Mesh incisional herniorrhaphy increases abdominal wall elastic properties: a mechanism for decreased hernia recurrences in comparison with suture repair.
BACKGROUND
An improved understanding of load-bearing soft tissue repair suggests that the mechanism for the improved outcomes after alloplastic incisional herniorrhaphy involves more than simple tissue replacement or material strength. We test the hypothesis that postrepair abdominal wall elastic properties are most predictive of successful abdominal wall reconstruction.


METHODS
A rodent model of chronic incisional hernia formation was used. Midline incisional hernias were repaired primarily with suture (n = 24) or polypropylene mesh (n = 24). Rodents were sacrificed at serial postoperative time points over 60 days. Intact abdominal wall strips were cut perpendicular to the wound for tensiometric analysis. Biopsies of wound provisional matrix were obtained for biochemical analysis.


RESULTS
Recurrent incisional hernia formation was significantly decreased in the mesh-repair group, compared with the suture-repair group (5/24 vs 14/24, P = .02). Mesh-repaired abdominal walls demonstrated significantly more elongation (P < .01) and less stiffness (P < .01). Toughness was equal between wounds, although the suture-repaired wounds had increased recovery of tensile strength (P < .01). There were no significant differences in collagen deposition after postoperative day 7.


CONCLUSIONS
Mesh incisional herniorrhaphy increases abdominal wall elastic properties as measured by increased elongation and reduced stiffness. Increased abdominal wall elasticity after incisional hernia repair in turn results in lower recurrence rates.
DuBay
Derek A
DA
Department of Surgery, Division of General Surgery, University of Michigan Medical Center, Ann Arbor, MI, USA.
Wang
Xue
X
Adamson
Belinda
B
Kuzon
William M
WM
Dennis
Robert G
RG
Franz
Michael G
MG
D034861:Abdominal Wall / Q000503:physiopathology / Q000601:surgery; D000818:Animals; D001483:Base Sequence; D001696:Biomechanical Phenomena; D024042:Collagen Type I / Q000235:genetics / Q000378:metabolism; D024061:Collagen Type III / Q000235:genetics / Q000378:metabolism; D004195:Disease Models, Animal; D004548:Elasticity; D006555:Hernia, Ventral / Q000503:physiopathology / Q000517:prevention & control / Q000601:surgery*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000503:physiopathology / Q000517:prevention & control / Q000601:surgery; D012333:RNA, Messenger / Q000235:genetics / Q000378:metabolism; D051381:Rats; D017207:Rats, Sprague-Dawley; D012008:Recurrence; D013526:Surgical Mesh; D013536:Suture Techniques; D014945:Wound Healing
D024042:Collagen Type I; D024061:Collagen Type III; D012333:RNA, Messenger