Development of a dynamic model for ventral hernia mesh repairReport as inadecuate

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Langenbeck-s Archives of Surgery

, Volume 399, Issue 7, pp 857–862

First Online: 21 August 2014Received: 05 December 2013Accepted: 05 August 2014


IntroductionThe adequate way of mesh fixation in laparoscopic ventral hernia repair is still subject to debate. So far, simulation has only been carried out in a static way, thereby omitting dynamic effects of coughing or vomiting. We developed a dynamic model of the anterior abdominal wall.

Materials and methodsAn aluminium cylinder was equipped with a pressure controlled, fluid-filled plastic bag, simulating the abdominal viscera. A computer-controlled system allowed the control of influx and efflux, thus creating pressure peaks of up to 200 mmHg to simulate coughing and 290 mmHg to simulate vomiting. We tested fixation with tacks Absorbatack, Covidien Deutschland, Neustadt a. D., Germany. The model was controlled for the friction coefficient of the tissue against the mesh and the physiologic elasticity of the abdominal wall surrogate.

ResultsThe model was able to create pressure peaks equivalent to physiologic coughs or vomiting. Physiologic elasticity was thereby maintained. We could show that the friction coefficient is crucial to achieve a physiologic situation.

The meshes showed a tendency to dislocate with an increasing number of coughs Fig. 4. Nevertheless, when applied in a plain manner, the meshes withstood more cough cycles than when applied with a bulge as in laparoscopic surgery.

ConclusionsThe dynamic movement of the abdominal wall, the friction between tissue and mesh and the way of mesh application are crucial factors that have to be controlled for in simulation of ventral abdominal hernia closure. We could demonstrate that patient specific factors such as the frequency of coughing as well as the application technique influence the long term stability of the mesh.

KeywordsLaparoscopic ventral hernia repair Dynamic simulation Friction coefficient Mesh fixation M. Siassi and A. Mahn have contributed equally to this paper.

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Author: M. Siassi - A. Mahn - E. Baumann - M. Vollmer - G. Huber - M. Morlock - F. Kallinowski


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