{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,2]],"date-time":"2025-11-02T12:03:35Z","timestamp":1762085015475,"version":"build-2065373602"},"reference-count":25,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2023,3,15]],"date-time":"2023-03-15T00:00:00Z","timestamp":1678838400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Donegal Clinical and Research Academy"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,4,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Incisional hernias occur after up to 40 per cent of laparotomies. Recent RCTs have demonstrated the role of prophylactic mesh placement in reducing the risk of developing an incisional hernia. An onlay approach is relatively straightforward; however, a variety of techniques have been described for mesh fixation. The biomechanical properties have not been interrogated extensively to date.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This ex vivo randomized controlled trial using porcine abdominal wall investigated the biomechanical properties of three techniques for prophylactic onlay mesh placement at laparotomy closure. A classical onlay, anchoring onlay, and novel bifid onlay approach were compared with small-bite primary closure. A biomechanical abdominal wall model and ball burst test were used to assess transverse stretch, bursting force, and loading characteristics.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Mesh placement took an additional 7\u201315 min compared with standard primary closure. All techniques performed similarly, with no clearly superior approach. The minimum burst force was 493 N, and the maximum 1053 N. The classical approach had the highest mean burst force (mean(s.d.) 853(152) N). Failure patterns fell into either suture-line or tissue failures. Classical and anchoring techniques provided a second line of defence in the event of primary suture failure, whereas the bifid method demonstrated a more compliant loading curve. All mesh approaches held up at extreme quasistatic loads.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Subtle differences in biomechanical properties highlight the strengths of each closure type and suggest possible uses. The failure mechanisms seen here support the known hypotheses for early fascial dehiscence. The influence of dynamic loading needs to be investigated further in future studies.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/bjs\/znad062","type":"journal-article","created":{"date-parts":[[2023,3,15]],"date-time":"2023-03-15T02:25:56Z","timestamp":1678847156000},"page":"568-575","source":"Crossref","is-referenced-by-count":2,"title":["Prophylactic onlay mesh placement techniques for optimal abdominal wall closure: randomized controlled trial in an <i>ex vivo<\/i> biomechanical model"],"prefix":"10.1093","volume":"110","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5097-4602","authenticated-orcid":false,"given":"Ian","family":"Stephens","sequence":"first","affiliation":[{"name":"Department of Surgery, Letterkenny University Hospital , Letterkenny , Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jack","family":"Conroy","sequence":"additional","affiliation":[{"name":"Donegal Clinical Research Academy, Letterkenny University Hospital , Letterkenny , Ireland"},{"name":"Trinity Centre for Bioengineering, Department of Mechanical, Manufacturing and Biomedical Engineering, Trinity College Dublin , Dublin , Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Des","family":"Winter","sequence":"additional","affiliation":[{"name":"Department of Surgery, St Vincent\u2019s University Hospital , Dublin , Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ciaran","family":"Simms","sequence":"additional","affiliation":[{"name":"Trinity Centre for Bioengineering, Department of Mechanical, Manufacturing and Biomedical Engineering, Trinity College Dublin , Dublin , Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Magda","family":"Bucholc","sequence":"additional","affiliation":[{"name":"EU INTERREG Centre for Personalized Medicine, Intelligent Systems Research Centre, School of Computing, Engineering and Intelligent Systems, Ulster University , Derry-Londonderry , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Sugrue","sequence":"additional","affiliation":[{"name":"Department of Surgery, Letterkenny University Hospital , Letterkenny , Ireland"},{"name":"Donegal Clinical Research Academy, Letterkenny University Hospital , Letterkenny , Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2023,3,15]]},"reference":[{"key":"2023112818163725300_znad062-B1","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1002\/bjs.9364","article-title":"Incisional hernia rate 3 years after midline laparotomy","volume":"101","author":"Fink","year":"2014","journal-title":"Br J Surg"},{"key":"2023112818163725300_znad062-B2","doi-asserted-by":"crossref","first-page":"874","DOI":"10.1016\/j.amjsurg.2020.03.027","article-title":"Incisional hernia repair surgery improves patient reported outcomes","volume":"219","author":"Manoharan","year":"2020","journal-title":"Am J Surg"},{"key":"2023112818163725300_znad062-B3","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1016\/j.amjsurg.2012.01.012","article-title":"Impact of incisional hernia on health-related quality of life and body image: a prospective cohort study","volume":"204","author":"van Ramshorst","year":"2012","journal-title":"Am J Surg"},{"key":"2023112818163725300_znad062-B4","doi-asserted-by":"crossref","first-page":"1497","DOI":"10.1002\/bjs.7137","article-title":"Randomized clinical trial of mesh versus sutured wound closure after open abdominal aortic aneurysm surgery","volume":"97","author":"Bevis","year":"2010","journal-title":"Br J Surg"},{"key":"2023112818163725300_znad062-B5","doi-asserted-by":"crossref","first-page":"1459","DOI":"10.1007\/s10029-021-02497-3","article-title":"Hybrid operation technique for incisional hernia repair: a systematic review and meta-analysis of intra- and postoperative complications","volume":"25","author":"Van den Dop","year":"2021","journal-title":"Hernia"},{"key":"2023112818163725300_znad062-B6","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1097\/00000658-200301000-00018","article-title":"Have outcomes of incisional hernia repair improved with time? 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