Page 42 - Read Online

Page 6 of 8 Nessel et al. Mini-invasive Surg 2023;7:21 https://dx.doi.org/10.20517/2574-1225.2023.21

[47]
Destructive testing under dry conditions is often performed to advance hernia repair . The force required
[48]
is usually more than one megapascal . Since this load is in excess of 7,500 mmHg, high-velocity shocks are
modeled. Such impacts simulate the feet-first passage of a parachutist through a roof. Under these
conditions, injuries to the lumbar spine and lower extremities predominate, with less than 2% trauma to the
abdominal wall . As shown above, cyclic pulse load simulating coughing or the Valsalva maneuver should
[49]
guide future endoscopic and other technical developments. Surgeons should take the opportunity to gain
knowledge about recent advances in basic and clinical research on the biomechanics of mesh repair of the
[50]
herniated abdominal wall . A recipe for the clinical application and practical examples are given in another
contribution in the Special Issue .
[18]
FUTURE DIRECTIONS
More materials need to be tested and classified with cyclic load. A future policy for market access of repair
material should include cyclic load bench testing. A tailored approach to incisional hernia repair should
consider biomechanical aspects.

DECLARATIONS
Acknowledgments
We thank Cristina Debellis, Personal Secretary, Department of General Surgery, University Heidelberg, for
consistently conducting the telephone interviews for the follow-up of patients in the last years. We thank
Angela Assing, Elena Baumann, Felix Harder, Yannik Ludwig, Axel Mahn, Donna Noeva, Ramesh Raschidi,
and Thiago da Silva for their valuable research assistance in Hamburg and Heidelberg.

Author’s contributions
Designed the project, gathered the funds, and conducted most of the experiments: Nessel R, Kallinowski F
Conducted the rest of the experiments or directed the laboratory work: Lesch C
Built and maintainance of the bench test: Vollmer M

Availability of data and materials
All research and patient data are achieved in the Department of Surgery, University Hospital of Heidelberg,
D-69120 Heidelberg, Germany, General and in the General, Visceral and Pediatric Surgery, SLK Klinikum
Am Gesundbrunnen, D-74078 Heilbronn, Germany. Upon request and in accordance with European and
German law regarding the disclosure, the data will be made available.

Financial support and sponsorship
Sources of funding for research: We thank for the financial support by the Heidelberger Stiftung Chirurgie
(grants 2016/22, 2017/171, 2018/215, 2019/288, 2020/376, 2021/444) and by Asklepios proresearch (projects
2173, 2805, 3115).

Conflicts of Interest
The corresponding author received financial and material support from Baxter, Becton Dickinson, Corza
Medical, Dahlhausen, Ethicon, FEG, GEM, Medtronic, Olympus, and PFM Medical based on a Third-
Party-Funding-Agreement with the Heidelberg University and/or Asklepios proresearch. The other authors
declare no conflict of interest.

Ethical approval and consent to participate
Animal tissue was used in the bench test studies. The use of the tissues was permitted by Bürgeramt
Veterinärwesen der Stadt Heidelberg according to European law with the permission DE 08 221 1018 21.
The studies involving human participants were reviewed and approved by the Ethics Committee of the