Background
Incisional hernia repair is one of the most common surgical complications. Despite
the introduction of mesh techniques of repair, recurrences are still prevalent. The
aim of the current study was to evaluate the dependence of mesh dislocation on defect
size, facial overlap, mesh-position, and orientation of the mesh in cases of anisotropic
stretchability.
Methods
An in vitro incisional hernia model was used, which consisted of a pressure chamber,
an elastic silicone pad representing the peritoneal sac, and a silicone mat with bovine
muscle tissue representing the abdominal wall. Intrinsic pressure (up to 200 mm Hg)
was generated within the pressure chamber by continuous inflation with CO2. A slit-like or flap-like defect was created in the silicone mat to simulate small
or large hernia defects, respectively. The implanted mesh was arranged in both onlay
and sublay configurations. A large pore polypropylene mesh with significant anisotropic
stretchability was investigated, whereas overlaps of 2, 3, and 4 cm were applied.
Results
Despite the application of pressures up to 200 mm Hg, no mesh ruptures occurred. In
the slit-like defect model, the minimal overlap required to prevent dislocation at
200 mm Hg was 3 cm using the sublay technique provided that the mesh was positioned
with its most stretchable axis parallel to the largest slit dehiscence. Perpendicular
rotation of the mesh resulted in dislocation at 160 mm Hg, despite using an overlap
of 3 cm. Mesh reinforcement showed less stability in both the onlay position and the
flap-like defect.
Conclusion
An overlap of 3 cm is sufficient to prevent early mesh dislocation. Meshes with anisotropic
stretchability should be orientated with the most stretchable axis in the direction
of least overlap.
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Article info
Publication history
Accepted:
April 9,
2007
Identification
Copyright
© 2007 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
