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Combined in vivo and ex vivo analysis of mesh mechanics in a porcine hernia model

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Abstract

Background

Hernia meshes exhibit variability in mechanical properties, and their mechanical match to tissue has not been comprehensively studied. We used an innovative imaging model of in vivo strain tracking and ex vivo mechanical analysis to assess effects of mesh properties on repaired abdominal walls in a porcine model. We hypothesized that meshes with dissimilar mechanical properties compared to native tissue would alter abdominal wall mechanics more than better-matched meshes.

Methods

Seven mini-pigs underwent ventral hernia creation and subsequent open repair with one of two heavyweight polypropylene meshes. Following mesh implantation with attached radio-opaque beads, fluoroscopic images were taken at insufflation pressures from 5 to 30 mmHg on postoperative days 0, 7, and 28. At 28 days, animals were euthanized and ex vivo mechanical testing performed on full-thickness samples across repaired abdominal walls. Testing was conducted on 13 mini-pig controls, and on meshes separately. Stiffness and anisotropy (the ratio of stiffness in the transverse versus craniocaudal directions) were assessed.

Results

3D reconstructions of repaired abdominal walls showed stretch patterns. As pressure increased, both meshes expanded, with no differences between groups. Over time, meshes contracted 17.65% (Mesh A) and 0.12% (Mesh B; p = 0.06). Mesh mechanics showed that Mesh A deviated from anisotropic native tissue more than Mesh B. Compared to native tissue, Mesh A was stiffer both transversely and craniocaudally. Explanted repaired abdominal walls of both treatment groups were stiffer than native tissue. Repaired tissue became less anisotropic over time, as mesh properties prevailed over native abdominal wall properties.

Conclusions

This technique assessed 3D stretch at the mesh level in vivo in a porcine model. While the abdominal wall expanded, mesh-ingrown areas contracted, potentially indicating stresses at mesh edges. Ex vivo mechanics demonstrate that repaired tissue adopts mesh properties, suggesting that a better-matched mesh could reduce changes to abdominal wall mechanics.

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Acknowledgements

This work was supported by a research Grant from the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES).

Funding

Society of American Gastrointestinal and Endoscopic Surgeons Award Number: 4185-81974, Recipient: L Michael Brunt, MD.

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Authors and Affiliations

  1. Department of Surgery, Washington University in St. Louis School of Medicine, 660 South Euclid Ave, Campus Box 8109, St. Louis, MO, 63110, USA

    Lindsey G. Kahan, Jared M. McAllister, Wen Hui Tan, Jennifer Yu, Dominic Thompson Jr., L. Michael Brunt & Jeffrey A. Blatnik

  2. Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, MO, USA

    Spencer P. Lake

  3. Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA

    Spencer P. Lake

  4. Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA

    Spencer P. Lake

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  1. Lindsey G. Kahan
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  2. Spencer P. Lake
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  4. Wen Hui Tan
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  5. Jennifer Yu
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Corresponding author

Correspondence to Jeffrey A. Blatnik.

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Disclosures

Jeffrey A. Blatnik is a consultant for Bard-Davol, Inc., Medtronic, Inc., Colorado Therapeutics and Intuitive Surgical, Inc. He also receives Grant support from Medtronic, Inc and Colorado Therapeutics. L. Michael Brunt receives research support from Karl Storz Endoscopy and W. L. Gore & Associates, Inc. Spencer P. Lake is a consultant for Covalent Bio, LLC. Lindsey G Kahan, Jared M McAllister, Wen Hui Tan, Jennifer Yu and Dominic Thompson have no conflicts of interest or financial ties to disclose.

Additional information

Presented at the SAGES 2017 Annual Meeting, March 22–25, 2017, Houston, TX.

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Kahan, L.G., Lake, S.P., McAllister, J.M. et al. Combined in vivo and ex vivo analysis of mesh mechanics in a porcine hernia model. Surg Endosc 32, 820–830 (2018). https://doi.org/10.1007/s00464-017-5749-9

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  • DOI: https://doi.org/10.1007/s00464-017-5749-9

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