2026; 9(3): 26-42
DOI: 10.32114/CCI.2026.9.3.26.42
Published online: 2026-09-30 (first online 2026-09-23)
Dynamic mechanical events after completion of minimally invasive hernia repair: an overlooked determinant of surgical success.
Krystian Kisielewski [1]
,
Kryspin Mitura [1,2] .
[1] Department of General Surgery, Siedlce Hospital, Siedlce, Poland
[2] Faculty of Medical and Health Sciences, University in Siedlce, Siedlce, Poland
Abstract:
Abstract [EN] -
Technical success in minimally invasive hernia repair is traditionally assessed at the completion of surgery, assuming that the final intraoperative appearance accurately reflects the definitive state of the reconstruction. However, restoration of physiological loading immediately after surgery initiates a series of biomechanical events that may substantially alter repair behavior before biological tissue integration occurs. This narrative review introduces the concept of the Dynamic Post-Closure Phase (DPCP), defined as the interval between completion of abdominal wall reconstruction and establishment of a new physiological mechanical equilibrium. During this phase, loss of pneumoperitoneum, collapse of the preperitoneal space, visceral redistribution, restoration of respiratory mechanics, transient pressure peaks, and early mobilization continuously modify the mechanical environment of the repair. We propose that these events should be regarded as a unified biomechanical process rather than isolated postoperative phenomena. Based on this framework, the mechanical consequences of the DPCP, including alterations in mesh configuration, redistribution of fascial tension, evolution of tissue apposition, and cumulative mechanical loading, are discussed. We further reinterpret contemporary surgical techniques and perioperative management strategies as complementary methods of preserving mechanical stability throughout this biomechanical transition. Recognition of the Dynamic Post-Closure Phase provides a new conceptual framework linking operative reconstruction with postoperative mechanical loading. Viewing abdominal wall reconstruction as a dynamic rather than static process may improve interpretation of postoperative repair behavior, offer a unified explanation for previously disconnected clinical observations, and provide a foundation for future biomechanical research and optimization of abdominal wall reconstruction.
Streszczenie [PL] -
Sukces techniczny w małoinwazyjnym leczeniu przepuklin jest tradycyjnie oceniany po zakończeniu zabiegu, przy założeniu, że końcowy obraz śródoperacyjny wiernie odzwierciedla ostateczny stan rekonstrukcji. Jednakże przywrócenie fizjologicznego obciążenia bezpośrednio po operacji uruchamia szereg procesów biomechanicznych, które mogą istotnie zmienić zachowanie miejsca naprawy, zanim dojdzie do biologicznej integracji tkanek. Niniejszy przegląd piśmiennictwa wprowadza pojęcie dynamicznej fazy po zamknięciu (ang. *Dynamic Post-Closure Phase* – DPCP), definiowanej jako okres między zakończeniem rekonstrukcji powłok brzusznych a ustaleniem się nowej, fizjologicznej równowagi mechanicznej. W fazie tej utrata odmy otrzewnowej, zapadnięcie się przestrzeni przedotrzewnowej, redystrybucja narządów wewnętrznych, przywrócenie mechaniki oddychania, przejściowe skoki ciśnienia oraz wczesna mobilizacja pacjenta nieustannie modyfikują środowisko mechaniczne miejsca naprawy. Proponujemy, aby zdarzenia te traktować jako jednolity proces biomechaniczny, a nie jako odrębne zjawiska pooperacyjne. W oparciu o to podejście omówiono mechaniczne konsekwencje DPCP, w tym zmiany w konfiguracji siatki, redystrybucję napięcia powięzi, ewolucję wzajemnego ułożenia tkanek oraz skumulowane obciążenie mechaniczne. Ponadto dokonujemy reinterpretacji współczesnych technik chirurgicznych i strategii postępowania okołooperacyjnego jako metod uzupełniających się w zakresie utrzymania stabilności mechanicznej w trakcie tej przemiany biomechanicznej. Uwzględnienie dynamicznej fazy po zamknięciu dostarcza nowych ram koncepcyjnych, łączących rekonstrukcję operacyjną z pooperacyjnym obciążeniem mechanicznym. Postrzeganie rekonstrukcji powłok brzusznych jako procesu dynamicznego, a nie statycznego, może poprawić interpretację zachowania miejsca naprawy po zabiegu, pozwolić na jednolite wyjaśnienie dotychczas niespójnych obserwacji klinicznych oraz stanowić podstawę dla przyszłych badań biomechanicznych i optymalizacji technik rekonstrukcji powłok brzusznych.
Citation:
VANCOUVER FORMAT
Kisielewski K, Mitura K. Dynamic mechanical events after completion of minimally invasive hernia repair: an overlooked determinant of surgical success.
Crit Care Innov. 2026; 9(3): 26-42.
DOI: 10.32114/CCI.2026.9.3.26.42
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