General, Visceral and Pediatric Surgery, Klinikum Am Gesundbrunnen, Am Gesundbrunnen 20‑26, 74078, Heilbronn, Germany.
General and Visceral Surgery, GRN Hospital Eberbach, Scheuerbergstrasse 3, 69412, Eberbach, Germany.
Hernia. 2024 Jun;28(3):913-924. doi: 10.1007/s10029-024-03064-2. Epub 2024 May 18.
We studied the effectiveness of biomechanically calculated abdominal wall reconstructions for incisional hernias of varying complexity in an open, prospective observational registry trial.
From July 1st, 2017 to December 31st, 2020, four hospitals affiliated with the University of Heidelberg recruited 198 patients with complex incisional hernias. Hernias were repaired using biomechanically calculated reconstructions and materials classified on their gripping force towards cyclic load. This approach determines the required strength preoperatively based on the hernia size, using the Critical Resistance to Impacts related to Pressure. The surgeon is supported in reliably determining the Gained Resistance, which is based on the mesh-defect-area-ratio, as well as other mesh and suture factors, and the tissue stability. Tissue stability is defined as a maximum distension of 1.5 cm upon a Valsalva maneuver. In complex cases, a CT scan of the abdomen can be used to assess unstable tissue areas both at rest and during Valsalva's maneuver.
Larger and stronger gripping meshes were required for more complex cases to achieve a durable repair, especially for larger hernia sizes. To achieve durable repairs, the number of fixation points increased while the mesh-defect area ratio decreased. Performing these repairs required more operating room time. The complication rate remained low. Less than 1% of recurrences and low pain levels were observed after 3 years.
Biomechanical stability, defined as the resistance to cyclic load, is crucial in preventing postoperative complications, including recurrences and chronic pain.
我们研究了在一项开放性、前瞻性观察性注册试验中，针对不同复杂性的切口疝，通过生物力学计算的腹壁重建的有效性。
从 2017 年 7 月 1 日至 2020 年 12 月 31 日，海德堡大学附属医院的四家医院共招募了 198 例复杂切口疝患者。使用生物力学计算的重建和根据其对循环负荷的夹持力分类的材料来修复疝。这种方法基于疝的大小，使用与压力相关的临界冲击阻力（Critical Resistance to Impacts related to Pressure），在术前确定所需的强度。外科医生可以使用网格缺陷面积比（mesh-defect-area-ratio）以及其他网格和缝线因素和组织稳定性，可靠地确定增益阻力（Gained Resistance）。组织稳定性定义为在瓦氏动作（Valsalva maneuver）时最大扩张度为 1.5 厘米。在复杂情况下，可以使用腹部 CT 扫描来评估静息和瓦氏动作时不稳定的组织区域。
对于更复杂的病例，需要更大和更强夹持力的网格来实现持久修复，特别是对于更大的疝大小。为了实现持久修复，固定点数增加，而网格缺陷面积比降低。进行这些修复需要更多的手术室时间。并发症发生率仍然较低。在 3 年后，复发率低于 1%，疼痛水平较低。
生物力学稳定性，定义为对循环负荷的抵抗力，对于预防术后并发症（包括复发和慢性疼痛）至关重要。
