Dynamic intermittent strain can rapidly impair ventral hernia repair

Kallinowski, F.; Baumann, E.; Harder, F.; Siassi, Michael; Mahn, A.; Vollmer, Matthias; Morlock, Michael M.

doi:10.1016/j.jbiomech.2015.09.045

Cited by 19 publications

(28 citation statements)

References 25 publications

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“…It is currently used for the repair of abdominal and thoracic wall defects and for hernias ( 60 ). To prevent mesh dislocation, meshes must be fixated ( 67 ). So far, little is known how to best fasten a hernia mesh in the hiatal position.…”

Section: Discussionmentioning

confidence: 99%

Functional Results after Repair of Large Hiatal Hernia by Use of a Biologic Mesh

2016

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BackgroundThe aim of this observational study is to analyze the results of patients with large hiatal hernia and upside-down stomach after surgical closure with a biological mesh (Permacol®, Covidien, Neustadt an der Donau, Germany). Biological mesh is used to prevent long-term detrimental effects of artificial meshes and to reduce recurrence rates.MethodsA total of 13 patients with a large hiatal hernia and endothoracic stomach, who underwent surgery between 2010 and 2014, were included. Interviews and upper endoscopy were conducted to determine recurrences, lifestyle restrictions, and current complaints.ResultsAfter a mean follow-up of 26 ± 18 months (range: 3–58 months), 10 patients (3 men, mean age 73 ± 13, range: 26–81 years) were evaluated. A small recurrent axial hernia was found in one patient postoperatively. Dysphagia was the most common complaint (four cases); while in one case, the problem was solved after endoscopic dilatation. In three cases, bloat and postprandial pain were documented. In one case, an explantation of the mesh was necessary due to mesh migration and painful adhesions. In one further case with gastroparesis, pyloroplasty was performed without success. The data are compared to the available literature. It was found that dysphagia and recurrence rates are unrelated both in biological and in synthetic meshes if the esophagus is encircled. In series preserving the esophagus at least partially uncoated, recurrences after the use of biological meshes relieve dysphagia. After the application of synthetic meshes, dysphagia is aggravated by recurrences.ConclusionRecurrence is rare after encircling hiatal hernia repair with the biological mesh Permacol®. Dysphagia, gas bloat, and intra-abdominal pain are frequent complaints. Despite the small number of patients, it can be concluded that a biological mesh may be an alternative to synthetic meshes to reduce recurrences at least for up to 2 years. Our study demonstrates that local fibrosis and thickening of the mesh can affect the outcome being associated with abdominal discomfort despite a successful repair. The review of the literature indicates comparable results after 2 years with both biologic and synthetic meshes embracing the esophagus. At the same point in time, reconstruction with synthetic and biologic materials differs when the esophagus is not or only partially encircled in the repair. This is important since encircling artificial meshes can erode the esophagus after 5–10 years.

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Section: Discussionmentioning

confidence: 99%

Functional Results after Repair of Large Hiatal Hernia by Use of a Biologic Mesh

2016

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“…In patients, up to 400 coughs were observed within 24 h which can reach intraabdominal pressures well above 200 mmHg [ 12 , 13 ]. Using a self-built device delivering dynamic impact strain (DIS) simulating coughing actions, repeated impacts can rapidly impair ventral hernia repair [ 5 , 6 ]. The grip calculation can give the threshold for a repair to survive more than 400 DIS strains [ 7 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…The DIS test has been described previously [ [5] , [6] , [7] , [8] ]. In brief, the test bench consists of a water-filled aluminium cylinder coated with a thin polyethylene foil and covered with tissues derived from pig bellies.…”

Section: Methodsmentioning

confidence: 99%

“…Grip of the reconstructions was calculated taking into account the mesh: defect area ratio (MDAR) and the fixation strength as described earlier [ 8 ]. Data were assessed using non-parametric statistics as described earlier [ [6] , [7] , [8] ].…”

Section: Methodsmentioning

confidence: 99%

“…Coughs seem to rapidly impair ventral hernia repair [ 5 ]. A new bench test permits the analysis of biomechanical stability upon dynamic intermittent strain (DIS) which simulates coughing actions [ 6 ]. A dimensionless measure called “grip” can be derived which defines the durability of the reconstruction [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Increasing hernia size requires higher GRIP values for a biomechanically stable ventral hernia repair

Kallinowski

Gutjahr

Vollmer

et al. 2019

Annals of Medicine and Surgery

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Background Increasing hernia sizes lead to higher recurrence rates after ventral hernia repair. A better grip might reduce the failure rates. Material and methods A biomechanical model delivering dynamic intermittent strain (DIS) was used to assess grip values at various hernia orifices. The model consists of a water-filled aluminium cylinder covered with tissues derived from pig bellies which are punched with a central defect varying in diameter. DIS was applied mimicking coughs lasting for up to 2 s with peak pressures between 180 and 220 mmHg and a plateau phase of 0.1 s. Ventral hernia repair was simulated with hernia meshes in the sublay position secured by tacks, glue or sutures as needed to achieve certain grip values. Grip was calculated taking into account the mesh: defect area ratio and the fixation strength. Data were assessed using non-parametric statistics. Results Using a mesh classified as highly stable upon DIS testing (DIS class A) a reduced overlap without fixation led to early slippage (p < 0.001). With the application of 16 fixation points, transmural sutures were better than tacks with Securestrap ® being better than Absorbatack ® (p < 0.001). Plotting the likelihood of a durable repair as a function of the calculated grip higher grip values were needed with increasing hernia diameter to achieve biomechanical stability. This is important for clinical work since the calculated grip values both from a registry and from published data tend to drop as hernia sizes increase indicating biomechanical instability. Conclusion The experimental work reported here demonstrates for the first time that higher grip values should be reached when repairing larger ventral hernias.

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Mechanics of mesh implanted into abdominal wall under repetitive load. Experimental and numerical study

2018

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There are a number of papers discussing medical and mechanical aspects of ventral hernia management. Despite intensive work on the problem understanding, recurrences of the sickness still happen too often. For that reason, new aspects of the problem must be considered. In this article, a change in the abdominal implant's stiffness is discussed, which is caused by cyclic loading. Such loading influence abdominal implant, for example, while patient is coughing or exercising. For the first time, this stiffness change is quantitatively described for a selected knitted mesh. The influence of mesh stiffness changes on repaired hernia persistence is studied. Then, ex vivo experiments on a repaired hernia model under cyclic pressure loading are performed. Finally, numerical simulations of the experiments are made in which stresses and forces in the system are calculated. The two following cases are considered. In the first case, the mesh has its baseline stiffness, and in the second case, the mesh is preconditioned by former loading; thus, it is stiffened. Reaction forces at the mesh fixation points appear to be approximately twofold higher in the second case than in the first case. That may be a reason for a fixation damage in operated hernia system. The results presented shed new light on the necessary strength of mesh fixation in the abdominal wall. They enlarge the state of the art on laparoscopic hernia management with the use of a synthetic implant. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 1400–1409, 2019.

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Dynamic intermittent strain can rapidly impair ventral hernia repair

Cited by 19 publications

References 25 publications

Functional Results after Repair of Large Hiatal Hernia by Use of a Biologic Mesh

Functional Results after Repair of Large Hiatal Hernia by Use of a Biologic Mesh

Increasing hernia size requires higher GRIP values for a biomechanically stable ventral hernia repair

Mechanics of mesh implanted into abdominal wall under repetitive load. Experimental and numerical study

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