Department of Surgery, Letterkenny University Hospital, Letterkenny, Ireland.
Donegal Clinical Research Academy, Letterkenny University Hospital, Letterkenny, Ireland.
Br J Surg. 2023 Apr 12;110(5):568-575. doi: 10.1093/bjs/znad062.
Incisional hernias occur after up to 40 per cent of laparotomies. Recent RCTs have demonstrated the role of prophylactic mesh placement in reducing the risk of developing an incisional hernia. An onlay approach is relatively straightforward; however, a variety of techniques have been described for mesh fixation. The biomechanical properties have not been interrogated extensively to date.
This ex vivo randomized controlled trial using porcine abdominal wall investigated the biomechanical properties of three techniques for prophylactic onlay mesh placement at laparotomy closure. A classical onlay, anchoring onlay, and novel bifid onlay approach were compared with small-bite primary closure. A biomechanical abdominal wall model and ball burst test were used to assess transverse stretch, bursting force, and loading characteristics.
Mesh placement took an additional 7-15 min compared with standard primary closure. All techniques performed similarly, with no clearly superior approach. The minimum burst force was 493 N, and the maximum 1053 N. The classical approach had the highest mean burst force (mean(s.d.) 853(152) N). Failure patterns fell into either suture-line or tissue failures. Classical and anchoring techniques provided a second line of defence in the event of primary suture failure, whereas the bifid method demonstrated a more compliant loading curve. All mesh approaches held up at extreme quasistatic loads.
Subtle differences in biomechanical properties highlight the strengths of each closure type and suggest possible uses. The failure mechanisms seen here support the known hypotheses for early fascial dehiscence. The influence of dynamic loading needs to be investigated further in future studies.
切口疝在多达 40%的剖腹手术后发生。最近的 RCT 已经证明了预防性放置补片在降低切口疝发展风险方面的作用。覆盖法相对简单；然而，已经描述了多种用于固定补片的技术。迄今为止，尚未广泛研究其生物力学特性。
本研究使用猪的腹壁进行了一项离体随机对照试验，以研究三种预防性覆盖式补片放置技术在剖腹术关闭时的生物力学特性。将经典覆盖式、锚固覆盖式和新型分叉覆盖式与小切口一期缝合进行比较。使用生物力学腹壁模型和球爆裂试验来评估横向拉伸、爆裂力和加载特性。
与标准一期缝合相比，补片放置额外需要 7-15 分钟。所有技术的表现相似，没有明显更优的方法。最小爆裂力为 493N，最大为 1053N。经典方法的平均爆裂力最高（平均(s.d.) 853(152)N）。失效模式要么是缝线线要么是组织失效。经典和锚固技术在缝线最初失效的情况下提供了第二道防线，而分叉方法则表现出更符合的加载曲线。所有的补片方法都能承受极端准静态负载。
生物力学特性的细微差异突出了每种闭合类型的优势，并提出了可能的用途。这里观察到的失效机制支持早期筋膜裂开的已知假设。在未来的研究中需要进一步研究动态加载的影响。
