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Zamkowski M, Tomaszewska A, Lubowiecka I, Śmietański M. Biomechanical causes for failure of the Physiomesh/Securestrap system. Sci Rep 2023; 13:17504. [PMID: 37845369 PMCID: PMC10579252 DOI: 10.1038/s41598-023-44940-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 10/13/2023] [Indexed: 10/18/2023] Open
Abstract
This study investigates the mechanical behavior of the Physiomesh/Securestrap system, a hernia repair system used for IPOM procedures associated with high failure rates. The study involved conducting mechanical experiments and numerical simulations to investigate the mechanical behavior of the Physiomesh/Securestrap system under pressure load. Uniaxial tension tests were conducted to determine the elasticity modulus of the Physiomesh in various directions and the strength of the mesh-tissue-staple junction. Ex-vivo experiments on porcine abdominal wall models were performed to observe the system's behavior under simulated intra-abdominal pressure load. Numerical simulations using finite element analysis were employed to support the experimental findings. The results reveal nonlinearity, anisotropy, and non-homogeneity in the mechanical properties of the Physiomesh, with stress concentration observed in the polydioxanone (PDO) stripe. The mesh-tissue junction exhibited inadequate fixation strength, leading to staple pull-out or breakage. The ex-vivo models demonstrated failure under higher pressure loads. Numerical simulations supported these findings, revealing the reaction forces exceeding the experimentally determined strength of the mesh-tissue-staple junction. The implications of this study extend beyond the specific case of the Physiomesh/Securestrap system, providing insights into the mechanics of implant-tissue systems. By considering biomechanical factors, researchers and clinicians can make informed decisions to develop improved implants that mimic the mechanics of a healthy abdominal wall. This knowledge can contribute to better surgical outcomes and reduce complications in abdominal hernia repair and to avoid similar failures in future.
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Affiliation(s)
- Mateusz Zamkowski
- Department of General Surgery and Hernia Center, Swissmed Hospital, Wileńska 44, 80-215, Gdańsk, Poland.
| | - Agnieszka Tomaszewska
- Department of Structural Mechanics, Faculty of Civil and Environmental Engineering, Gdańsk University of Technology, Gdańsk, Poland
| | - Izabela Lubowiecka
- Department of Structural Mechanics, Faculty of Civil and Environmental Engineering, Gdańsk University of Technology, Gdańsk, Poland
| | - Maciej Śmietański
- Department of General Surgery and Hernia Center, Swissmed Hospital, Wileńska 44, 80-215, Gdańsk, Poland
- II Department of Radiology, Medical University of Gdańsk, Gdańsk, Poland
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Is mesh fixation necessary in laparoendoscopic techniques for M3 inguinal defects? An experimental study. Surg Endosc 2023; 37:1781-1788. [PMID: 36229552 DOI: 10.1007/s00464-022-09699-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/29/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Although international guidelines recommend not fixing the mesh in almost all cases of laparoendoscopic repairs, in case of large direct hernias (M3) mesh fixation is recommended to reduce recurrence risk. Despite lack of high-quality evidence, the recommendation was upgraded to strong by expert panel. The authors conducted a research experiment to verify the hypothesis that it is possible to preserve the mesh in the operating field in large direct hernias (M3) without the need to use fixing materials. METHOD The authors conducted an experiment with scientists from Universities of Technology in a model that reflects the conditions in the groin area. By simulating conditions of the highest possible intra-abdominal pressure, they examined the mesh behavior within the groin and its ability to dislocate under the forces generated by this pressure. The experiment involved six spatial implants and one flat macroporous mesh. RESULTS Heavyweight spatial meshes and lightweight spatial-individualized meshes showed no tendency to dislocate or move directly to the orifice, which was considered a rapid hernia recurrence. Lightweight meshes, both spatial and flat, underwent significant migration and shifting toward the hernial orifices. CONCLUSION Based on the results, we believe that mesh fixation is not the only alternative to preventing recurrence in complex defects. Similar effects can be achieved using a larger, more rigid, and anatomically fitted implant. The type of implant (rather than its fixation) seems to be a key factor from the point of view of mechanics and biophysics. Clinical trials confirming the results in vivo will allow to supplement or amend the guidelines for the treatment of large inguinal hernias.
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Zhou H, Shen Y, Zhang Z, Liu X, Zhang J, Chen J. Comparison of outcomes of ventral hernia repair using different meshes: a systematic review and network meta-analysis. Hernia 2022; 26:1561-1571. [PMID: 35925502 DOI: 10.1007/s10029-022-02652-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 07/14/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE We conducted a network meta-analysis to evaluate potential differences in patient outcomes when different meshes, especially biological meshes, were used for ventral hernia repair. METHODS PubMed, Embase, Cochrane Library, and Clinical Trials.gov databases were searched for studies comparing biological meshes with biological or synthetic meshes for ventral hernia repair. The outcomes were hernia recurrence rate, surgical site infection, and seroma. We performed a two-step network meta-analysis to investigate the outcomes of several biological meshes: non-cross-linked human acellular dermal matrix (NCHADM), non-cross-linked porcine ADM (NCPADM), non-cross-linked bovine ADM (NCBADM), cross-linked porcine ADM (CPADM), and porcine small intestinal submucosa (PSIS). RESULTS From 6304 publications, 23 studies involving 2603 patients were finally included. We found no differences between meshes in recurrence at 1-year follow-up and in surgical site infection rate. NCBADM was associated with the lowest recurrence rate and the lowest surgical site infection rate. NCHADM implantation was associated with the lowest rate of seroma. PSIS was associated with a higher risk of seroma than NCHADM (pooled risk ratio 3.89, 95% confidence interval 1.13-13.39) and NCPADM (RR 3.42, 95% CI 1.29-9.06). CONCLUSIONS Our network meta-analysis found no differences in recurrence rate or surgical site infection among different biological meshes. The incidence of postoperative seroma was higher with PSIS than with acellular dermal matrices. We observed large heterogeneity in the studies of ventral hernia repair using biological meshes, and, therefore, well-designed randomized clinical trials are needed.
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Affiliation(s)
- H Zhou
- The Third Clinical Medical School of Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Y Shen
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Z Zhang
- The Third Clinical Medical School of Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - X Liu
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - J Zhang
- Department of General Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China.
| | - J Chen
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China.
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Tomaszewska A, Reznikov D. Combined numerical and experimental approach to determine numerical model of abdominal scaffold. Comput Methods Biomech Biomed Engin 2021; 25:1235-1248. [PMID: 34841994 DOI: 10.1080/10255842.2021.2005788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
A proper junction of the prosthesis and the abdominal wall is important in successful hernia repair. The number of tacks should be balanced to assure appropriate mesh fixation and not to induce post-operative pain. Numerical simulations help to find this balance. The study is aimed at creating a proper numerical model of a knitted surgical mesh subjected to boundary conditions and load occurring in the abdominal cavity. Continuous, anisotropic constitutive relation is considered to reflect the mesh behaviour. Different sets of material law parameters are determined on the basis of different bi-axial tests setups. Force- and displacement-controlled tests with different ratios are considered. Consequently, some numerical model variants are obtained featuring various reaction distributions in the scaffold fixation points. The proper variant is selected based on comparison of the position of maximal reaction force in the numerical model and in the reference physical model of operated hernia. Force-driven tests have shown anisotropic mesh behaviour, while equibiaxial displacement-driven test has demonstrated reduced anisotropic response. Within seven scenarios of constitutive parameters identification (based on single or combined experimental data), the equibiaxial force-controlled test appeared to produce the most relevant model to follow the prosthesis behaviour under pressure. The position of maximal reaction force in such model is similar to obtained in the physical hernia model. The equibiaxial force-driven test provides most suitable data for Gasser-Ogden-Holzapfel constitutive model identification of a considered surgical mesh to be used to model the mesh under pressure.
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Affiliation(s)
- Agnieszka Tomaszewska
- Department of Structural Mechanics, Faculty of Civil and Environmental Engineering, Gdańsk University of Technology, Gdańsk, Poland
| | - Daniil Reznikov
- Department of Structural Mechanics, Faculty of Civil and Environmental Engineering, Gdańsk University of Technology, Gdańsk, Poland
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Hu Q, Zhang R, Zhang H, Yang D, Liu S, Song Z, Gu Y, Ramalingam M. Topological Structure Design and Fabrication of Biocompatible PLA/TPU/ADM Mesh with Appropriate Elasticity for Hernia Repair. Macromol Biosci 2021; 21:e2000423. [PMID: 33870647 DOI: 10.1002/mabi.202000423] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/21/2021] [Indexed: 11/06/2022]
Abstract
The meshes for hernia repair result in many problems that are related to complications including chronic pain and limited movement due to inadequate mechanical strength, non-absorbability, or low elasticity. In this study, degradable polylactic acid (PLA), synthetic thermoplastic polyurethane (TPU), and acellular dermal matrix (ADM) powders are combined to prepare a novel PLA/TPU/ADM mesh with three different topological structures (square, circular, and diamond) by 3D printing. The physicochemical properties and structural characteristics of mesh are studied, the results show that the diamond structure mesh with the pore size of 3 mm has sufficient elasticity and tensile strength, which provides the efficient mechanical strength required for hernia repair (16 N cm-1 ) and the value more than polypropylene(PP) mesh. Besides, in vitro and in vivo experiments demonstrate human umbilical vein endothelial cells could successfully proliferate on the PLA/TPU/ADM mesh whose biocompatibility with the host is shown using a rat model of abdominal wall defect. In conclusion, the results of this study demonstrate that the PLA/TPU/ADM mesh may be considered a good choice for hernia repair as its potential to overcome the elastic and strength challenges associated with a highly flexible abdominal wall, as well as its good biocompatibility.
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Affiliation(s)
- Qingxi Hu
- Rapid Manufacturing Engineering Center, Shanghai University, Shanghai, 200444, China.,Shanghai Key Laboratory of Intelligent Manufacturing and Robotics, Shanghai University, Shanghai, 200072, China
| | - Rennan Zhang
- Rapid Manufacturing Engineering Center, Shanghai University, Shanghai, 200444, China
| | - Haiguang Zhang
- Rapid Manufacturing Engineering Center, Shanghai University, Shanghai, 200444, China.,Shanghai Key Laboratory of Intelligent Manufacturing and Robotics, Shanghai University, Shanghai, 200072, China
| | - Dongchao Yang
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200011, China
| | - Suihong Liu
- Rapid Manufacturing Engineering Center, Shanghai University, Shanghai, 200444, China
| | - Zhicheng Song
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200011, China
| | - Yan Gu
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200011, China
| | - Murugan Ramalingam
- Biomaterials and Organ Engineering Group, Centre for Biomaterials, Cellular and Molecular Theranostics, School of Mechanical Engineering, Vellore Institute of Technology, Vellore, 632014, India
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Liu W, Xie Y, Zheng Y, He W, Qiao K, Meng H. Regulatory science for hernia mesh: Current status and future perspectives. Bioact Mater 2021; 6:420-432. [PMID: 32995670 PMCID: PMC7490592 DOI: 10.1016/j.bioactmat.2020.08.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/16/2020] [Accepted: 08/23/2020] [Indexed: 11/25/2022] Open
Abstract
Regulatory science for medical devices aims to develop new tools, standards and approaches to assess the safety, effectiveness, quality and performance of medical devices. In the field of biomaterials, hernia mesh is a class of implants that have been successfully translated to clinical applications. With a focus on hernia mesh and its regulatory science system, this paper collected and reviewed information on hernia mesh products and biomaterials in both Chinese and American markets. The current development of regulatory science for hernia mesh, including its regulations, standards, guidance documents and classification, and the scientific evaluation of its safety and effectiveness was first reported. Then the research prospect of regulatory science for hernia mesh was discussed. New methods for the preclinical animal study and new tools for the evaluation of the safety and effectiveness of hernia mesh, such as computational modeling, big data platform and evidence-based research, were assessed. By taking the regulatory science of hernia mesh as a case study, this review provided a research basis for developing a regulatory science system of implantable medical devices, furthering the systematic evaluation of the safety and effectiveness of medical devices for better regulatory decision-making. This was the first article reviewing the regulatory science of hernia mesh and biomaterial-based implants. It also proposed and explained the concepts of evidence-based regulatory science and technical review for the first time.
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Affiliation(s)
- Wenbo Liu
- School of Material Science and Engineering, University of Science and Technology Beijing, 30 Xueyuan Road, Haidian District, Beijing, China
- Center for Medical Device Evaluation, National Medical Products Administration, Intellectual Property Publishing House Mansion, Qixiang Road, Haidian District, Beijing, China
| | - Yajie Xie
- School of Material Science and Engineering, University of Science and Technology Beijing, 30 Xueyuan Road, Haidian District, Beijing, China
| | - Yudong Zheng
- School of Material Science and Engineering, University of Science and Technology Beijing, 30 Xueyuan Road, Haidian District, Beijing, China
| | - Wei He
- School of Material Science and Engineering, University of Science and Technology Beijing, 30 Xueyuan Road, Haidian District, Beijing, China
| | - Kun Qiao
- School of Material Science and Engineering, University of Science and Technology Beijing, 30 Xueyuan Road, Haidian District, Beijing, China
| | - Haoye Meng
- School of Material Science and Engineering, University of Science and Technology Beijing, 30 Xueyuan Road, Haidian District, Beijing, China
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Pierrat B, Nováček V, Avril S, Turquier F. Mechanical characterization and modeling of knitted textile implants with permanent set. J Mech Behav Biomed Mater 2020; 114:104210. [PMID: 33338783 DOI: 10.1016/j.jmbbm.2020.104210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/09/2020] [Accepted: 11/11/2020] [Indexed: 10/22/2022]
Abstract
Textile-based implant (mesh) treatment is considered as a standard of care for abdominal wall hernia repair. Computational models and simulations have appeared as one of the most promising approach to investigate biomechanics related to hernia repair and to improve clinical outcomes. This paper presents a novel anisotropic hypo-elastoplastic constitutive model specifically established for surgical knitted textile implants. The major mechanical characteristics of these materials such as anisotropy and permanent set have been reproduced. For the first time ever, we report an extensive mechanical characterization of one of these meshes, including cyclic uniaxial tension, planar equibiaxial tension and plunger type testing. These tests highlight the complex mechanical behavior with strong nonlinearity, anisotropy and permanent set. The novel anisotropic hypo-elasto-plastic constitutive model has been identified based on the tensile experiments and validated successfully against the data of the plunger experiment. In the future, implementation of this characterization and modeling approach to additional surgical knitted textiles should be the direction to follow in order to develop clinical decision support software for abdominal wall repair.
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Affiliation(s)
- Baptiste Pierrat
- Mines Saint-Etienne, Univ Lyon, Univ Jean Monnet, INSERM, U 1059 Sainbiose, Centre CIS, F - 42023, Saint-Etienne, France.
| | - Vít Nováček
- New Technologies - Research Centre, University of West Bohemia, Univerzitní 8, 301 00, Plzeň, Czech Republic
| | - Stéphane Avril
- Mines Saint-Etienne, Univ Lyon, Univ Jean Monnet, INSERM, U 1059 Sainbiose, Centre CIS, F - 42023, Saint-Etienne, France
| | - Frédéric Turquier
- Mines Saint-Etienne, Univ Lyon, Univ Jean Monnet, INSERM, U 1059 Sainbiose, Centre CIS, F - 42023, Saint-Etienne, France
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