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  4. Primary and recurrent repair of incisional hernia based on biomechanical considerations to avoid mesh-related complications
 
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Primary and recurrent repair of incisional hernia based on biomechanical considerations to avoid mesh-related complications

Citation Link: https://doi.org/10.15480/882.4088
Publikationstyp
Journal Article
Date Issued
2021-12-15
Sprache
English
Author(s)
Nessel, Regine  
Löffler, Thorsten  
Rinn, Johannes  
Lösel, Philipp  
Voß, Samuel  
Heuveline, Vincent  
Vollmer, Matthias  
Görich, Johannes  
Ludwig, Yannique  
Al-Hileh, Luai  
Kallinowski, Friedrich  
Institut
Biomechanik M-3  
TORE-DOI
10.15480/882.4088
TORE-URI
http://hdl.handle.net/11420/11449
Journal
Frontiers in Surgery  
Volume
8
Article Number
764470
Citation
Frontiers in Surgery 8 : 764470 (2021-12-15)
Publisher DOI
10.3389/fsurg.2021.764470
Scopus ID
2-s2.0-85121978932
Publisher
Frontiers Media
Aim: Mechanical principles successfully guide the construction of polymer material composites in engineering. Since the abdominal wall is a polymer composite augmented with a textile during incisional hernia repair we ask: can incisional hernia be repaired safely and durably based on biomechanical principles? Material and Methods: Repair materials were assessed on a self-built bench test using pulse loads to elude influences on the reconstruction of the abdominal wall. Tissue elasticity was analyzed preoperatively as needed with computed tomography at rest and during Valsalva's maneuver. Preoperatively, the critical retention force of the reconstruction to pulse loads was calculated and a biomechanically durable repair was designed based on the needs of the individual patient. Intraoperatively, the design was adjusted as needed. Hernia meshes with high grip factors (Progrip®, Dahlhausen® Cicat) were used for the repairs. Mesh sizes, fixation elements and reconstructive details were oriented on the biomechanical design. All patients recieved single-shot antibiosis. Patients were discharged after full ambulation was achieved. Results: A total of 163 patients (82 males and 81 females) were treated for incisional hernia in four hospitals by ten surgeons. Primary hernia was repaired in 119 patients. Recurrent hernia was operated on in 44 cases. Recurrent hernia was significantly larger (median 161 cm2 vs. 78 cm2; u-test: p = 0.00714). Re-do surgery took significantly longer (median 229 min vs. 150 min; p < 0.00001) since recurrent disease required more often transversus abdominis release (70% vs. 47%). GRIP tended to be higher in recurrent repair (p = 0.01828). Complication rates (15%) and hospital stay were the same (6 vs. 6 days; p = 0.28462). After 1 year, no recurrence was detected in either group. Pain levels were equally low in both primary and recurrent hernia repairs (median NAS = 0 in both groups at rest and under load, p = 0.88866). Conclusion: Incisional hernia can safely and durably be repaired based on biomechanical principles both in primary and recurrent disease. The GRIP concept provides a base for the application of biomechanical principles in incisional hernia repair.
Subjects
bench test
computerized tomography
CRIP
GRIP
hernia repair
hernia repair mesh
incisional hernia
DDC Class
600: Technik
610: Medizin
More Funding Information
This study was supported by Heidelberger Stiftung Chirurgie Grant Nos. 2016/22, 2017/171, 2018/215, 2019/288, 2020/376, and 2021/444.
Publication version
acceptedVersion
Lizenz
https://creativecommons.org/licenses/by/4.0/
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