Biomechanics of the front abdominal wall as a potential factor leading to recurrence with laparoscopic ventral hernia repair
Biomechanics of the front abdominal wall as a potential factor leading to recurrence with laparoscopic ventral hernia repair
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DOI：
10.1007/s00464-011-2056-8
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发表时间：
2012-05-01
影响因子：
3.1
通讯作者：
Szymczak, Czeslaw
中科院分区：
文献类型：
--
作者：
Smietanski, Maciej;Bury, Kamil;Szymczak, Czeslaw
腹内压常常被认为是腹腔镜腹疝修补术后网状筋膜连接失败的原因。咳嗽或排便时网片的拉伸可能会导致复发。对于手术后腹腔内网片的运动知之甚少。本研究调查了前腹壁，以描述其体内弹性，并寻找可能拉伸植入网片的伸长，从而导致固定失败和随后的复发。为了测量前腹壁伸长，创建了筋膜运动模型。在运动过程中对八名健康志愿者进行了测量，以确定其前腹壁的伸长程度。在三个位置分析视频以创建数学外壳结构。计算基于节点净运动的计算机模型以确定最大伸长率的轴和值。最大平均伸长率是在上中线（32.08％）和下侧区域的横线（34.06％）处测量的。这些线的最大值大于中线的 100% (133.78%)，并且超过整个中线的 50%。水平线的值在任何级别都没有达到 10%。根据这些数据，定义了高弹性和低弹性区域。所提出的实验为理解体内网格行为添加了新参数。前腹壁的伸长可能会拉伸植入的网片，并且在固定不充分的情况下可能会导致复发。
Intraabdominal pressure often is blamed as the cause of mesh-fascia junction failure after laparoscopic ventral hernia repair. Stretching of the mesh during a cough or defecation may lead to recurrence. Little is known about the movements of mesh in the abdominal cavity after this operation. This study investigated the front abdominal wall to describe its elasticity in vivo and searched for elongations that possibly stretched an implanted mesh, thereby causing fixation failure and subsequent recurrence.To measure front abdominal wall elongations, a model of fascia movements was created. Eight healthy volunteers were measured during exercise to determine the extent of elongations in their front abdominal wall. Videos were analyzed in three positions to create a mathematical shell structure. A computerized model based on the net movement of nodes was calculated to determine the axes and values for maximum elongations.The largest average elongations were measured for the upper midline (32.08%) and the transverse line in the low lateral area (34.06%). The maximum values for these lines were larger than 100% for the middle line (133.78%) and exceeded 50% for the entire middle line. The values for the horizontal lines did not reach 10% at any level. According to these data, areas of both high and low elasticity were defined.The presented experiment adds new parameters to the understanding of in vivo mesh behavior. Elongation of the front abdominal wall may stretch implanted mesh and could be a cause of recurrence in cases of insufficient fixation.