Biomechanical Causes for Failure of The Physiomesh™/Securestrap™ System in IPOM procedure. Ex-vivo experimental study.

Abstract

Abstract BACKGROUND This study investigates the mechanical behavior of the Physiomesh™/Securestrap™ system, a hernia repair system used for IPOM procedures associated with high failure rates. MATERIAL AND METHODS The study involved conducting mechanical experiments and numerical simulations to investigate the mechanical behavior of the Physiomesh™/Securestrap™ system under pressure load. Uniaxial tension tests were conducted to determine the elasticity modulus of the Physiomesh™ in various directions and the strength of the mesh-tissue-staple junction. Ex-vivo experiments on porcine abdominal wall models were performed to observe the system's behavior under simulated intra-abdominal pressure load. Numerical simulations using finite element analysis were employed to support the experimental findings. RESULTS The results reveal nonlinearity, anisotropy, and non-homogeneity in the mechanical properties of the Physiomesh™, with stress concentration observed in the polydioxanone (PDO) strip. The mesh-tissue junction exhibited inadequate fixation strength, leading to staple pull-out or breakage. The ex-vivo models demonstrated failure under higher pressure loads. Numerical simulations supported these findings, revealing the reaction forces exceeding the experimentally determined strength of the mesh-tissue-staple junction. CONCLUSIONS The implications of this study extend beyond the specific case of the Physiomesh™/Securestrap™ system, providing insights into the mechanics of implant-tissue systems. By considering biomechanical factors, researchers and clinicians can make informed decisions to develop improved implants that mimic the mechanics of a healthy abdominal wall. This knowledge can contribute to better surgical outcomes and reduce complications in abdominal hernia repair and to avoid similar failures in future.