Abstract：
OBJECTIVE: We studied the effectiveness of biomechanically calculated abdominal wall reconstructions for incisional hernias of varying complexity in an open, prospective observational registry trial.
METHODS: From July 1st, 2017 to December 31st, 2020, four hospitals affiliated with the University of Heidelberg recruited 198 patients with complex incisional hernias. Hernias were repaired using biomechanically calculated reconstructions and materials classified on their gripping force towards cyclic load. This approach determines the required strength preoperatively based on the hernia size, using the Critical Resistance to Impacts related to Pressure. The surgeon is supported in reliably determining the Gained Resistance, which is based on the mesh-defect-area-ratio, as well as other mesh and suture factors, and the tissue stability. Tissue stability is defined as a maximum distension of 1.5 cm upon a Valsalva maneuver. In complex cases, a CT scan of the abdomen can be used to assess unstable tissue areas both at rest and during Valsalva\'s maneuver.
RESULTS: Larger and stronger gripping meshes were required for more complex cases to achieve a durable repair, especially for larger hernia sizes. To achieve durable repairs, the number of fixation points increased while the mesh-defect area ratio decreased. Performing these repairs required more operating room time. The complication rate remained low. Less than 1% of recurrences and low pain levels were observed after 3 years.
CONCLUSIONS: Biomechanical stability, defined as the resistance to cyclic load, is crucial in preventing postoperative complications, including recurrences and chronic pain.
METHODS: From July 1st, 2017 to December 31st, 2020, four hospitals affiliated with the University of Heidelberg recruited 198 patients with complex incisional hernias. Hernias were repaired using biomechanically calculated reconstructions and materials classified on their gripping force towards cyclic load. This approach determines the required strength preoperatively based on the hernia size, using the Critical Resistance to Impacts related to Pressure. The surgeon is supported in reliably determining the Gained Resistance, which is based on the mesh-defect-area-ratio, as well as other mesh and suture factors, and the tissue stability. Tissue stability is defined as a maximum distension of 1.5 cm upon a Valsalva maneuver. In complex cases, a CT scan of the abdomen can be used to assess unstable tissue areas both at rest and during Valsalva\'s maneuver.
RESULTS: Larger and stronger gripping meshes were required for more complex cases to achieve a durable repair, especially for larger hernia sizes. To achieve durable repairs, the number of fixation points increased while the mesh-defect area ratio decreased. Performing these repairs required more operating room time. The complication rate remained low. Less than 1% of recurrences and low pain levels were observed after 3 years.
CONCLUSIONS: Biomechanical stability, defined as the resistance to cyclic load, is crucial in preventing postoperative complications, including recurrences and chronic pain.
摘要：
目的：我们研究了生物力学计算的腹壁重建对不同复杂性的切开疝的有效性，前瞻性观察性登记试验。
方法：从7月1日起，2017年12月31日,2020年，海德堡大学附属四家医院招募了198名复杂切口疝患者。使用生物力学计算的重建方法修复了疝，并根据其对循环载荷的抓力对材料进行了分类。这种方法根据疝气大小确定术前所需的强度，使用与压力有关的冲击的临界阻力。外科医生在可靠地确定获得的阻力方面得到了支持，这是基于网格缺陷面积比，以及其他网格和缝合因素，和组织稳定性。组织稳定性定义为Valsalva动作时最大扩张1.5cm。在复杂的情况下,腹部CT扫描可用于评估静息和Valsalva动作期间的不稳定组织区域。
结果：对于更复杂的情况，需要更大和更坚固的夹持网，以实现持久的修复，特别是对于较大的疝气。为了实现持久的维修，固定点数量增加，而网状缺损面积比降低。执行这些维修需要更多的手术室时间。并发症发生率仍然很低。3年后观察到少于1％的复发和低疼痛水平。
结论：生物力学稳定性，定义为对循环载荷的抵抗力，对预防术后并发症至关重要，包括复发和慢性疼痛.
方法：从7月1日起，2017年12月31日,2020年，海德堡大学附属四家医院招募了198名复杂切口疝患者。使用生物力学计算的重建方法修复了疝，并根据其对循环载荷的抓力对材料进行了分类。这种方法根据疝气大小确定术前所需的强度，使用与压力有关的冲击的临界阻力。外科医生在可靠地确定获得的阻力方面得到了支持，这是基于网格缺陷面积比，以及其他网格和缝合因素，和组织稳定性。组织稳定性定义为Valsalva动作时最大扩张1.5cm。在复杂的情况下,腹部CT扫描可用于评估静息和Valsalva动作期间的不稳定组织区域。
结果：对于更复杂的情况，需要更大和更坚固的夹持网，以实现持久的修复，特别是对于较大的疝气。为了实现持久的维修，固定点数量增加，而网状缺损面积比降低。执行这些维修需要更多的手术室时间。并发症发生率仍然很低。3年后观察到少于1％的复发和低疼痛水平。
结论：生物力学稳定性，定义为对循环载荷的抵抗力，对预防术后并发症至关重要，包括复发和慢性疼痛.
