Abstract
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.
Highlights
The occurrence of an incisional hernia indicates the development of a weakness of the sutured abdominal wall caused by mechanical overload, defective wound healing, and/or inadequate scar formation
Patients with an incisional hernia often complain of pain and a gradually increasing hernia size indicating an overstretching of the tissues
Some of the main reasons why incisional hernia recur in such high incidence is the inappropriate selection of the adequate mesh, its size and its fixation according to the size of the hernia
Summary
The occurrence of an incisional hernia indicates the development of a weakness of the sutured abdominal wall caused by mechanical overload, defective wound healing, and/or inadequate scar formation. Patients with an incisional hernia often complain of pain and a gradually increasing hernia size indicating an overstretching of the tissues. The rates of recurrences are still unacceptably high. Some of the main reasons why incisional hernia recur in such high incidence is the inappropriate selection of the adequate mesh, its size and its fixation according to the size of the hernia. Abdominal wall elasticity plays an important role, which is rarely examined preoperatively. Long-lasting repair of incisional hernias be designed? We wanted to gain insight into the potential of cyclic loading and shakedown analysis for incisional hernia repair Long-lasting repair of incisional hernias be designed? We wanted to gain insight into the potential of cyclic loading and shakedown analysis for incisional hernia repair
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