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Publisher DOI: 10.3389/fsurg.2021.764470
Title: Primary and recurrent repair of incisional hernia based on biomechanical considerations to avoid mesh-related complications
Language: English
Authors: Nessel, Regine 
Löffler, Thorsten 
Rinn, Johannes 
Lösel, Philipp 
Voß, Samuel 
Heuveline, Vincent 
Vollmer, Matthias 
Görich, Johannes 
Ludwig, Yannique 
Al-Hileh, Luai 
Kallinowski, Friedrich 
Keywords: bench test;computerized tomography;CRIP;GRIP;hernia repair;hernia repair mesh;incisional hernia
Issue Date: 15-Dec-2021
Publisher: Frontiers Media
Source: Frontiers in Surgery 8 : 764470 (2021-12-15)
Journal: Frontiers in Surgery 
Abstract (english): 
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.
DOI: 10.15480/882.4088
ISSN: 2296-875X
Institute: Biomechanik M-3 
Document Type: Article
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.
License: CC BY 4.0 (Attribution) CC BY 4.0 (Attribution)
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