Biomechanics of the front abdominal wall as a potential factor leading to recurrence with laparoscopic ventral hernia repair

Śmietański, Maciej; Bury, Kamil; Tomaszewska, Agnieszka; Lubowiecka, Izabela; Szymczak, Czesław

doi:10.1007/s00464-011-2056-8

Cited by 42 publications

(27 citation statements)

References 16 publications

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“…Experimental studies revealed that abdominal wall elongates approximately 11-32% under physiologic tension (approximately 16 N/cm). If high pressure is applied, the difference in dimensions may reach even 100% [38]. In such circumstances, implantation of standard, rigid prosthesis induces significant tension at the fixation points.…”

Section: Partially Absorbable Composite Implantsmentioning

confidence: 99%

Synthetic Implants in Hernia Surgery

Łukasiewicz¹,

Drewa²

2014

Adv Clin Exp Med

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Abdominal wall hernia correction is one of the most common surgical procedures. 85,000 hernia operations are performed in Poland each year. Modern techniques of abdominal wall reconstruction utilize surgical implants for fascial defect closure. In the 70s and the 80s of the last century, these techniques gained widespread acceptance among surgeons. Significant improvement of results in terms of recurrences was observed. Treatment of large abdominal wall defects became possible. Three types of surgical implants were developed early: polipropylene (PP), poliethylene (PE) and politetrafluoroethylene (PTfE). Unfortunately, negative effects of implanted material soon became apparent. Excessive native tissues inflammatory response to the implanted material, leading to multiple complications was observed. Recurrences due to fibrosis, chronic regional pain, stiffness of the operation site, intestinal adhesions and fistulas, infertility and infections were reported. In some cases the use of standard synthetic implant was contraindicated. Analyzing drawbacks of the standard hernia implants, the medical industry developed new materials to improve treatment results. The most popular, currently utilized synthetic materials, are presented in this review in the context of clinical results (Adv Clin Exp Med 2014, 23, 1, 135-142).

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Section: Partially Absorbable Composite Implantsmentioning

confidence: 99%

Synthetic Implants in Hernia Surgery

Łukasiewicz¹,

Drewa²

2014

Adv Clin Exp Med

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“…The aim of this study was to show the superiority of an elastic mesh concept (VS) versus a control, rigid mesh concept (PH) to confirm theoretical findings from the biomathematical model [14,16,19,20].…”

Section: Objectivementioning

confidence: 90%

“…In previous publications [14][15][16][17][18], the physiomechanical properties of available meshes and the tissue-implant link along with the junction forces were examined. To achieve that goal, we investigated the in vivo elasticity of the front abdominal wall and distinguished the strain zones [18].…”

Section: Theoretical Backgroundmentioning

confidence: 99%

“…To achieve that goal, we investigated the in vivo elasticity of the front abdominal wall and distinguished the strain zones [18]. Subsequently, the forces applied to the fascia-mesh system with the division of the crucial elements, such as the implant elasticity and size, tackers and sutures maintenance forces, hernia ring localization and size as well as the intra-abdominal pressure were highlighted and examined [14][15][16][17]. As a result, it was possible to construct computer software that supports the decision-making process when performing IPOM surgeries [14,19,20].…”

Section: Theoretical Backgroundmentioning

confidence: 99%

“…Moreover, our studies proved that the mesh, fixation and fascia are functional systems that should not be treated and described separately [14,[16][17][18]. To further explore and validate this in clinical settings, authors have decided to compare two mesh implants, with different elastic properties, dedicated for the intraperitoneal onlay mesh (IPOM) procedures: first mesh initially stiff and a second one presenting high elasticity prior to incorporation.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of two different concepts of mesh and fixation technique in laparoscopic ventral hernia repair: a randomized controlled trial

et al. 2015

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Although this clinical trial was terminated prior to the preplanned recruitment goal, the obtained results from the enrolled patients indicate that the PH system associated with significantly greater hernia recurrences and postoperative pain compared with the VS system. This confirms the superiority of the elastic mesh concept, which may be a safer and more efficacious option for laparoscopic ventral hernia repairs.

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Additive Manufacturing of Biomechanically Tailored Meshes for Compliant Wearable and Implantable Devices

Pattinson

Huber

Kim

et al. 2019

Adv Funct Materials

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Additive manufacturing (AM) of medical devices such as orthopedic implants and hearing aids is highly attractive because of the potential of AM to match the complex form and mechanics of individual human bodies. Externally worn and implantable tissue-support devices, such as ankle or knee braces, and hernia repair mesh, offer a new opportunity for AM to mimic tissuelike mechanics and improve both patient outcomes and comfort. Here, it is demonstrated how explicit programming of the toolpath in an extrusion AM process can enable new, flexible mesh materials having digitally tailored mechanical properties and geometry. Meshes are fabricated by extrusion of thermoplastics, optionally with continuous fiber reinforcement, using a continuous toolpath that tailors the elasticity of unit cells of the mesh via incorporation of slack and modulation of filament-filament bonding. It is shown how the tensile mesh mechanics can be engineered to match the nonlinear response of muscle. An ankle brace with directionally specific inversion stiffness arising from embedded mesh is validated, and further concepts for 3D mesh devices are prototyped.

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Biomechanics of the front abdominal wall as a potential factor leading to recurrence with laparoscopic ventral hernia repair

Abstract: The presented experiment adds new parameters to the understanding of in vivo mesh behavior. Elongation of the front abdominal wall may stretch implanted mesh and could be a cause of recurrence in cases of insufficient fixation.

Cited by 42 publications

References 16 publications

Synthetic Implants in Hernia Surgery

Synthetic Implants in Hernia Surgery

Comparison of two different concepts of mesh and fixation technique in laparoscopic ventral hernia repair: a randomized controlled trial

Additive Manufacturing of Biomechanically Tailored Meshes for Compliant Wearable and Implantable Devices

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