Optimal tissue tension, reinforcement, and defect closure remain challenges for surgeons performing abdominal protrusion procedures such as hernia repair or rectus diastasis. There is a need for reliable reinforcement to reduce surgical site tissue stress that can lead to tissue repair dehiscense and mesh fixation failure. 

Mesh fixation can fail when suture cuts through tissue or mesh, leading to painful, “Swiss-cheese” outcomes. Failed anchor points can lead to:

  • Mesh migration

  • Contraction

  • Tearing from tissue

In addition, ensuring mesh is smooth and flat with good tissue contact is important; wrinkles, gaps, or folds can contribute to complications or recurrence.  Often, interrupted or running sutures and tacks do not pull the mesh flat, and cannot offload tension.

HERNIA: A common problem that can lead to recurrence

Ventral hernia repairs have high recurrence rates and can lead to serious consequences including reoperation.  A major reason for recurrence in ventral hernia repair is the failure of mesh at fixation sites¹¯², where sutures can cut or “cheese-wire” through tissue or mesh.

 

Mesh fixation strength is always important, but particularly so in the period before significant bio-incorporation into the mesh has occurred.

Over time and under pressure, sutures used for fixation can cut through tissue or mesh. Suture fixation can fail below abdominal pressures that can spike up to ~32N/cm (e.g. when coughing or lifting), and even higher with obese patients.³⁻⁴

Failed anchor points lead to mesh migration, mesh contraction, and mesh tearing from tissue, which can cause hernia recurrence.

SUTURES CUTTING THROUGH TISSUE

TRADITIONAL ANCHOR POINTS CUT THROUGH TISSUE OR MESH

 
 
 

#1 REASON for ventral hernia recurrences can be attributed in large part to failure of mesh at fixation sites¹¯²

 

32%: 10 year ventral hernia recurrence rate with mesh (5)

 

63%: 10 year ventral hernia recurrence rate without mesh (5)

 
 

WHAT IS A HERNIA?

Hernias occur when layers of the abdominal muscle become weak or tear. Abdominal pressure then pushes the lining of the abdominal wall out through the area of weakness, creating a bulge under the skin. A hernia may start as a small lump, but over time can grow large and may require surgical repair.

Even after surgical repair, hernias often recur. Implantation of a surgical mesh can help; recurrence rates for adults are lower in clinical literature when mesh is used. However, hernia occurrence and recurrence remain a consistent problem following abdominal surgery, with unacceptably high rates. A primary cause of failure is that sutures placed during the repair surgery can cut or pull through the tissue or mesh. Often hernias form at the location of a prior surgery where an incision occurred, when the abdominal pressure overcomes the strength of the closed surgical site. Thus these hernias are often called "incisional hernias" and are one of the most common types of hernias.

 

References here