Biomechanical compatibility of surgical mesh and fascia being reinforced: dependence of experimental hernia defect repair results on anisotropic surgical mesh positioning

Abstract

In prosthetic hernia repair, the mechanical properties of surgical mesh should correspond with those of the fascia being repaired. A mismatch of mechanical properties may result in implant deformation, abdominal wall biomechanics impairment, and recurrent herniation at the edges of the meshes.

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

“…6). This observation corresponds to the results obtained experimentally by Anurov et al (2012) and numerically by Hernández-Gascón et al (2013), who investigated only two orientations of a surgical mesh in the central area of the abdominal wall. However, also a frequent solution of our optimisation scheme is 75 deg especially for hernia located in zone 4.…”

“…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.…”

Mechanical Response of the Herniated Human Abdomen to the Placement of Different Prostheses

“…Other studies have focused on analyzing the effects of the anisotropy of a surgical mesh once implanted [8, 9,12]. However, the distensibility and stress produced to the tissues and implant cannot be experimentally addressed.…”

“…Numerous experimental animal studies have examined the outcome of the use of different prosthetic materials [8][9][10][11]. Other studies have focused on analyzing the effects of the anisotropy of a surgical mesh once implanted [8, 9,12].…”

Surgical mesh for ventral incisional hernia repairs:Understanding mesh design

“…Because mechanical properties differ greatly based on directionality in knitted mesh, it has been recommended that anisotropy be identified and marked on the meshes to help surgeons orient meshes during implantation to optimize postsurgical outcomes (59,101,102). The rationale that the meshes should be aligned to maximally resist forces has yet to be tested or verified (101).…”