Evidence map›Paper›PMID 28733734›Full record

ArticleSurgical endoscopy2018

Combined in vivo and ex vivo analysis of mesh mechanics in a porcine hernia model.

Lindsey G Kahan, Spencer P Lake, Jared M McAllister, Wen Hui Tan, Jennifer Yu, Dominic Thompson, L Michael Brunt, Jeffrey A Blatnik

Abstract read
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In one paragraph

Article in Surgical endoscopy, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Article
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Lindsey G KahanDepartment of Surgery, Washington University in St. Louis School of Medicine, 660 South Euclid Ave, Campus Box 8109, St. Louis, MO, 63110, USA.
Spencer P LakeDepartment of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, MO, USA.
Jared M McAllisterDepartment of Surgery, Washington University in St. Louis School of Medicine, 660 South Euclid Ave, Campus Box 8109, St. Louis, MO, 63110, USA.
Wen Hui TanDepartment of Surgery, Washington University in St. Louis School of Medicine, 660 South Euclid Ave, Campus Box 8109, St. Louis, MO, 63110, USA.
Jennifer YuDepartment of Surgery, Washington University in St. Louis School of Medicine, 660 South Euclid Ave, Campus Box 8109, St. Louis, MO, 63110, USA.
Dominic ThompsonDepartment of Surgery, Washington University in St. Louis School of Medicine, 660 South Euclid Ave, Campus Box 8109, St. Louis, MO, 63110, USA.
L Michael BruntDepartment of Surgery, Washington University in St. Louis School of Medicine, 660 South Euclid Ave, Campus Box 8109, St. Louis, MO, 63110, USA.
Jeffrey A BlatnikDepartment of Surgery, Washington University in St. Louis School of Medicine, 660 South Euclid Ave, Campus Box 8109, St. Louis, MO, 63110, USA. jblatnik@wustl.edu.

Funding

Society of American Gastrointestinal and Endoscopic Surgeons 4185-81974
6 · The paper itself

Abstract

backgroundHernia meshes exhibit variability in mechanical properties, and their mechanical match to tissue has not been comprehensively studied. We used an innovative imaging model of in vivo strain tracking and ex vivo mechanical analysis to assess effects of mesh properties on repaired abdominal walls in a porcine model. We hypothesized that meshes with dissimilar mechanical properties compared to native tissue would alter abdominal wall mechanics more than better-matched meshes.

methodsSeven mini-pigs underwent ventral hernia creation and subsequent open repair with one of two heavyweight polypropylene meshes. Following mesh implantation with attached radio-opaque beads, fluoroscopic images were taken at insufflation pressures from 5 to 30 mmHg on postoperative days 0, 7, and 28. At 28 days, animals were euthanized and ex vivo mechanical testing performed on full-thickness samples across repaired abdominal walls. Testing was conducted on 13 mini-pig controls, and on meshes separately. Stiffness and anisotropy (the ratio of stiffness in the transverse versus craniocaudal directions) were assessed.

results3D reconstructions of repaired abdominal walls showed stretch patterns. As pressure increased, both meshes expanded, with no differences between groups. Over time, meshes contracted 17.65% (Mesh A) and 0.12% (Mesh B; p = 0.06). Mesh mechanics showed that Mesh A deviated from anisotropic native tissue more than Mesh B. Compared to native tissue, Mesh A was stiffer both transversely and craniocaudally. Explanted repaired abdominal walls of both treatment groups were stiffer than native tissue. Repaired tissue became less anisotropic over time, as mesh properties prevailed over native abdominal wall properties.

conclusionsThis technique assessed 3D stretch at the mesh level in vivo in a porcine model. While the abdominal wall expanded, mesh-ingrown areas contracted, potentially indicating stresses at mesh edges. Ex vivo mechanics demonstrate that repaired tissue adopts mesh properties, suggesting that a better-matched mesh could reduce changes to abdominal wall mechanics.

Indexed as

Materials TestingSurgical MeshAbdominal WallAnimalsDisease Models, AnimalFluoroscopyHernia, VentralInsufflationPolypropylenesSwinePolypropylenesMechanicsMeshPorcine modelVentral hernia

Identifiers

PMID28733734

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.