Static tension measurements of inguinal hernia repair models

Summary

Due to a higher incidence of recurrent hernia after Bassini's herniorrhaphy compared to the laparoscopic mesh implantation technique, one may assume that the former procedure fails to produce sufficient reinforcement of the inguinal region. The aim of our study was to determine the reasons for these results by using static measurements in mathematical models of these different surgical approaches. From a static point of view, based on anatomic findings we calculated the distribution of forces after laparoscopic preperitoneal mesh placement with and without a gap, and Bassini's technique. For tension calculations we used a computer-based finite element (FE) static program. 10N were applied on each FE in all models. The most stressed area in the Bassini model is the surrounding tissue located immediately adjacent to the inguinal canal with a 6.7 fold of the applied load. This concentration of stress results from an unequal distribution of force in the Bassini model. The peak stress in the gap mesh model, on the other hand, is 2.1 fold of the applied load in the area surrounding the gap, compared to the mesh model without tension elevation (in any mesh area). The poor stability in the Bassini model may be a reason for the higher recurrence rate of inguinal hernia. From the static point of view we recommend mesh implants for inguinal hernia repair. Preperitoneal placement of a mesh without a gap is the preferable method.