title: Functional abdominal wall reconstruction improves core physiology and quality-of-life.
abstract: BACKGROUND
  One of the goals of modern ventral hernia repair (VHR) is restoring the linea alba by returning the rectus muscles to the midline. Although this practice presumably restores native abdominal wall function, improvement of abdominal wall function has never been measured in a scientific fashion. We hypothesized that a dynamometer could be used to demonstrate an improvement in rectus muscle function after open VHR with restoration of the midline, and that this improvement would be associated with a better quality-of-life.
  
  
  METHODS
  Thirteen patients agreed to dynamometric analysis before and 6 months after an open posterior component separation (Rives-Stoppa technique complimented with a transversus abdominis muscle release) and mesh sublay. Analysis done using a dynamometer (Biodex 3, Corp, Shirley, NY) included measurement of peak torque (PT; N*m) and PT per bodyweight (BW; %) generated during abdominal flexion in 5 settings: Isokinetic analysis at 45°/s and 60°/s as well as isometric analysis at 0°, -15°, and +15°. Power (W) was calculated during isokinetic settings. Quality-of-life was measured using our validated HerQles survey at the time of each dynamometric analysis.
  
  
  RESULTS
  Thirteen patients (mean age, 54 ± 9 years; mean body mass index, 31 ± 7 kg/m(2)) underwent repair with restoration of the midline using the aforementioned technique. Mean hernia width was 12.5 cm (range, 5-19). Improvements in PT and PT/BW were significant in all 5 settings (P < .05). Improvement in power during isokinetic analyses at 45°/s and 60°/s was also significant (P < .05). All patients reported an improvement in quality-of-life, which was associated positively with each dynamometric parameter.
  
  
  CONCLUSIONS
  Restoration of the linea alba during VHR is associated with improved abdominal wall functionality. Analysis of rectus muscle function using a dynamometer showed statistical improvement by isokinetic and isometric measurements, all of which were associated with an improvement in quality-of-life.
authors.affiliation: University Hospitals Case Medical Center, Case Comprehensive Hernia Center, Cleveland, OH.
authors.forename: Cory N
authors.initials: CN
authors.lastname: Criss
authors.affiliation: University Hospitals Case Medical Center, Case Comprehensive Hernia Center, Cleveland, OH. Electronic address: Clayton.Petro@UHhospitals.org.
authors.forename: Clayton C
authors.initials: CC
authors.lastname: Petro
authors.affiliation: University Hospitals Case Medical Center, Case Comprehensive Hernia Center, Cleveland, OH.
authors.forename: David M
authors.initials: DM
authors.lastname: Krpata
authors.affiliation: University Hospitals Case Medical Center, Case Comprehensive Hernia Center, Cleveland, OH.
authors.forename: Christina M
authors.initials: CM
authors.lastname: Seafler
authors.affiliation: Department of Biomedical Engineering, Case Western Reserve, Cleveland, OH; Department of Pediatrics, Rainbow Babies and Children's Hospital, Cleveland, OH.
authors.forename: Nicola
authors.initials: N
authors.lastname: Lai
authors.affiliation: Department of Pediatrics, Rainbow Babies and Children's Hospital, Cleveland, OH.
authors.forename: Justin
authors.initials: J
authors.lastname: Fiutem
authors.affiliation: University Hospitals Case Medical Center, Case Comprehensive Hernia Center, Cleveland, OH.
authors.forename: Yuri W
authors.initials: YW
authors.lastname: Novitsky
authors.affiliation: University Hospitals Case Medical Center, Case Comprehensive Hernia Center, Cleveland, OH.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Rosen
mesh_terms: D000009:Abdominal Muscles / Q000502:physiology / Q000601:surgery*; D034861:Abdominal Wall / Q000502:physiology / Q000601:surgery*; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000503:physiopathology / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D053581:Muscle Strength Dynamometer; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D016896:Treatment Outcome