Dear reader,
The topic of "mesh" is raised again and again and questions arise that go deep into the surgical techniques and possible risks. This is a broad area, but I would like to try to explain such topics to you in a condensed manner.
The use of mesh has its origins in hernia surgery, or more simply, the surgery of holes mainly in the body. There are inguinal hernias, umbilical hernias, femoral hernias, scar hernias, abdominal wall hernias and also diaphragmatic hernias. The term "hernia" has a long history, because 200 years ago the so-called "hernia cutters" traveled around the country and operated on inguinal hernias without anesthesia on tied-up patients. A terrible undertaking for both the patient and the hernia cutter. Nobody wanted to have an operation and only when it was simply no longer possible and the hernia was too large or even trapped did they entrust their surgical colleagues.
New technical developments made it possible to weave plastic threads into a latticework, a net. It became possible not only to sew up holes, which was painful, but also to simply cover them with a net and thus heal the patient. After initial difficulties, truly serious complications and discussions between opponents and supporters of the net technology, the procedure prevailed.
Conclusion: A net is ideal for compensating for and stabilizing weak spots in the body. However, you have to know the effect and behavior of a net in the body and take into account the anatomy and function of the surgical area.
But back to the diaphragm. You will have noticed that hernias are generally lumped together: inguinal hernia, umbilical hernia, incisional hernia and unfortunately also diaphragmatic hernia. But the diaphragmatic hernia is anatomically and functionally completely different from all other hernias! With a diaphragmatic hernia, it is not about closing a hole, but about reconstructing a function! You can even feel or see that the stomach in the diaphragm has bulged a little into the chest cavity, as with an inguinal hernia. It is not bad or even dangerous. But what we clearly feel is the associated loss of function with heartburn, coughing, belching, etc.!
This means that we cannot simply transfer the techniques of inguinal hernia surgery to the diaphragm and hope that it will somehow help! That will not work! Because all nets used in inguinal hernia surgery are 2-dimensional and are glued to the diaphragm like postage stamps, anchored with metal staples or even wrapped around the esophagus. This creates dangerous contact between the often large nets, which are up to 15x10cm in size, and the liver, stomach and esophagus. Attaching such nets can cause life-threatening injuries. Well-known surgeons in Germany have even simply cut out the troublesome left lobe of the liver from its anchorage in order to be able to place these huge nets on the diaphragm somehow. The procedures in which the nets are wrapped around the esophagus have the worst consequences. Irreparable damage to the wall of the esophagus and subsequent organ removal are known to occur.
These and many other problems have been a problem in diaphragm surgery for decades. Is it any wonder that internists, general practitioners and even responsible surgeons cringe and see red when they hear the word "mesh"? No, because they have all certainly had to care for patients who have suffered or are still suffering from the consequences of surgical procedures that were initially highly praised but later discarded.
But what is the difference to the network in the l.oe.hde process?
The DeltaMesh follows a completely new mesh concept that I developed specifically for the hiatal hernia. The basis for this was our new findings on the function of the esophagus and hiatus and the knowledge of the anatomical peculiarity of the diaphragm.
The DeltaMesh principle is based on restoring the internal stability of the muscles and the mesh has been precisely adapted to the spatial structure of the hiatus in the body. The 3-dimensional mesh structure enables the deep 2-axis embedding of the torn, delicate diaphragm muscles.
The crucial central bar induces an active impact-on-impact muscle fusion with the highest stability, especially in relation to the bilateral and axial force vectors that prevail here. The forces of sutures that penetrate through are absorbed by the protective rear wings of the DeltaMesh. The DeltaMesh is designed exclusively for the fusion of the so-called "target tissue", i.e. the small diaphragm muscles as the target tissue, and therefore leaves out other tissue structures.
Therefore, it remains small and measures only 2-3cm, not 15x10cm(!) like other nets. The DeltaMesh lies outside the abdominal cavity without contact with the stomach and intestines. It also does not require any special fastening, such as with dangerous staplers or adhesives, but is pulled into its diaphragmatic bed by the normal sutures of the l.oe.hde procedure. It is therefore impossible for it to tear out.
The special delta shape is designed for the attacking force vectors in the hiatus. As a result, the DeltaMesh does not cover a hole, as is usually the case in hernia surgery, but rather strengthens the internal stability of the muscles as a kind of aid to self-help. Therefore, the DeltaMesh with the l.oe.hde procedure cannot be thrown into the same big "pot" as conventional mesh implants.
I am often asked whether the l.oe.hde procedure can be performed without DeltaMesh. Yes, it can, and every patient would be just as healthy as everyone else afterwards. Sutures alone cannot withstand the heavy loads in the hiatus in the long term. Recurrence would be inevitable.
Therefore, every broken diaphragm must be helped to become stronger and more stable than ever before. Only then will it be able to successfully defend itself against all forces in the future. This is exactly the philosophy of the DeltaMesh that has been developed.
Dear reader, I hope I was able to present the dry content and background of the web application to you in a more vivid way, as it is of great importance in surgery.
Yours
Dr. med. Eckhard Löhde
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