Bridging with reduced overlap: fixation and peritoneal grip can prevent slippage of DIS class A meshes
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Ventral hernia repair can be performed safely using meshes which are primarily stable upon dynamic intermittent straining (DIS) at recommended overlap. In specific clinical situations, e.g., at bony edges, bridging of the hernial orifice with reduced overlap might be necessary. To gain insight into the durability of various applications, two different meshes with the best tissue grip known so far were assessed.
The model uses dynamic intermittent strain and comprises the repetition of submaximal impacts delivered via a hydraulically driven plastic containment. Pig tissue simulates a ventral hernia with a standardized 5 cm defect. Commercially available meshes classified as primarily stable at recommended overlap were used to bridge this defect at recommended and reduced overlap.
Using Parietex Progrip®, the peritoneum adds sufficient stability at least to a 2.5 cm overlap. Using Dynamesh Cicat®, four gluing spots with Glubran® are sufficient to stabilize a 3.75 cm overlap. A 2.5 cm overlap is stabilized with eight bonding spots Glubran® and 8 bonding spots combined with four sutures stabilize a 1.25 cm overlap. Here again, an intact peritoneum stabilizes the reconstruction significantly.
Based on a pig tissue model, a total of 23 different conditions were tested. A DIS class A mesh can be easily stabilized bridging a 5 cm hernial orifice with reduced overlap. Caution must be exerted to extend these results to other DIS classes and larger hernial orifices. Further DIS investigations can improve the durability of hernia repair.
KeywordsVentral hernia repair Dynamic intermittent strain Bridging Overlap Fixation
The project was funded by the institutional support of ASKLEPIOS Proresearch project number 2805, clinical research and development, Lohmühlenstraße 5, 20099 Hamburg, Germany. Further institutional support was granted by Heidelberger Stiftung Chirurgie, project number D.10052599, Chirurgische Universitätsklinik Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany. In addition, financial support was supplied by Covidien contracted as project number SS3438 with ASKLEPIOS Proresearch. Materials were supplied in part by Dahlhausen and Covidien. We thank Angela Assing for supporting the data acquisition. We thank Mia Stine Matzkow for review of the language used.
Compliance with ethical standards
Conflict of interest
FK reports grants from Covidien and non-financial support from Dahlhausen, during the conduct of the study. AM reports grants from Covidien and non-financial support from Dahlhausen during the conduct of the study. FK and AM declare conflicts of interest not directly related to the submitted work. FH, TGS, MV declare no conflict of interests
All applicable international, national, and/ or institutional guidelines for the care and use of animals were followed.
Statement of human and animal rights
I hereby undersign and certificate that the procedures and the experiments I have conducted respect the ethical standards in the Helsinki Declaration of 1975, as revised in 2000, as well as the national law. Experiments with laboratory animals were not conducted.
Informed consent was obtained from all individual participants included in the study.
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