Clinically Applied Biomechanics of Mesh-reinforced Ventral Hernia Repair: A Practical Review.

Abstract

Background: Ventral hernia repair is inherently prone to recurrence. This article is a practical review that summarizes the literature on the biomechanics of ventral hernia repairs to provide clinically applicable, evidence-based recommendations to reduce hernia recurrence.

Methods: A practical review of all relevant literature in PubMed concerning the mechanics of ventral hernia repairs and the forces involved was conducted in August 2023.

Results: Of the 598 full-text publications retrieved, 29 satisfied inclusion criteria. Among these, 5 articles included enough numeric data for a quantitative analysis of the ultimate tensile strength of the layers of the abdominal wall.

Conclusions: The utilization of mesh in ventral hernia repairs is recommended to strengthen weakened abdominal wall tissue. It is essential to primarily close the anterior sheath with a robust mesh-tissue overlap to promote "load-sharing" between the mesh and the abdominal wall. This approach reduces mesh deformity and stress on fixation points, leading to lower hernia recurrence rates. Minimizing mesh fixation (when placed in the retromuscular plane) can reduce postoperative pain and hospital stay without significantly affecting hernia recurrence. Orienting mesh according to abdominal anisotropy is crucial for reducing mesh stiffness, improving healing, and preventing recurrence. Future studies with advanced computer modeling will continue to provide further insights into mesh biomechanics and abdominal wall healing.