Pereira Xavier, De Oliveira Pedro, Tagerman Daniel, Romero-Velez Gustavo, Liu Rockson, Malcher Flavio
Department of Surgery, NYU Langone Medical Center, 550 First Ave, HCC 12th Floor, New York, NY, 10016, USA.
Department of Physics, Harvard University, Boston, MA, USA.
Hernia. 2024 Dec 26;29(1):55. doi: 10.1007/s10029-024-03230-6.
Closure of large hernia defects with minimally invasive surgery has long-been a challenge. Barbed sutures have helped us bridge this technical gap, but their off-label use is not well studied.
We describe a suturing technique for minimally invasive ventral hernia repair (MIS-VHR) termed "progressive defect tensioning" and explore its theoretical advantages. Progressive defect tensioning utilizes barbed sutures to progressively and evenly re-approximate the fascia along the entire defect length. Tension is then sequentially applied to each throw, distributing the load across multiple anchor points along the closure. This redistribution of tension is explained using a physics model to depict its theoretical benefit. We also explore how biomechanical properties, such as tissue creep and hysteresis, impact closure of complex defects.
Our initial, proof-of-concept cohort of 12 patients with hernias larger than 10 cm undergoing MIS-VHR had acceptable perioperative outcomes compared to the literature.
Ultimately, progressive defect tensioning leverages the properties of barbed sutures and the biomechanics of fascia to achieve optimal tension distribution during MIS-VHR.
使用微创手术闭合大型疝缺损长期以来一直是一项挑战。倒刺缝线帮助我们弥补了这一技术差距，但其超说明书使用情况尚未得到充分研究。
我们描述了一种用于微创腹疝修补术（MIS-VHR）的缝合技术，称为“渐进性缺损张紧”，并探讨其理论优势。渐进性缺损张紧利用倒刺缝线沿着整个缺损长度逐步且均匀地重新对合筋膜。然后依次对每个缝线节段施加张力，将负荷分布在闭合过程中的多个锚定部位。使用一个物理模型来解释这种张力的重新分布，以描述其理论益处。我们还探讨了生物力学特性，如组织蠕变和滞后现象，如何影响复杂缺损的闭合。
与文献相比，我们最初的12例疝大于10厘米且接受MIS-VHR的概念验证队列患者的围手术期结果是可接受的。
最终，渐进性缺损张紧利用倒刺缝线的特性和筋膜的生物力学原理，在MIS-VHR过程中实现最佳的张力分布。
