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Three-year follow-up of the grip concept: an open, prospective, observational registry study on biomechanically calculated abdominal wall repair for complex incisional hernias

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Titel: Three-year follow-up of the grip concept: an open, prospective, observational registry study on biomechanically calculated abdominal wall repair for complex incisional hernias
Autoren: R. Nessel, T. Löffler, J. Rinn, F. Kallinowski
Quelle: Hernia
Verlagsinformationen: Springer Science and Business Media LLC, 2024.
Publikationsjahr: 2024
Schlagwörter: Male, 0301 basic medicine, 0303 health sciences, Abdominal Wall, Surgical Mesh, Middle Aged, Abdominal Wall/surgery [MeSH], Female [MeSH], Follow-Up Studies [MeSH], Aged [MeSH], GRIP, Humans [MeSH], Prospective Studies [MeSH], Complex Incisional Hernia, Biomechanical Phenomena [MeSH], Middle Aged [MeSH], Complex incisional hernia, Surgical Mesh [MeSH], Original Article, Male [MeSH], Biomechanically stable incisional hernia repair, CRIP, Incisional Hernia/surgery [MeSH], Computerized tomography with Valsalva maneuver, Herniorrhaphy/methods [MeSH], Abdominal wall reconstruction, Registries [MeSH], Biomechanical Phenomena, 03 medical and health sciences, Humans, Incisional Hernia, Female, Prospective Studies, Registries, Herniorrhaphy, Aged, Follow-Up Studies
Beschreibung: Purpose We studied the effectiveness of biomechanically calculated abdominal wall reconstructions for incisional hernias of varying complexity in an open, prospective observational registry trial. Methods From July 1st, 2017 to December 31st, 2020, four hospitals affiliated with the University of Heidelberg recruited 198 patients with complex incisional hernias. Hernias were repaired using biomechanically calculated reconstructions and materials classified on their gripping force towards cyclic load. This approach determines the required strength preoperatively based on the hernia size, using the Critical Resistance to Impacts related to Pressure. The surgeon is supported in reliably determining the Gained Resistance, which is based on the mesh-defect-area-ratio, as well as other mesh and suture factors, and the tissue stability. Tissue stability is defined as a maximum distension of 1.5 cm upon a Valsalva maneuver. In complex cases, a CT scan of the abdomen can be used to assess unstable tissue areas both at rest and during Valsalva’s maneuver. Results Larger and stronger gripping meshes were required for more complex cases to achieve a durable repair, especially for larger hernia sizes. To achieve durable repairs, the number of fixation points increased while the mesh-defect area ratio decreased. Performing these repairs required more operating room time. The complication rate remained low. Less than 1% of recurrences and low pain levels were observed after 3 years. Conclusions Biomechanical stability, defined as the resistance to cyclic load, is crucial in preventing postoperative complications, including recurrences and chronic pain.
Publikationsart: Article
Other literature type
Sprache: English
ISSN: 1248-9204
DOI: 10.1007/s10029-024-03064-2
Zugangs-URL: https://pubmed.ncbi.nlm.nih.gov/38761301
https://repository.publisso.de/resource/frl:6506178
Rights: CC BY
Dokumentencode: edsair.doi.dedup.....25b50ca291939e2616c1b816bf4919c2
Datenbank: OpenAIRE
Beschreibung
Abstract:Purpose We studied the effectiveness of biomechanically calculated abdominal wall reconstructions for incisional hernias of varying complexity in an open, prospective observational registry trial. Methods From July 1st, 2017 to December 31st, 2020, four hospitals affiliated with the University of Heidelberg recruited 198 patients with complex incisional hernias. Hernias were repaired using biomechanically calculated reconstructions and materials classified on their gripping force towards cyclic load. This approach determines the required strength preoperatively based on the hernia size, using the Critical Resistance to Impacts related to Pressure. The surgeon is supported in reliably determining the Gained Resistance, which is based on the mesh-defect-area-ratio, as well as other mesh and suture factors, and the tissue stability. Tissue stability is defined as a maximum distension of 1.5 cm upon a Valsalva maneuver. In complex cases, a CT scan of the abdomen can be used to assess unstable tissue areas both at rest and during Valsalva’s maneuver. Results Larger and stronger gripping meshes were required for more complex cases to achieve a durable repair, especially for larger hernia sizes. To achieve durable repairs, the number of fixation points increased while the mesh-defect area ratio decreased. Performing these repairs required more operating room time. The complication rate remained low. Less than 1% of recurrences and low pain levels were observed after 3 years. Conclusions Biomechanical stability, defined as the resistance to cyclic load, is crucial in preventing postoperative complications, including recurrences and chronic pain.
ISSN:12489204
DOI:10.1007/s10029-024-03064-2