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Lesch et al. Mini-invasive Surg 2023;7:20 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2023.24

Original Article Open Access

Cyclic pulse loads generate the new concept in

abdominal wall reconstruction: suture closure

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Carolin Lesch 1 , Fabio Kugel , Katharina Uhr , Matthias Vollmer , Regine Nessel , Friedrich Kallinowski ,
René H. Fortelny 4
1
Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg 69120, Germany.
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Hamburg University of Technology, Biomechanics, Hamburg 21073, Germany.
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Visceral and Pediatric Surgery, Klinikum Am Gesundbrunnen, Heilbronn 74078, Germany.
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Fakultät für Medizin der Sigmund Freud PrivatUniversität, Freudplatz 3, Österreich.
Correspondence to: Carolin Lesch, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld
410, Heidelberg 69120, Germany. E-mail: carolin.lesch@stud.uni-heidelberg.de; carolesch@gmx.de
How to cite this article: Lesch C, Kugel F, Uhr K, Vollmer M, Nessel R, Kallinowski F, Fortelny RH. Cyclic pulse loads generate the
new concept in abdominal wall reconstruction: suture closure. Mini-invasive Surg 2023;7:20. https://dx.doi.org/10.20517/2574-
1225.2023.24
Received: 20 Mar 2023 First Decision: 11 May 2023 Revised: 24 May 2023 Accepted: 30 May 2023 Published: 8 Jun 2023
Academic Editors: Giulio Belli, Luca Gordini Copy Editor: Dong-Li Li Production Editor: Dong-Li Li

Abstract
Aim: Incisional hernias frequently occur after open abdominal surgery. Up to 30% of elective midline laparotomy
closures result in an incisional hernia. The properties of a safe abdominal wall reconstruction must be assessed
under lifelike conditions to obtain a realistic estimate of the durability. The interplay of the biomechanical qualities
determines the long-term stability of a repair. Various suture materials and techniques for optimal closure of the
abdominal wall are still under discussion. The results of this experimental study might significantly affect the active
discussion about optimal suturing techniques for median abdominal wall closure.

Methods: For this purpose, a bench test was developed that delivers repetitive cyclic pressure impacts to the
abdominal wall, simulating coughs. This allows the assessment of the reconstructed abdominal wall as a
compound. We used stiff porcine abdominal walls and elastic bovine flanks as model tissues. We chose two
different types of defects. Type one consisted of a 15 cm long medial incision, whereas for type two, a 5 cm circular
defect was added in the center of the incision. The incisions were solely sutured in large-bite (0.8-1.2 mm bites) or
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small-bite (0.5-0.8 mm bites) technique with Monomax or PDS sutures USP 2-0 or USP 1. The suture to wound
length (SWL) ratio had to exceed 4:1. After suturing, the tissues were subjected to repetitive cyclic loading on a
validated bench test.

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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