Covidien-Surgical Solutions, Research and Development, 116 Avenue du Formans, 01600, Trévoux, France,
Hernia. 2013 Oct;17(5):647-55. doi: 10.1007/s10029-013-1050-6. Epub 2013 Mar 2.
Ventral hernia repairs (VHRs) still exhibit clinical complications in terms of recurrence, pain, and discomfort. Factors such as surgical technique or mesh features are thought to be highly influent. The aim was to evaluate the impact of the defect size, the mesh overlap and the fixation depth on VHR using both physical and numerical models.
The physical model was developed to mimic a passive abdominal wall. Healthy, damaged, and repaired configurations were evaluated using a spherical plunger. The associated numerical (Finite Elements) model was first loaded by a plunger for validation. A parametric study was then conducted with the numerical model loaded by a uniform pressure. Two defect sizes (3.5 × 5 cm and 8.25 × 12 cm elliptic shape), two overlaps (2 and 5 cm), and two fixation depths (peritoneum or muscle) were investigated for both passive and active abdominal walls.
With the physical model, the repaired configuration was 22 % stiffer than the damaged configuration. The statistical analysis of the parametric study showed that the defect size was the most influential parameter regarding the stress in the mesh, the bulging and the pull-out force at the fixation points. The overlap was influential in terms of stress in the mesh. The fixation depth was not influential. These trends increased with the abdominal wall activity.
Increase of the defect size and decrease of the overlap affected significantly the VHR mechanical performances. Such numerical models could help to better understand the behavior of the repaired abdominal wall and finally to reduce the clinical complications.
尽管在复发、疼痛和不适等方面，腹疝修复（VHR）已取得临床进展，但仍存在临床并发症。人们认为手术技术或网片特性等因素具有重要影响。本研究旨在通过物理模型和数值模型评估缺损大小、网片重叠和固定深度对 VHR 的影响。
物理模型用于模拟被动腹壁。通过球形柱塞评估健康、受损和修复配置。相关的数值（有限元）模型首先通过柱塞加载进行验证。然后，通过数值模型对均匀压力进行参数研究。对两种缺陷大小（3.5×5cm 和 8.25×12cm 椭圆形）、两种重叠（2cm 和 5cm）和两种固定深度（腹膜或肌肉）进行了被动和主动腹壁的研究。
在物理模型中，修复后的配置比受损配置硬 22%。参数研究的统计分析表明，在网片的应力、隆起和固定点的拔出力方面，缺陷大小是最具影响力的参数。重叠在网片的应力方面具有影响力。固定深度没有影响。这些趋势随着腹壁活动的增加而增加。
缺陷大小的增加和重叠的减少显著影响 VHR 的力学性能。这种数值模型可以帮助更好地理解修复后腹壁的行为，并最终减少临床并发症。
