Systems and methods for mesh augmentation and prevention of incisional hernia
Techniques for mesh augmentation and prevention of incisional hernia, including systems and methods for affixing mesh to a fascial incision. A mesh strip can be integrated with one or more uni-directional fasteners. Each fastener can include an anchoring mechanism adapted for affixation to anterior abdominal wall fascia and a mating interface. An applicator can include tension arms adapted to interface with the mating interfaces of the fasteners to maintain a vertical tension of the mesh strip and a handle coupled with the tension arms adapted to spread the tension arms and thereby control a horizontal tension of the mesh strip. The mesh strip can be configured to be aligned over a fascial incision using the applicator and affixed under tension to anterior abdominal wall fascia by tissue penetration of the anchoring mechanisms of the one or more fasteners.
1. A method for affixing mesh to a fascial incision to reinforce and augment hernia fascia closures, comprising:
aligning a mesh strip over the fascial incision using an applicator, the mesh strip being integrated with one or more uni-directional fasteners, each fastener including at least one anchoring mechanism adapted for affixation to anterior abdominal wall fascia and a mating interface, the applicator comprising a first tension arm and a second tension arm adapted to interface with the mating interfaces of the fasteners to maintain a vertical tension of the mesh strip and a handle coupled with the first and second tension arms adapted to spread the first and second tension arms;
controlling a first horizontal tension of the mesh strip when the mesh strip is placed on the fascial incision by using the handle to spread the first tension arm a first distance from the second tension arm, the first distance corresponding to the first horizontal tension of the mesh strip, wherein the first horizontal tension corresponds to a predetermined amount of horizontal tension applied to the mesh strip by the applicator without application of external force;
affixing the mesh strip under the vertical tension and the first horizontal tension to the anterior abdominal wall fascia by applying a force to the fasteners to thereby achieve tissue penetration of the at least one anchoring mechanism of the one or more fasteners; and incrementally tensioning the mesh strip placed on the fascial incision to reinforce the fascial incision by using the handle to spread the first tension arm from the second tension arm by a second distance that is greater than the first distance, wherein an incremental horizontal tension corresponds to the second distance, the incremental horizontal tension being greater than the first horizontal tension.
2. The method of claim 1 , wherein the force applied to the fasteners is mediated mechanically or electro-mechanically through the applicator and by interfacing with the mating interface of each fastener and transduced into the mesh strip to allow pre-tensioned application into the fascia.
3. The method of claim 1 , wherein the applicator further comprises a tensiometer configured to measure and display the horizontal tension of the mesh strip.
4. The method of claim 1 , wherein the applicator further comprises a spring to facilitate out of plane affixation of the mesh strip to the fascia.
5. The method of claim 4 , wherein the applicator has an omega shape, wherein the handle of the applicator comprises the spring.
6. The method of claim 1 , wherein the applicator further comprises an electro-mechanical actuator to affix the fasteners and the mesh strip to the fascia.