Development of a dynamic model for ventral hernia mesh repair

Area of Science:

• Biomechanical Engineering
• Surgical Simulation
• Abdominal Wall Dynamics

Background:

• Mesh fixation in laparoscopic ventral hernia repair lacks standardized dynamic simulation.
• Previous models omitted dynamic effects like coughing and vomiting.
• A novel dynamic model of the anterior abdominal wall was developed.

Purpose of the Study:

• To develop and validate a dynamic simulation model for assessing mesh fixation in laparoscopic ventral hernia repair.
• To investigate the impact of dynamic abdominal wall movements on mesh stability.
• To evaluate the influence of friction and application technique on mesh fixation.

Main Methods:

• A dynamic model simulating the anterior abdominal wall was created using a pressure-controlled fluid-filled bag.
• Computer-controlled systems generated pressure peaks simulating coughing (200 mmHg) and vomiting (290 mmHg).
• Mesh fixation was tested using tacks, controlling for friction coefficient and abdominal wall elasticity.

Main Results:

• The model successfully simulated physiological pressure peaks of coughing and vomiting while maintaining elasticity.
• Friction coefficient was identified as a critical factor for achieving a physiological situation.
• Meshes showed a tendency to dislocate with increased coughing, but plain application withstood more cycles than bulging application.

Conclusions:

• Dynamic abdominal wall movement, tissue-mesh friction, and application technique are vital for accurate simulation of ventral hernia closure.
• Patient-specific factors like coughing frequency and surgical application technique significantly impact long-term mesh stability.