title: Biomechanical analyses of prosthetic mesh repair in a hiatal hernia model.
abstract: Recurrence rate of hiatal hernia can be reduced with prosthetic mesh repair; however, type and shape of the mesh are still a matter of controversy. The purpose of this study was to investigate the biomechanical properties of four conventional meshes: pure polypropylene mesh (PP-P), polypropylene/poliglecaprone mesh (PP-U), polyvinylidenefluoride/polypropylene mesh (PVDF-I), and pure polyvinylidenefluoride mesh (PVDF-S). Meshes were tested either in warp direction (parallel to production direction) or perpendicular to the warp direction. A Zwick testing machine was used to measure elasticity and effective porosity of the textile probes. Stretching of the meshes in warp direction required forces that were up to 85-fold higher than the same elongation in perpendicular direction. Stretch stress led to loss of effective porosity in most meshes, except for PVDF-S. Biomechanical impact of the mesh was additionally evaluated in a hiatal hernia model. The different meshes were used either as rectangular patches or as circular meshes. Circular meshes led to a significant reinforcement of the hiatus, largely unaffected by the orientation of the warp fibers. In contrast, rectangular meshes provided a significant reinforcement only when warp fibers ran perpendicular to the crura. Anisotropic elasticity of prosthetic meshes should therefore be considered in hiatal closure with rectangular patches.
authors.affiliation: Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, 52074, Aachen, Germany.
authors.forename: Patrick Hamid
authors.initials: PH
authors.lastname: Alizai
authors.forename: Sofie
authors.initials: S
authors.lastname: Schmid
authors.forename: Jens
authors.initials: J
authors.lastname: Otto
authors.forename: Christian Daniel
authors.initials: CD
authors.lastname: Klink
authors.forename: Anjali
authors.initials: A
authors.lastname: Roeth
authors.forename: Jochen
authors.initials: J
authors.lastname: Nolting
authors.forename: Ulf Peter
authors.initials: UP
authors.lastname: Neumann
authors.forename: Uwe
authors.initials: U
authors.lastname: Klinge
mesh_terms: D006551:Hernia, Hiatal / Q000503:physiopathology* / Q000601:surgery*; D008422:Materials Testing / Q000379:methods*; D008954:Models, Biological; D013526:Surgical Mesh
keywords: anisotropy; hiatal closure; hiatal hernia; mesh; porosity