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Troka M, Szepietowska K, Lubowiecka I. Self-organising maps in the analysis of strains of human abdominal wall to identify areas of similar mechanical behaviour. J Mech Behav Biomed Mater 2024; 156:106578. [PMID: 38781775 DOI: 10.1016/j.jmbbm.2024.106578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 03/05/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024]
Abstract
The study refers to the application of a type of artificial neural network called the Self-Organising Map (SOM) for the identification of areas of the human abdominal wall that behave in a similar mechanical way. The research is based on data acquired during in vivo tests using the digital image correlation technique (DIC). The mechanical behaviour of the human abdominal wall is analysed during changing intra-abdominal pressure. SOM allow to study simultaneously three variables in four time/load steps. The variables refer to the principal strains and their directions. SOM classifies all the abdominal surface data points into clusters that behave similarly in accordance with the 12 variables. The analysis of the clusters provides a better insight into abdominal wall deformation and its evolution under pressure than when observing a single mechanical variable. The presented results may provide a better understanding of the mechanics of the living human abdominal wall. It might be particularly useful when selecting proper implants as well as for the design of surgical meshes for the treatment of abdominal hernias, which would be mechanically compatible with identified regions of the human anterior abdominal wall, and possibly open the way for patient-specific solutions.
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Affiliation(s)
- Mateusz Troka
- Faculty of Civil and Environmental Engineering, Gdańsk University of Technology, Gdańsk, Poland
| | - Katarzyna Szepietowska
- Faculty of Civil and Environmental Engineering, Gdańsk University of Technology, Gdańsk, Poland
| | - Izabela Lubowiecka
- Faculty of Civil and Environmental Engineering, Gdańsk University of Technology, Gdańsk, Poland.
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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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Śmietański M, Śmietańska IA, Zamkowski M. Post-partum abdominal wall insufficiency syndrome (PPAWIS): lessons learned from a single surgeon's experience based on 200 cases. BMC Surg 2022; 22:305. [PMID: 35941642 PMCID: PMC9358894 DOI: 10.1186/s12893-022-01757-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 07/29/2022] [Indexed: 11/23/2022] Open
Abstract
Background Post-partum abdominal wall insufficiency (PPAWI) with rectus diastasis is present in over 30% of women after pregnancy. Little is known about how PPAWI affects the social, sexual life and self-esteem of patients. This study was designed to evaluate the safety of onlay mesh combined with abdominoplasty and its impact on the well-being of the patients. Method Two hundred patients with PPAWI underwent surgery with onlay mesh and abdominoplasty. The safety of the procedure was assessed by postoperative complications, time of hospitalization and time of drainage. Before the operation and 6 months later, a questionnaire asking about the patient’s sexual and social life and the presence of back pain was completed. The final cosmetic effect was assessed separately. Results The onlay procedure with abdominoplasty was found to be safe and fast. The mean operation time was 82 min, and the drainage time was 2.1 days. In this group < 2% postoperative complications were noted. There were no recurrences within the 6 month. Significant improvements in social and sexual life and the level of self-esteem were noted. Back pain was relieved or minimalized in all patients. The final cosmetic effect was insufficient for 2 patients (1%). Conclusion PPAWI can be treated safely with onlay mesh and abdominoplasty. The patients’ symptoms were strongly correlated with the morphological status of the front abdominal wall and improved after the procedure. Describing the psychological and social consequences of PPAWI should lead the surgical societies to propose a definition of a new disease called PPAWIS (post-partum abdominal wall insufficiency syndrome). Supplementary Information The online version contains supplementary material available at 10.1186/s12893-022-01757-y.
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Affiliation(s)
- Maciej Śmietański
- 2nd Department of Radiology, Medical University of Gdansk, Dębinki 7, 80-952, Gdańsk, Poland. .,Swissmed Hospital in Gdansk, Department of Surgery and Hernia Centre, Gdańsk, Wileńska 44, 80-215, Poland.
| | - Irmina Anna Śmietańska
- Department of Anaesthesiology and Intensive Care, Medical University of Gdansk, Gdańsk, Dębinki 7, 80-952, Poland
| | - Mateusz Zamkowski
- Swissmed Hospital in Gdansk, Department of Surgery and Hernia Centre, Gdańsk, Wileńska 44, 80-215, Poland
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Skolimowska-Rzewuska M, Mitura K. Essential anatomical landmarks in placement of an adequate size mesh for a successful ventral hernia repair. POLISH JOURNAL OF SURGERY 2021; 93:1-5. [PMID: 34552025 DOI: 10.5604/01.3001.0014.9349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Safe and effective hernia repair requires a surgeon to have the appropriate knowledge necessary to learn details of the surgical technique. Long-term results of treatment, even with the use of synthetic implants, have shown that recurrences were still a significant clinical problem concerning up to every fourth patient. Therefore, it was pointed out that the mere presence of synthetic material is not a solitary circumstance sufficient for a successful repair. A key finding in recurrence prevention has been to focus surgeons' attention on the relationship between the size of the hernia orifice and the mesh surface. An optimal ratio of these values has not been established yet, however, it is considered that the mesh surface area should be at least sixteen times larger than the area of the abdominal wall defect. In cases of medium and large hernias, in order to place an extensive mesh sheet in the appropriate anatomical space of the abdominal wall, an extensive dissection needs to be performed, including several different compartments. Therefore, a surgeon undertaking a hernia repair needs to know perfectly the anatomy and function of all the myofascial structures involved. Performing an incorrect dissection of a mistaken structure may lead to catastrophic abdominal deformities. Depriving the patient of the natural support of the abdominal wall provided by the muscles may lead to total or partial destabilization of the trunk and lead to disability. In this paper a detailed description of anatomical structures and its practical use has been presented.
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Affiliation(s)
| | - Kryspin Mitura
- Faculty of Medical Sciences and Health Sciences, Siedlce University of Natural Sciences and Humanities, Poland
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Lubowiecka I, Tomaszewska A, Szepietowska K, Szymczak C, Śmietański M. In vivo performance of intraperitoneal onlay mesh after ventral hernia repair. Clin Biomech (Bristol, Avon) 2020; 78:105076. [PMID: 32535476 DOI: 10.1016/j.clinbiomech.2020.105076] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/01/2020] [Accepted: 06/04/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Ventral hernia repair needs to be improved since recurrence, postoperative pain and other complications are still reported in many patients. The behavior of implants in vivo is not sufficiently understood to design a surgical mesh mechanically compatible with the human abdominal wall. METHODS This analysis was based on radiological pictures of patients who underwent laparoscopic ventral hernia repair. The pictures show the trunk of the patient at rest in a standing position and under side bending. The change in the distance between different tacks due to trunk movement was analyzed, which allowed us to determine the in vivo elongation of the mesh incorporated into the abdominal wall. FINDINGS The relative elongations of the surgical mesh varied from a few percent to greater than 100% in two cases. The median of the median relative elongations obtained for all patients is 9.5%, and the median of the maximum relative elongations for all patients is 32.6%. The maximum elongation occurs between tacks that are next to each other. Trunk movement causes implant deformation, and this study provides quantitative information regarding changes in the distance between fasteners. INTERPRETATION The physiological movement of the human abdomen must be regarded as a very important factor in mesh deformation and should be considered in surgical practice to reduce the hernia recurrence rate and postoperative pain.
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Affiliation(s)
- Izabela Lubowiecka
- Gdansk University of Technology, Faculty of Civil and Environmental Engineering, Gdańsk, Poland.
| | - Agnieszka Tomaszewska
- Gdansk University of Technology, Faculty of Civil and Environmental Engineering, Gdańsk, Poland
| | - Katarzyna Szepietowska
- Gdansk University of Technology, Faculty of Civil and Environmental Engineering, Gdańsk, Poland
| | - Czesław Szymczak
- Gdansk University of Technology, Faculty of Ocean Engineering and Ship Technology, Gdańsk, Poland
| | - Maciej Śmietański
- Medical University of Gdańsk, 2(nd) Department of Radiology, Hospital Swissmed S.A., Department of Surgery, Poland
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Ahmed MA, Tawfic QA, Schlachta CM, Alkhamesi NA. Pain and Surgical Outcomes Reporting After Laparoscopic Ventral Hernia Repair in Relation to Mesh Fixation Technique: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. J Laparoendosc Adv Surg Tech A 2018; 28:1298-1315. [DOI: 10.1089/lap.2017.0609] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
- Mooyad A. Ahmed
- Canadian Surgical Technologies & Advanced Robotics (CSTAR), London, Canada
- Department of Surgery, London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Qutaiba A. Tawfic
- Department of Anesthesia, London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Christopher M. Schlachta
- Canadian Surgical Technologies & Advanced Robotics (CSTAR), London, Canada
- Department of Surgery, London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Nawar A. Alkhamesi
- Canadian Surgical Technologies & Advanced Robotics (CSTAR), London, Canada
- Department of Surgery, London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University, London, Canada
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Tomaszewska A, Lubowiecka I, Szymczak C. Mechanics of mesh implanted into abdominal wall under repetitive load. Experimental and numerical study. J Biomed Mater Res B Appl Biomater 2018; 107:1400-1409. [DOI: 10.1002/jbm.b.34232] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 07/25/2018] [Accepted: 08/18/2018] [Indexed: 01/06/2023]
Affiliation(s)
- Agnieszka Tomaszewska
- Gdańsk University of TechnologyFaculty of Civil and Environmental Engineering, Department of Structural Mechanics Narutowicza 11/12, 80‐233, Gdańsk Poland
| | - Izabela Lubowiecka
- Gdańsk University of TechnologyFaculty of Civil and Environmental Engineering, Department of Structural Mechanics Narutowicza 11/12, 80‐233, Gdańsk Poland
| | - Czesław Szymczak
- Gdańsk University of TechnologyFaculty of Ocean Engineering and Ship Technology, Department of Structural Mechanics Narutowicza 11/12, 80‐233, Gdańsk Poland
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9
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Deeken CR, Lake SP. Mechanical properties of the abdominal wall and biomaterials utilized for hernia repair. J Mech Behav Biomed Mater 2017; 74:411-427. [DOI: 10.1016/j.jmbbm.2017.05.008] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 04/26/2017] [Accepted: 05/04/2017] [Indexed: 12/29/2022]
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Kahan LG, Lake SP, McAllister JM, Tan WH, Yu J, Thompson D, Brunt LM, Blatnik JA. Combined in vivo and ex vivo analysis of mesh mechanics in a porcine hernia model. Surg Endosc 2017; 32:820-830. [DOI: 10.1007/s00464-017-5749-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 07/14/2017] [Indexed: 12/29/2022]
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Multi-directional mechanical analysis of synthetic scaffolds for hernia repair. J Mech Behav Biomed Mater 2017; 71:43-53. [DOI: 10.1016/j.jmbbm.2017.02.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 02/06/2017] [Accepted: 02/08/2017] [Indexed: 11/17/2022]
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Stetsko T, Bury K, Lubowiecka I, Szymczak C, Tomaszewska A, Śmietański M. Safety and efficacy of a Ventralight ST echo ps implant for a laparoscopic ventral hernia repair - a prospective cohort study with a one-year follow-up. POLISH JOURNAL OF SURGERY 2017; 88:7-14. [PMID: 27096768 DOI: 10.1515/pjs-2016-0020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Indexed: 11/15/2022]
Abstract
UNLABELLED Laparoscopic ventral hernia repair has become popular technique. Every year, companies are introducing new products Thus, every mesh prior to introduction in clinical settings should be tested with a dedicated tacker to discover the proper fixation algorithm. The aim of the study was to assess the safety and efficacy of the Ventralight ST implant with an ECHO positioning system and a dedicated fixation device, the SorbaFix stapler, in a prospective cohort of patients. MATERIAL AND METHODS The study was a prospective single centre cohort study with a one-year followup period. Fifty-two patients received operations for a ventral hernia using a laparoscopic IPOM mesh - Ventralight ST ECHO PS. The size of the mesh and the fixation method were based on mathematical considerations. A recurrence of the hernia and pain after 1, 2 and 12 months were assessed as the primary endpoints. RESULTS Two recurrences were noted, one in parastomal and one in a large incisional hernia. Pain was observed in 22 patients (41%) and mostly disappeared after 3 months (7%). The intensity of pain was low (VAS <2). However, 2 patients still experienced severe pain (VAS>6) until the end of the study. CONCLUSION The Ventralight ST Echo PS implant fixed with a Sorbafix stapler is a valuable and safe option for a laparoscopic ventral hernia repair. In our opinion, the implant could be used in all patients due to the hernia ring diameter. According to the mathematical models and clinical practice, we do not recommend this implant in orifices with a width larger than 10 cm.
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Szymczak C, Lubowiecka I, Szepietowska K, Tomaszewska A. Two-criteria optimisation problem for ventral hernia repair. Comput Methods Biomech Biomed Engin 2017; 20:760-769. [DOI: 10.1080/10255842.2017.1300658] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Czesław Szymczak
- Department of Theory and Ship Design, Faculty of Ocean Engineering and Ship Technology, Gdańsk University of Technology, Gdańsk, Poland
| | - Izabela Lubowiecka
- Department of Structural Mechanics, Faculty of Civil and Environmental Engineering, Gdańsk University of Technology, Gdańsk, Poland
| | - Katarzyna Szepietowska
- Department of Structural Mechanics, Faculty of Civil and Environmental Engineering, Gdańsk University of Technology, Gdańsk, Poland
| | - Agnieszka Tomaszewska
- Department of Structural Mechanics, Faculty of Civil and Environmental Engineering, Gdańsk University of Technology, Gdańsk, Poland
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Kallinowski F, Baumann E, Harder F, Siassi M, Mahn A, Vollmer M, Morlock MM. Dynamic intermittent strain can rapidly impair ventral hernia repair. J Biomech 2015; 48:4026-4036. [DOI: 10.1016/j.jbiomech.2015.09.045] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 09/25/2015] [Accepted: 09/26/2015] [Indexed: 12/29/2022]
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Pawlak M, Hilgers RD, Bury K, Lehmann A, Owczuk R, Śmietański M. Comparison of two different concepts of mesh and fixation technique in laparoscopic ventral hernia repair: a randomized controlled trial. Surg Endosc 2015; 30:1188-97. [PMID: 26139491 DOI: 10.1007/s00464-015-4329-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 06/09/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Patients' need to improve outcomes and to reduce the number of complications triggers the development of new materials and surgery concepts. Currently, there are many implants and fixation systems dedicated for intraperitoneal onlay mesh procedure. The aim of this study was to compare two different mesh/fixation system concepts (PH: Physiomesh/Securestrap and VS: Ventralight ST/SorbaFix) for laparoscopic ventral hernia repair with respect to pain. METHODS A single-center, prospective, randomized study was designed to include 50 patients per group with a planned interim analysis for safety after 25 patients. The endpoints were pain occurrences and intensity, which was measured with the visual analogue scale 7 days, 30 days, 3 months and 6 months after surgery. The safety parameters included the number of recurrences and postoperative complications. RESULTS During the interim analysis, the study was stopped due to safety reasons. We observed five (20 %) recurrences in the PH group in first 6 months and none in the VS group. We observed a significantly higher pain rate in the PH group after 3 months (p < 0.0001) and no difference after 7 days (p = 0. 7019). The pain intensity decreased significantly over time (p < 0.0001) and was significantly higher in the PH group (p < 0.0001). CONCLUSIONS Although this clinical trial was terminated prior to the preplanned recruitment goal, the obtained results from the enrolled patients indicate that the PH system associated with significantly greater hernia recurrences and postoperative pain compared with the VS system. This confirms the superiority of the elastic mesh concept, which may be a safer and more efficacious option for laparoscopic ventral hernia repairs.
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Affiliation(s)
- Maciej Pawlak
- Department of General Surgery, Ceynowa Hospital, Wejherowo, Poland.
- Department of Cardiac and Vascular Surgery, Medical University of Gdańsk, Gdańsk, Poland.
| | | | - Kamil Bury
- Department of Cardiac and Vascular Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - Andrzej Lehmann
- Department of General Surgery, Ceynowa Hospital, Wejherowo, Poland
| | - Radosław Owczuk
- Department of Anesthesiology and Intensive Care, Medical University of Gdańsk, Gdańsk, Poland
| | - Maciej Śmietański
- II Department of Radiology, Medical University of Gdańsk, Gdańsk, Poland
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Jafri M, Brown S, Arnold G, Abboud R, Wang W. Kinematical analysis of the trunk, upper limbs and fingers during minimal access surgery when using an armrest. ERGONOMICS 2015; 58:1868-1877. [PMID: 25952275 DOI: 10.1080/00140139.2015.1039603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
UNLABELLED This study investigated whether using an armrest could reduce the movements of the trunk, upper limb and hand of surgeons during simulated minimal access surgery. Sixteen surgeons carried out two trials of simulated laparoscopic surgery, one using an armrest and the other without. Reflective markers were attached on the trunk, upper limbs, fingers, minimal access camera (MAC) and scissors, allowing a motion capture system to record the movements. The error ratios during operation, subjective opinions and operative durations were collected. The results showed that total displacements at the trunk and shoulders were reduced by at least 25% when using an armrest compared with not using one; error ratios were reduced by 7%; velocity and acceleration in the trunk, shoulder and MAC were reduced. After simulated operations, 78% of the participants preferred using the armrest. The study indicates that an armrest could improve surgical outcomes by reducing trunk movements. PRACTITIONER SUMMARY An armrest may help surgeons to reduce unnecessary movements during operations. The error ratios were reduced by 7% when using an armrest compared with no armrest. Displacements at the trunk and shoulders were reduced by 25% when using an armrest. Seventy-eight per cent of participants preferred to use an armrest after the experiment.
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Affiliation(s)
- Mansoor Jafri
- a Department of Orthopaedic and Trauma Surgery, Institute of Motion Analysis and Research (IMAR) , Ninewells Hospital and Medical School, University of Dundee , Dundee DD1 9SY , UK
| | - Stuart Brown
- b Surgical Technology Group, Institute for Medical Science and Technology (IMSaT), University of Dundee , Dundee DD1 9SY , UK
| | - Graham Arnold
- a Department of Orthopaedic and Trauma Surgery, Institute of Motion Analysis and Research (IMAR) , Ninewells Hospital and Medical School, University of Dundee , Dundee DD1 9SY , UK
| | - Rami Abboud
- a Department of Orthopaedic and Trauma Surgery, Institute of Motion Analysis and Research (IMAR) , Ninewells Hospital and Medical School, University of Dundee , Dundee DD1 9SY , UK
| | - Weijie Wang
- a Department of Orthopaedic and Trauma Surgery, Institute of Motion Analysis and Research (IMAR) , Ninewells Hospital and Medical School, University of Dundee , Dundee DD1 9SY , UK
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Ambroziak A, Szepietowska K, Lubowiecka I. Mechanical properties of mosquito nets in the context of hernia repair. Comput Methods Biomech Biomed Engin 2015; 19:286-296. [PMID: 25756655 DOI: 10.1080/10255842.2015.1016004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The paper deals with issue of applying mosquito nets as implants in hernia repair, which have already been used in resource-poor developing countries. Uniaxial tensile tests have been conducted on polyester mosquito meshes in two orthogonal directions. Non-linear elastic constitutive laws parameters have been identified to be applied in dense net material models. Mechanical performance of tested mosquito nets has been compared with properties of commercial implants used in treatment of hernia and with properties of human tissue. This study contributes to mechanical knowledge of hernia repair issue by investigation of cheaper alternative to commercial implants.
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Affiliation(s)
- Andrzej Ambroziak
- a Department of Structural Mechanics , Faculty of Civil and Environmental Engineering, Gdansk University of Technology , Narutowicza 11/12, 80 - 233 Gdańsk , Poland
| | - Katarzyna Szepietowska
- a Department of Structural Mechanics , Faculty of Civil and Environmental Engineering, Gdansk University of Technology , Narutowicza 11/12, 80 - 233 Gdańsk , Poland
| | - Izabela Lubowiecka
- a Department of Structural Mechanics , Faculty of Civil and Environmental Engineering, Gdansk University of Technology , Narutowicza 11/12, 80 - 233 Gdańsk , Poland
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