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The Grip Concept of Incisional Hernia Repair—Dynamic Bench Test, CT Abdomen With Valsalva and 1-Year Clinical Results
Incisional hernia is a frequent consequence of major surgery. Most repairs augment the abdominal wall with artificial meshes fixed to the tissues with sutures, tacks, or glue. Pain and recurrences plague at least 10–20% of the patients after repair of the abdominal defect. How should a repair of inc...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8080034/ https://www.ncbi.nlm.nih.gov/pubmed/33937312 http://dx.doi.org/10.3389/fsurg.2021.602181 |
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author | Kallinowski, Friedrich Gutjahr, Dominik Harder, Felix Sabagh, Mohammad Ludwig, Yannique Lozanovski, Vladimir J. Löffler, Thorsten Rinn, Johannes Görich, Johannes Grimm, Annette Vollmer, Matthias Nessel, Regine |
author_facet | Kallinowski, Friedrich Gutjahr, Dominik Harder, Felix Sabagh, Mohammad Ludwig, Yannique Lozanovski, Vladimir J. Löffler, Thorsten Rinn, Johannes Görich, Johannes Grimm, Annette Vollmer, Matthias Nessel, Regine |
author_sort | Kallinowski, Friedrich |
collection | PubMed |
description | Incisional hernia is a frequent consequence of major surgery. Most repairs augment the abdominal wall with artificial meshes fixed to the tissues with sutures, tacks, or glue. Pain and recurrences plague at least 10–20% of the patients after repair of the abdominal defect. How should a repair of incisional hernias be constructed to achieve durability? Incisional hernia repair can be regarded as a compound technique. The biomechanical properties of a compound made of tissue, textile, and linking materials vary to a large extent. Tissues differ in age, exercise levels, and comorbidities. Textiles are currently optimized for tensile strength, but frequently fail to provide tackiness, dynamic stiction, and strain resistance to pulse impacts. Linking strength with and without fixation devices depends on the retention forces between surfaces to sustain stiction under dynamic load. Impacts such a coughing or sharp bending can easily overburden clinically applied composite structures and can lead to a breakdown of incisional hernia repair. Our group developed a bench test with tissues, fixation, and textiles using dynamic intermittent strain (DIS), which resembles coughing. Tissue elasticity, the size of the hernia under pressure, and the area of instability of the abdominal wall of the individual patient was assessed with low-dose computed tomography of the abdomen preoperatively. A surgical concept was developed based on biomechanical considerations. Observations in a clinical registry based on consecutive patients from four hospitals demonstrate low failure rates and low pain levels after 1 year. Here, results from the bench test, the application of CT abdomen with Valsalva's maneuver, considerations of the surgical concept, and the clinical application of our approach are outlined. |
format | Online Article Text |
id | pubmed-8080034 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-80800342021-04-29 The Grip Concept of Incisional Hernia Repair—Dynamic Bench Test, CT Abdomen With Valsalva and 1-Year Clinical Results Kallinowski, Friedrich Gutjahr, Dominik Harder, Felix Sabagh, Mohammad Ludwig, Yannique Lozanovski, Vladimir J. Löffler, Thorsten Rinn, Johannes Görich, Johannes Grimm, Annette Vollmer, Matthias Nessel, Regine Front Surg Surgery Incisional hernia is a frequent consequence of major surgery. Most repairs augment the abdominal wall with artificial meshes fixed to the tissues with sutures, tacks, or glue. Pain and recurrences plague at least 10–20% of the patients after repair of the abdominal defect. How should a repair of incisional hernias be constructed to achieve durability? Incisional hernia repair can be regarded as a compound technique. The biomechanical properties of a compound made of tissue, textile, and linking materials vary to a large extent. Tissues differ in age, exercise levels, and comorbidities. Textiles are currently optimized for tensile strength, but frequently fail to provide tackiness, dynamic stiction, and strain resistance to pulse impacts. Linking strength with and without fixation devices depends on the retention forces between surfaces to sustain stiction under dynamic load. Impacts such a coughing or sharp bending can easily overburden clinically applied composite structures and can lead to a breakdown of incisional hernia repair. Our group developed a bench test with tissues, fixation, and textiles using dynamic intermittent strain (DIS), which resembles coughing. Tissue elasticity, the size of the hernia under pressure, and the area of instability of the abdominal wall of the individual patient was assessed with low-dose computed tomography of the abdomen preoperatively. A surgical concept was developed based on biomechanical considerations. Observations in a clinical registry based on consecutive patients from four hospitals demonstrate low failure rates and low pain levels after 1 year. Here, results from the bench test, the application of CT abdomen with Valsalva's maneuver, considerations of the surgical concept, and the clinical application of our approach are outlined. Frontiers Media S.A. 2021-04-14 /pmc/articles/PMC8080034/ /pubmed/33937312 http://dx.doi.org/10.3389/fsurg.2021.602181 Text en Copyright © 2021 Kallinowski, Gutjahr, Harder, Sabagh, Ludwig, Lozanovski, Löffler, Rinn, Görich, Grimm, Vollmer and Nessel. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Surgery Kallinowski, Friedrich Gutjahr, Dominik Harder, Felix Sabagh, Mohammad Ludwig, Yannique Lozanovski, Vladimir J. Löffler, Thorsten Rinn, Johannes Görich, Johannes Grimm, Annette Vollmer, Matthias Nessel, Regine The Grip Concept of Incisional Hernia Repair—Dynamic Bench Test, CT Abdomen With Valsalva and 1-Year Clinical Results |
title | The Grip Concept of Incisional Hernia Repair—Dynamic Bench Test, CT Abdomen With Valsalva and 1-Year Clinical Results |
title_full | The Grip Concept of Incisional Hernia Repair—Dynamic Bench Test, CT Abdomen With Valsalva and 1-Year Clinical Results |
title_fullStr | The Grip Concept of Incisional Hernia Repair—Dynamic Bench Test, CT Abdomen With Valsalva and 1-Year Clinical Results |
title_full_unstemmed | The Grip Concept of Incisional Hernia Repair—Dynamic Bench Test, CT Abdomen With Valsalva and 1-Year Clinical Results |
title_short | The Grip Concept of Incisional Hernia Repair—Dynamic Bench Test, CT Abdomen With Valsalva and 1-Year Clinical Results |
title_sort | grip concept of incisional hernia repair—dynamic bench test, ct abdomen with valsalva and 1-year clinical results |
topic | Surgery |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8080034/ https://www.ncbi.nlm.nih.gov/pubmed/33937312 http://dx.doi.org/10.3389/fsurg.2021.602181 |
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