardzhikov, Vasil

doi:10.5504/bbeq.2012.0068

Cited by 10 publications

(3 citation statements)

References 5 publications

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“…The principle that the properties of surgical meshes should match the properties of the abdominal wall and that implants should be oriented in the human body in accordance with the mechanics of the abdominal wall has been reported in the literature since 2001 (Junge et al, 2001). This issue was discussed e.g., by Kirilova et al (2012), Hernández-Gascón et al (2013), Anurov et al (2012). All these studies are limited to just one position of hernia orifice and two perpendicular orientations of implants.…”

Section: Introductionmentioning

confidence: 99%

A preliminary study on the optimal choice of an implant and its orientation in ventral hernia repair

Lubowiecka

Szepietowska

Szymczak

et al. 2016

jtam

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This paper addresses the problem of ventral hernia repair. The main goals are to find an optimal surgical mesh for hernia repair and to define its optimal orientation in the abdominal wall to minimise the maximum force at the tissue-implant juncture. The optimal mesh is chosen from a set of orthotropic meshes with different stiffness ratios for typical hernia placement in the abdominal area. The implant is subjected to an anisotropic displacement field, different for the selected hernia placements. The assumed displacement fields correspond to regular human activity. Proper implantation of the mesh may determine the success of hernia repair and/or the postoperative comfort of patients. The proposed solution is based on FEM simulations of different surgical meshes behaviour. In typical hernia placements, the optimal orientation of the stiffer direction of the implant is perpendicular to the spine. However, the presented results show some cases that an oblique direction may be the optimum one.

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Section: Introductionmentioning

confidence: 99%

A preliminary study on the optimal choice of an implant and its orientation in ventral hernia repair

Lubowiecka

Szepietowska

Szymczak

et al. 2016

jtam

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“…Where a hernia occurs in the AW, it was modelled as a damage zone of diameter 8 mm throughout the wall. The mesh implant used to simulate hernia repair or wall reinforcement was considered to have a Young modulus of 8 MPa, based on the experimental data of Kirilova et al 15 . Poisson’s ratio of the mesh implant was 0.3 according to the experimental data of Szepietowska and Lubowiecka 16 .…”

Section: Methodsmentioning

confidence: 99%

Biomechanical stability of hernia-damaged abdominal walls

Karrech

Ahmad

Hamdorf

2023

Sci Rep

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Hernia occurs when the peritoneum and/or internal organs penetrate through a defect in the abdominal wall. Implanting mesh fabrics is a common way to reinforce the repair of hernia-damaged tissues, despite the risks of infection and failure associated with them. However, there is neither consensus on the optimum mesh placement within the abdominal muscles complex nor on the minimum size of hernia defect that requires surgical correction. Here we show that the optimum position of the mesh depends on the hernia location; placing the mesh on the transversus abdominis muscles reduces the equivalent stresses in the damaged zone and represents the optimum reinforcement solution for incisional hernia. However, retrorectus reinforcement of the linea alba is more effective than preperitoneal, anterectus, and onlay implantations in the case of paraumbilical hernia. Using the principles of fracture mechanics, we found that the critical size of a hernia damage zone becomes severe at 4.1 cm in the rectus abdominis and at larger sizes (5.2–8.2 cm) in other anterior abdominal muscles. Furthermore, we found that the hernia defect size must reach 7.8 mm in the rectus abdominis before it influences the failure stress. In other anterior abdominal muscles, hernia starts to influence the failure stress at sizes ranging from 1.5 to 3.4 mm. Our results provide objective criteria to decide when a hernia damage zone becomes severe and requires repair. They demonstrate where mesh should be implanted for a mechanically stable reinforcement, depending on the type of hernia. We anticipate our contribution to be a starting point for sophisticated models of damage and fracture biomechanics. For example, the apparent fracture toughness is an important physical property that should be determined for patients living with different obesity levels. Furthermore, relevant mechanical properties of abdominal muscles at various ages and health conditions would be significant to generate patient specific results.

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“…Junge et al (2001) studied the ex vivo elasticity of the human abdominal wall and compared this parameter with the elasticity of select surgical meshes. Similar stiffness investigations were then conducted to compare and evaluate surgical meshes (Eliason et al, 2011;Kirilova et al, 2012;Tomaszewska, 2016). Some papers address identification of the mechanical properties of specific components in the abdominal wall based on ex vivo tests, e.g., connective tissues in the abdominal wall (Astruc et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

In vivo performance of intraperitoneal onlay mesh after ventral hernia repair

Lubowiecka

Tomaszewska

Szepietowska

et al. 2020

Clinical Biomechanics

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Background: Ventral hernia repair needs to be improved since recurrence, postoperative pain and other complications are still reported in many patients. The behavior of implants in vivo is not sufficiently understood to design a surgical mesh mechanically compatible with the human abdominal wall. Methods: This analysis was based on radiological pictures of patients who underwent laparoscopic ventral hernia repair. The pictures show the trunk of the patient at rest in a standing position and under side bending. The change in the distance between different tacks due to trunk movement was analyzed, which allowed us to determine the in vivo elongation of the mesh incorporated into the abdominal wall. Findings: The relative elongations of the surgical mesh varied from a few percent to greater than 100% in two cases. The median of the median relative elongations obtained for all patients is 9.5%, and the median of the maximum relative elongations for all patients is 32.6%. The maximum elongation occurs between tacks that are next to each other. Trunk movement causes implant deformation, and this study provides quantitative information regarding changes in the distance between fasteners. Interpretation: The physiological movement of the human abdomen must be regarded as a very important factor in mesh deformation and should be considered in surgical practice to reduce the hernia recurrence rate and postoperative pain.

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A Selection of Hernia Meshes on the Basis of Experimental Results for Abdominal Layers

Cited by 10 publications

References 5 publications

A preliminary study on the optimal choice of an implant and its orientation in ventral hernia repair

A preliminary study on the optimal choice of an implant and its orientation in ventral hernia repair

Biomechanical stability of hernia-damaged abdominal walls

In vivo performance of intraperitoneal onlay mesh after ventral hernia repair

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