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Modifying hernia mesh design to improve device mechanical performance and promote tension-free repair.

Publication ,  Journal Article
Ibrahim, MM; Poveromo, LP; Glisson, RR; Cornejo, A; Farjat, AE; Gall, K; Levinson, H
Published in: J Biomech
April 11, 2018

PURPOSE: Approximately 348,000 ventral hernia repairs are performed annually in the United States and the incisional hernia recurrence rate is approximately 20% as a result of suture and mesh device failure. Device failure is related to changes at the suture/tissue interface that leads to acute or chronic suture pull-through and surgical failure. To better manage mechanical tension, we propose a modified mesh design with extensions and demonstrate its mechanical superiority. METHODS: Comparative uniaxial static tensile testing was conducted on polypropylene suture and a modified mesh. Subsequently, a standard of care (SOC) mesh and modified mesh were evaluated using a tensometer in an acute hernia bench-top model. RESULTS: Modified mesh breaking strength, extension knot breaking strength, extension disruption, and extension anchoring were superior to suture (p < .05). Modified mesh ultimate tensile strength of anchoring was superior to SOC mesh (p < .05). Various stitch patterns and modifications in device design significantly improved device tension-free performance far beyond clinically relevant benchmarks (p < .05). CONCLUSIONS: Testing demonstrates that the modified mesh outperforms SOC mesh and suture in all tested failure modes. SOC hernia mesh tears through tissue at stress levels below maximum physiologic stress, whereas, the modified hernia mesh is up to 200% stronger than SOC mesh at resisting suture tearing through tissue and maintains anchoring at stresses far beyond clinically relevant benchmarks. Modifying hernia mesh design significantly improves device mechanical performance and enhances tension-free repair.

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Published In

J Biomech

DOI

EISSN

1873-2380

Publication Date

April 11, 2018

Volume

71

Start / End Page

43 / 51

Location

United States

Related Subject Headings

  • Tensile Strength
  • Swine
  • Sutures
  • Suture Techniques
  • Surgical Mesh
  • Recurrence
  • Prostheses and Implants
  • Polypropylenes
  • Humans
  • Herniorrhaphy
 

Citation

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Chicago
ICMJE
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Ibrahim, M. M., Poveromo, L. P., Glisson, R. R., Cornejo, A., Farjat, A. E., Gall, K., & Levinson, H. (2018). Modifying hernia mesh design to improve device mechanical performance and promote tension-free repair. J Biomech, 71, 43–51. https://doi.org/10.1016/j.jbiomech.2018.01.022
Ibrahim, Mohamed M., Luke P. Poveromo, Richard R. Glisson, Agustin Cornejo, Alfredo E. Farjat, Ken Gall, and Howard Levinson. “Modifying hernia mesh design to improve device mechanical performance and promote tension-free repair.J Biomech 71 (April 11, 2018): 43–51. https://doi.org/10.1016/j.jbiomech.2018.01.022.
Ibrahim MM, Poveromo LP, Glisson RR, Cornejo A, Farjat AE, Gall K, et al. Modifying hernia mesh design to improve device mechanical performance and promote tension-free repair. J Biomech. 2018 Apr 11;71:43–51.
Ibrahim, Mohamed M., et al. “Modifying hernia mesh design to improve device mechanical performance and promote tension-free repair.J Biomech, vol. 71, Apr. 2018, pp. 43–51. Pubmed, doi:10.1016/j.jbiomech.2018.01.022.
Ibrahim MM, Poveromo LP, Glisson RR, Cornejo A, Farjat AE, Gall K, Levinson H. Modifying hernia mesh design to improve device mechanical performance and promote tension-free repair. J Biomech. 2018 Apr 11;71:43–51.
Journal cover image

Published In

J Biomech

DOI

EISSN

1873-2380

Publication Date

April 11, 2018

Volume

71

Start / End Page

43 / 51

Location

United States

Related Subject Headings

  • Tensile Strength
  • Swine
  • Sutures
  • Suture Techniques
  • Surgical Mesh
  • Recurrence
  • Prostheses and Implants
  • Polypropylenes
  • Humans
  • Herniorrhaphy