Department of General, Endocrine Surgery and Transplantation, Medical University of Gdansk, ul. Dębinki 7, 80-211, Gdańsk, Poland.
Surg Endosc. 2012 May;26(5):1461-7. doi: 10.1007/s00464-011-2056-8. Epub 2011 Dec 15.
Intraabdominal pressure often is blamed as the cause of mesh-fascia junction failure after laparoscopic ventral hernia repair. Stretching of the mesh during a cough or defecation may lead to recurrence. Little is known about the movements of mesh in the abdominal cavity after this operation. This study investigated the front abdominal wall to describe its elasticity in vivo and searched for elongations that possibly stretched an implanted mesh, thereby causing fixation failure and subsequent recurrence.
To measure front abdominal wall elongations, a model of fascia movements was created. Eight healthy volunteers were measured during exercise to determine the extent of elongations in their front abdominal wall. Videos were analyzed in three positions to create a mathematical shell structure. A computerized model based on the net movement of nodes was calculated to determine the axes and values for maximum elongations.
The largest average elongations were measured for the upper midline (32.08%) and the transverse line in the low lateral area (34.06%). The maximum values for these lines were larger than 100% for the middle line (133.78%) and exceeded 50% for the entire middle line. The values for the horizontal lines did not reach 10% at any level. According to these data, areas of both high and low elasticity were defined.
The presented experiment adds new parameters to the understanding of in vivo mesh behavior. Elongation of the front abdominal wall may stretch implanted mesh and could be a cause of recurrence in cases of insufficient fixation.
腹腔镜腹疝修补术后，常将腹内压归咎为网片-筋膜交界处失败的原因。咳嗽或排便时网片的拉伸可能导致复发。术后腹腔内网片的运动知之甚少。本研究调查了前腹壁，以描述其体内弹性，并寻找可能拉伸植入网片的伸长，从而导致固定失败和随后的复发。
为了测量前腹壁的伸长，创建了一个筋膜运动模型。对 8 名健康志愿者进行运动测量，以确定其前腹壁的伸长程度。对视频进行了 3 个位置的分析，以创建数学壳结构。基于节点的净运动计算了一个计算机模型，以确定最大伸长的轴和值。
上中线（32.08%）和低侧区的横向线（34.06%）测量到的平均伸长最大。这些线的最大伸长值超过中线的 100%（133.78%），超过中线的 50%。水平线上的任何位置的数值都没有达到 10%。根据这些数据，定义了高弹性和低弹性的区域。
本实验为体内网片行为的理解增加了新的参数。前腹壁的伸长可能会拉伸植入的网片，并且可能是固定不充分导致复发的原因。
