Figure - available from: Surgical Endoscopy
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A Intact fascia lata, (black arrows for x/y-fiber orientation); B handsewn suture; C stapled suture; D hybrid suture
Source publication
Background
Recently, in the field of abdominal wall repair surgery, some minimally invasive procedures introduced the use of staplers to provide a retromuscular prosthetic repair. However, to the knowledge of the authors, there are little data in the literature about the outcomes of stapled sutures adoption for midline reconstruction. This study ai...
Citations
... Therefore, further studies should focus on understanding the impact of adopting specific stapling devices, also in comparison with manual or mixed operations as documented in [2] regarding suture resistances, for different tissues and explore the potential influence of staple height and the number of staple rows on the overall surgical outcome. By undertaking such investigations, we can better optimize the use of stapling devices, tailor their applications to specific tissues, and potentially enhance the overall success and safety of surgical procedures. ...
Stapling devices have emerged as a widespread and effective option for soft tissue surgery, offering promising outcomes for patients by reducing complication rates and surgery time. This review aims to provide an exhaustive analysis of commercially available alternatives in the market, incorporating insights from market analysis, patent landscape, and the existing literature. The main focus lies in identifying and evaluating the most widely adopted and innovative stapling devices, including linear, linear cutting, circular, and powered staplers. In addition, this review delves into the realm of bioabsorbable staples, exploring the materials utilized and the surgical fields where these advanced staples find applications. To facilitate easy comprehension, the gathered information is presented in tables, highlighting the essential parameters for each stapling device. This comprehensive research about stapling devices is intended to aid healthcare practitioners and researchers in making informed decisions when choosing the most appropriate instrument for specific surgical procedures.
... Destructive testing under dry conditions is often performed to advance hernia repair [47] . The force required is usually more than one megapascal [48] . ...
The article reviews the biomechanical principles of durable abdominal wall reconstructions. The aim is to provide insights and conclusions for future research in this area. Incisional hernia repair implies the creation of a compound made of tissue, textile, and fixation elements. A pulse load bench test for incisional hernia repair has been available since 2014, and its influences are evaluated in three different versions of the test stand. Based on these evaluations, a biomechanical concept for long-term durable reconstructions was determined. To apply the concept to individual patients, computed tomography of the abdomen at rest and during the Valsalva maneuver was used. A load limit can be given for every patient based on the hernia defect area (CRIP- critical resistance to impacts related to pressure). By considering the mesh to defect area ratio, the retention strength of a planned reconstruction can be calculated (GRIP-gained resistance to impacts related to pressure). The gripping coefficients for tissues vary significantly, up to 18 fold. About half of the patients have overall tissue distensions up to 350% or more, with potential high regional variations. The surface retention forces for hernia meshes and for different sutures, tacks, and adhesives span a wide range of 14fold. Suturing a defect strengthens the reconstruction up to 3fold. Furthermore, recalculating data taken from multicentric randomized studies on primary sutures reveals that improved GRIP values are associated with reduced rates of incisional hernia. Repairing consecutive incisional hernias according to the GRIP concept results in no recurrence and low pain levels after one year. A future policy for market access of repair materials should include cyclic load bench testing. Moreover, a tailored approach to incisional hernia repair should take into account the biomechanical aspects involved.
