{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T21:15:10Z","timestamp":1790716510221,"version":"4.1.0"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2024,5,18]],"date-time":"2024-05-18T00:00:00Z","timestamp":1715990400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,5,18]],"date-time":"2024-05-18T00:00:00Z","timestamp":1715990400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100017515","name":"Heidelberger Stiftung Chirurgie","doi-asserted-by":"publisher","award":["2021\/444"],"award-info":[{"award-number":["2021\/444"]}],"id":[{"id":"10.13039\/501100017515","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100018936","name":"Universit\u00e4tsklinikum Heidelberg","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100018936","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Hernia"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Purpose<\/jats:title>\n                <jats:p>We studied the effectiveness of biomechanically calculated abdominal wall reconstructions for incisional hernias of varying complexity in an open, prospective observational registry trial.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>From July 1st, 2017 to December 31st, 2020, four hospitals affiliated with the University of Heidelberg recruited 198 patients with complex incisional hernias. Hernias were repaired using biomechanically calculated reconstructions and materials classified on their gripping force towards cyclic load. This approach determines the required strength preoperatively based on the hernia size, using the Critical Resistance to Impacts related to Pressure. The surgeon is supported in reliably determining the Gained Resistance, which is based on the mesh-defect-area-ratio, as well as other mesh and suture factors, and the tissue stability. Tissue stability is defined as a maximum distension of 1.5\u00a0cm upon a Valsalva maneuver. In complex cases, a CT scan of the abdomen can be used to assess unstable tissue areas both at rest and during Valsalva\u2019s maneuver.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Larger and stronger gripping meshes were required for more complex cases to achieve a durable repair, especially for larger hernia sizes. To achieve durable repairs, the number of fixation points increased while the mesh-defect area ratio decreased. Performing these repairs required more operating room time. The complication rate remained low. Less than 1% of recurrences and low pain levels were observed after 3\u00a0years.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Biomechanical stability, defined as the resistance to cyclic load, is crucial in preventing postoperative complications, including recurrences and chronic pain.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s10029-024-03064-2","type":"journal-article","created":{"date-parts":[[2024,5,18]],"date-time":"2024-05-18T09:02:07Z","timestamp":1716022927000},"page":"913-924","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Three-year follow-up of the grip concept: an open, prospective, observational registry study on biomechanically calculated abdominal wall repair for complex incisional hernias"],"prefix":"10.1007","volume":"28","author":[{"given":"R.","family":"Nessel","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T.","family":"L\u00f6ffler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Rinn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4657-9938","authenticated-orcid":false,"given":"F.","family":"Kallinowski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,5,18]]},"reference":[{"key":"3064_CR1","doi-asserted-by":"publisher","first-page":"1239","DOI":"10.1093\/bjs\/znac302","volume":"109","author":"EB Deerenberg","year":"2022","unstructured":"Deerenberg EB, Henriksen NA, Antoniou GA, Antoniou SA, Bramer WM, Fischer JP, Fortelny RH, G\u00f6k H, Harris HW, Hope W, Horne CM, Jensen TK, K\u00f6ckerling F, Kretschmer A, L\u00f3pez-Cano M, Malcher F, Shao JM, Slieker JC, de Smet GHJ, Stabilini C, Torkington J, Muysoms FE (2022) Updated guideline for closure of abdominal wall incisions from the European and American Hernia Societies. Br J Surg 109:1239\u20131250. https:\/\/doi.org\/10.1093\/bjs\/znac302","journal-title":"Br J Surg"},{"key":"3064_CR2","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1007\/s10029-020-02263-x","volume":"25","author":"H Hoffmann","year":"2021","unstructured":"Hoffmann H, K\u00f6ckerling F, Adolf D, Mayer F, Weyhe D, Reinpold W, Fortelny R, Kirchhoff P (2021) Analysis of 4,015 recurrent incisional hernia repairs from the Herniamed registry: risk factors and outcomes. Hernia 25:61\u201375. https:\/\/doi.org\/10.1007\/s10029-020-02263-x","journal-title":"Hernia"},{"key":"3064_CR3","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1007\/s10029-023-02897-7","volume":"28","author":"C Lesch","year":"2024","unstructured":"Lesch C, Nessel R, Adolf D, Hukauf M, K\u00f6ckerling F, Kallinowski F, STRONGHOLD, Herniamed-Collaborators GROUP; Willms A, Schwab R, Zarras K, (2024) STRONGHOLD first-year results of biomechanically calculated abdominal wall repair: a propensity score matching. Hernia 28:63\u201373. https:\/\/doi.org\/10.1007\/s10029-023-02897-7","journal-title":"Hernia"},{"key":"3064_CR4","doi-asserted-by":"publisher","first-page":"105253","DOI":"10.1016\/j.clinbiomech.2020.105253","volume":"82","author":"F Kallinowski","year":"2021","unstructured":"Kallinowski F, Ludwig Y, L\u00f6ffler T, Vollmer M, L\u00f6sel PD, Vo\u00df S, G\u00f6rich J, Heuveline V, Nessel R (2021) Biomechanics applied to incisional hernia repair - Considering the critical and the gained resistance towards impacts related to pressure. Clin Biomech (Bristol, Avon) 82:105253. https:\/\/doi.org\/10.1016\/j.clinbiomech.2020.105253","journal-title":"Clin Biomech (Bristol, Avon)"},{"key":"3064_CR5","doi-asserted-by":"publisher","DOI":"10.3389\/fsurg.2021.764470","volume":"8","author":"R Nessel","year":"2021","unstructured":"Nessel R, L\u00f6ffler T, Rinn J, L\u00f6sel P, Voss S, Heuveline V, Vollmer M, G\u00f6rich J, Ludwig YM, Al-Hileh L, Kallinowski F (2021) Primary and recurrent repair of incisional hernia based on biomechanical considerations to avoid mesh-related complications. Front Surg 8:764470. https:\/\/doi.org\/10.3389\/fsurg.2021.764470","journal-title":"Front Surg"},{"key":"3064_CR6","unstructured":"Herniamed Qualit\u00e4tssicherungsstudie. Datenschutzrechtliche Aufkl\u00e4rung und Einwilligung inkl. Information gem. Art.13 DS-GVO und Information \u00fcber die wesentlichen Inhalte der Vereinbarung \u00fcber die gemeinsame Verantwortlichkeit nach Art. 26 Abs. 2 S.2 der DS-GVO (2022). Available at https:\/\/www.herniamed.de\/sites\/default\/files\/Einwilligungserklaerung.pdf"},{"key":"3064_CR7","first-page":"1006","volume":"2","author":"F Kallinowski","year":"2020","unstructured":"Kallinowski F, Nessel R, Gorich J, Grimm A, Loffler T (2020) CT Abdomen with Valsalva\u2019s maneuver facilitates grip-based incisional hernia repair. J Abdom Wall Reconstr. 2:1006","journal-title":"J Abdom Wall Reconstr."},{"key":"3064_CR8","doi-asserted-by":"publisher","DOI":"10.48550\/arXiv.2307.01502","author":"JJ Relle","year":"2023","unstructured":"Relle JJ, Vo\u00df S, Raschidi R, Nessel R, G\u00f6rich J, Wielp\u00fctz MO, L\u00f6ffler T, Heuveline V, Kallinowski F, L\u00f6sel PD (2023) HEDI: First-Time Clinical Application and Results of a Biomechanical Evaluation and Visualisation Tool for Incisional Hernia Repair. Preprint at  arXiv.2307.01502","journal-title":"Nat Commun Med"},{"key":"3064_CR9","doi-asserted-by":"publisher","first-page":"78","DOI":"10.3389\/fsurg.2017.00078","volume":"4","author":"F Kallinowski","year":"2018","unstructured":"Kallinowski F, Harder F, Gutjahr D, Raschidi R, Silva TG, Vollmer M, Nessel R (2018) Assessing the GRIP of ventral hernia repair: How to securely fasten dis classified meshes. Front Surg 4:78. https:\/\/doi.org\/10.3389\/fsurg.2017.00078","journal-title":"Front Surg"},{"key":"3064_CR10","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1016\/j.jmbbm.2017.05.008","volume":"74","author":"CR Deeken","year":"2017","unstructured":"Deeken CR, Lake SP (2017) Mechanical properties of the abdominal wall and biomaterials utilized for hernia repair. J Mech Behav Biomed Mater 74:411\u2013427. https:\/\/doi.org\/10.1016\/j.jmbbm.2017.05.008","journal-title":"J Mech Behav Biomed Mater"},{"key":"3064_CR11","doi-asserted-by":"publisher","first-page":"4936","DOI":"10.1038\/s41598-023-31674-w","volume":"13","author":"A Karrech","year":"2023","unstructured":"Karrech A, Ahmad H, Hamdorf JM (2023) Biomechanical stability of hernia-damaged abdominal walls. Sci Rep 13:4936. https:\/\/doi.org\/10.1038\/s41598-023-31674-w","journal-title":"Sci Rep"},{"key":"3064_CR12","doi-asserted-by":"publisher","DOI":"10.3389\/fsurg.2021.763957","volume":"8","author":"F Kallinowski","year":"2021","unstructured":"Kallinowski F, Ludwig Y, Gutjahr D, Gerhard C, Schulte-H\u00f6rmann H, Krimmel L, Lesch C, Uhr K, L\u00f6sel P, Vo\u00df S, Heuveline V, Vollmer M, G\u00f6rich J, Nessel R (2021) Biomechanical influences on mesh-related complications in incisional hernia repair. Front Surg 8:763957. https:\/\/doi.org\/10.3389\/fsurg.2021.763957","journal-title":"Front Surg"},{"key":"3064_CR13","doi-asserted-by":"publisher","first-page":"12197","DOI":"10.1073\/pnas.1222787110","volume":"110","author":"S M\u00fcnster","year":"2013","unstructured":"M\u00fcnster S, Jawerth LM, Leslie BA, Weitz JI, Fabry B, Weitz DA (2013) Strain history dependence of the nonlinear stress response of fibrin and collagen networks. Proc Natl Acad Sci USA 110:12197\u201312202. https:\/\/doi.org\/10.1073\/pnas.1222787110","journal-title":"Proc Natl Acad Sci USA"},{"key":"3064_CR14","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmbbm.2020.103639","volume":"104","author":"A Ristaniemi","year":"2020","unstructured":"Ristaniemi A, Torniainen J, Stenroth L, Finnil\u00e4 MAJ, Paakkonen T, T\u00f6yr\u00e4s J, Korhonen RK (2020) Comparison of water, hydroxyproline, uronic acid and elastin contents of bovine knee ligaments and patellar tendon and their relationships with biomechanical properties. J Mech Behav Biomed Mater 104:103639. https:\/\/doi.org\/10.1016\/j.jmbbm.2020.103639","journal-title":"J Mech Behav Biomed Mater"},{"key":"3064_CR15","doi-asserted-by":"publisher","first-page":"21","DOI":"10.20517\/2574-1225.2023.21","volume":"7","author":"R Nessel","year":"2023","unstructured":"Nessel R, Lesch C, Vollmer M, Kallinowsk F (2023) Biomechanical principles of a permanently durable abdominal wall reconstruction: current status and potential future development. Mini-invasive Surg 7:21. https:\/\/doi.org\/10.20517\/2574-1225.2023.21","journal-title":"Mini-invasive Surg"},{"key":"3064_CR16","doi-asserted-by":"publisher","first-page":"26","DOI":"10.3390\/bioengineering9010026","volume":"9","author":"SNSH Chittajallu","year":"2022","unstructured":"Chittajallu SNSH, Richhariya A, Tse KM, Chinthapenta V (2022) A Review on damage and rupture modelling for soft tissues. Bioengineering 9:26. https:\/\/doi.org\/10.3390\/bioengineering9010026","journal-title":"Bioengineering"},{"key":"3064_CR17","doi-asserted-by":"publisher","first-page":"565","DOI":"10.1007\/s10029-022-02704-9","volume":"27","author":"OE Aly","year":"2023","unstructured":"Aly OE (2023) Addressing parastomal herniation through biomechanical simulation. Hernia 27:565\u2013573. https:\/\/doi.org\/10.1007\/s10029-022-02704-9","journal-title":"Hernia"},{"key":"3064_CR18","doi-asserted-by":"publisher","first-page":"1929","DOI":"10.1007\/s00464-017-5886-1","volume":"32","author":"JS Roth","year":"2018","unstructured":"Roth JS, Anthone GJ, Selzer DJ, Poulose BK, Bittner JG, Hope WW, Dunn RM, Martindale RG, Goldblatt MI, Earle DB, Romanelli JR, Mancini GJ, Greenberg JA, Linn JG, Parra-Davila E, Sandler BJ, Deeken CR, Voeller GR (2018) Prospective evaluation of poly-4-hydroxybutyrate mesh in CDC class I\/high-risk ventral and incisional hernia repair: 18-month follow-up. Surg Endosc 32:1929\u20131936. https:\/\/doi.org\/10.1007\/s00464-017-5886-1","journal-title":"Surg Endosc"},{"key":"3064_CR19","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1177\/1457496919863943","volume":"109","author":"P Petersson","year":"2020","unstructured":"Petersson P, Montgomery A, Petersson U (2020) Modified peritoneal flap hernioplasty versus retromuscular technique for incisional hernia repair: a retrospective Cohort study. Scand J Surg 109:279\u2013288. https:\/\/doi.org\/10.1177\/1457496919863943","journal-title":"Scand J Surg"},{"key":"3064_CR20","doi-asserted-by":"publisher","first-page":"3073","DOI":"10.1007\/s00464-022-09486-2","volume":"37","author":"M Katzen","year":"2023","unstructured":"Katzen M, Ayuso SA, Sacco J, Ku D, Scarola GT, Kercher KW, Colavita PD, Augenstein VA, Heniford BT (2023) Outcomes of biologic versus synthetic mesh in CDC class 3 and 4 open abdominal wall reconstruction. Surg Endosc 37:3073\u20133083. https:\/\/doi.org\/10.1007\/s00464-022-09486-2","journal-title":"Surg Endosc"},{"key":"3064_CR21","doi-asserted-by":"publisher","first-page":"85","DOI":"10.3390\/bioengineering10010085","volume":"10","author":"D Saul","year":"2023","unstructured":"Saul D, Menger MM, Ehnert S, N\u00fcssler AK, Histing T, Laschke MW (2023) Bone healing gone wrong: pathological fracture healing and non-unions-overview of basic and clinical aspects and systematic review of risk factors. Bioengineering (Basel) 10:85. https:\/\/doi.org\/10.3390\/bioengineering10010085","journal-title":"Bioengineering (Basel)"},{"key":"3064_CR22","unstructured":"Kallinowski F (2022) Biomechanics of mesh repair of the herniated abdominal wall: requires some knowledge of stochastic processes. https:\/\/websurg.com\/doi\/lt03en24558. Accessed 16 Mar 2022"},{"issue":"1\u201315","key":"3064_CR23","doi-asserted-by":"publisher","first-page":"vii","DOI":"10.1016\/j.suc.2007.10.007","volume":"88","author":"MG Franz","year":"2008","unstructured":"Franz MG (2008) The biology of hernia formation. Surg Clin North Am 88(1\u201315):vii. https:\/\/doi.org\/10.1016\/j.suc.2007.10.007","journal-title":"Surg Clin North Am"},{"key":"3064_CR24","doi-asserted-by":"publisher","first-page":"24","DOI":"10.3389\/fsurg.2015.00024","volume":"2","author":"F K\u00f6ckerling","year":"2015","unstructured":"K\u00f6ckerling F, Koch A, Lorenz R, Schug-Pass C, Stechemesser B, Reinpold W (2015) How long do we need to follow-up our hernia patients to find the real recurrence rate? Front Surg 2:24. https:\/\/doi.org\/10.3389\/fsurg.2015.00024","journal-title":"Front Surg"},{"key":"3064_CR25","doi-asserted-by":"publisher","unstructured":"Zamkowski M, Tomaszewska A, Lubowiecka I, \u015amieta\u0144ski M (2023) Biomechanical causes for failure of the Physiomesh\/Securestrap system. Sci Rep 13: 17504. https\/doi.org\/https:\/\/doi.org\/10.1038\/s41598-023-44940-8","DOI":"10.1038\/s41598-023-44940-8"}],"container-title":["Hernia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10029-024-03064-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10029-024-03064-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10029-024-03064-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,15]],"date-time":"2024-07-15T13:11:01Z","timestamp":1721049061000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10029-024-03064-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,18]]},"references-count":25,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2024,6]]}},"alternative-id":["3064"],"URL":"https:\/\/doi.org\/10.1007\/s10029-024-03064-2","relation":{},"ISSN":["1248-9204"],"issn-type":[{"value":"1248-9204","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,18]]},"assertion":[{"value":"14 January 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 April 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 May 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The studies for computed tomography at rest and during Valsalva maneuver were reviewed and approved by the Ethics Committee of the Heidelberg University vote S-522\/2020. STRONGHOLD as part of the HERNIAMED registry complies with the Declaration of Consent of the HERNIAMED database [<u>amedHernie; 6<\/u>]. The Herniamed Registry has ethical approval (BASEC Nr. 2016-00123, 287\/2017BO2\/F-2022-111). The patients\/participants provided their written informed consent to participate in the respective study\u00a0in accordance with the national legislation and the institutional requirements.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"The patients\/participants provided their\nwritten informed consent to participate in the respective study in accordance with the national legislation and the\ninstitutional requirements.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"The institution of FK recieved honoraria for lectures or educational events from Medtronic\u00ae and Becton Dickinson\u00ae,\nsupport for attending meetings by Becton Dickinson\u00ae and Dahlhausen\u00ae and receipt of equipment and materials from\nDahlhausen\u00ae and Corza\u00ae medical, Germany. The other authors have no conflict of interests to disclose.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interests"}}]}}