Mesh incisional herniorrhaphy increases abdominal wall elastic properties: A mechanism for decreased hernia recurrences in comparison with suture repair

DuBay, Derek A.; Wang, Xue; Adamson, Belinda; Kuzon, William M.; Dennis, Robert G.; Franz, Michael

doi:10.1016/j.surg.2006.01.007

Cited by 45 publications

(20 citation statements)

References 21 publications

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“…The factors most blamed for causing recurrence are insufficient fixation, abdominal pressure, and small overlap. The main mechanism of recurrence shown in an experimental model by DuBay et al [12] was insufficiency in a small part of the mesh. This occurred after a rupture in fixation at a single site, where forces trying to rip the junction were stronger than the mesh.…”

Section: Discussionmentioning

confidence: 94%

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

et al. 2011

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Section: Discussionmentioning

confidence: 94%

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

et al. 2011

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“…The degree to which these factors come into consideration varies with the extent of the repair being considered. Abdominal wall compliance after prosthesis implantation was shown in a small animal study to be the most important mechanical property for predicting a low incisional hernia recurrence rate [33]. Incisional hernia repair, which may be associated with increased stiffness in the abdominal wall, potentially due to fibrosis and atrophy, results in a progressive mechanical impedance mismatch that increases the transfer of load forces to the wound healing interface and increases herniation risk [34].…”

Section: Discussionmentioning

confidence: 99%

Morphological and mechanical characteristics of the reconstructed rat abdominal wall following use of a wet electrospun biodegradable polyurethane elastomer scaffold

et al. 2010

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Although a variety of materials are currently used for abdominal wall repair, general complications encountered include herniation, infection, and mechanical mismatch with native tissue. An approach wherein a degradable synthetic material is ultimately replaced by tissue mechanically approximating the native state could obviate these complications. We report here on the generation of biodegradable scaffolds for abdominal wall replacement using a wet electrospinning technique in which fibers of a biodegradable elastomer, poly(ester urethane)urea (PEUU), were concurrently deposited with electrosprayed serum-based culture medium. Wet electrospun PEUU (wet ePEUU) was found to exhibit markedly different mechanical behavior and to possess an altered microstructure relative to dry processed ePEUU. In a rat model for abdominal wall replacement, wet ePEUU scaffolds (1 × 2.5 cm) provided a healing result that developed toward approximating physiologic mechanical behavior at 8 wks. An extensive cellular infiltrate possessing contractile smooth muscle markers was observed together with extensive extracellular matrix (collagens, elastin) elaboration. Control implants of dry ePEUU and expanded polytetrafluoroethylene did not experience substantial cellular infiltration and did not take on the native mechanical anisotropy of the rat abdominal wall. These results illustrate the markedly different in vivo behavior observed with this newly reported wet electrospinning process, offering a potentially useful refinement of an increasingly common biomaterial processing technique.

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“…15,16 Acute hernia models do not capture the biology of chronic hernia wounds, which result in an increased hernia recurrence rate. 14 Small-animal hernia models, such as the one used by DuBay et al, 12–14 provide an opportunity to understand the biology of hernia repair; however, they fall short in addressing the loading characteristics of the human abdominal wall. Furthermore, young and healthy rats used for research purposes may obscure the true effectiveness of any repair due to their robust innate repair mechanisms.…”

Section: Introductionmentioning

confidence: 99%

Porcine incisional hernia model: Evaluation of biologically derived intact extracellular matrix repairs

Monteiro¹,

Delossantos²,

Rodriguez³

et al. 2013

J Tissue Eng

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We compared fascial wounds repaired with non-cross-linked intact porcine-derived acellular dermal matrix versus primary closure in a large-animal hernia model. Incisional hernias were created in Yucatan pigs and repaired after 3 weeks via open technique with suture-only primary closure or intraperitoneally placed porcine-derived acellular dermal matrix. Progressive changes in mechanical and biological properties of porcine-derived acellular dermal matrix and repair sites were assessed. Porcine-derived acellular dermal matrix–repaired hernias of additional animals were evaluated 2 and 4 weeks post incision to assess porcine-derived acellular dermal matrix regenerative potential and biomechanical changes. Hernias repaired with primary closure showed substantially more scarring and bone hyperplasia along the incision line. Mechanical remodeling of porcine-derived acellular dermal matrix was noted over time. Porcine-derived acellular dermal matrix elastic modulus and ultimate tensile stress were similar to fascia at 6 weeks. The biology of porcine-derived acellular dermal matrix–reinforced animals was more similar to native abdominal wall versus that with primary closure. In this study, porcine-derived acellular dermal matrix–reinforced repairs provided more complete wound healing response compared with primary closure.

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Mesh incisional herniorrhaphy increases abdominal wall elastic properties: A mechanism for decreased hernia recurrences in comparison with suture repair

Cited by 45 publications

References 21 publications

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

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

Morphological and mechanical characteristics of the reconstructed rat abdominal wall following use of a wet electrospun biodegradable polyurethane elastomer scaffold

Porcine incisional hernia model: Evaluation of biologically derived intact extracellular matrix repairs

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