DynaMesh®-CICAT
For repair and prophylaxis of abdominal wall hernia with extraperitoneal mesh position
and/or
For repair of umbilical hernia with extraperitoneal mesh position.
Abdominal wall hernia and Umbilical hernia
Optimally adapted tri-elasticity
Because of its tri-elasticity, which is adapted to the anatomical and biomechanical properties (dynamometry) of the human abdominal wall, DynaMesh®-CICAT provides the highest possible degree of patient comfort.
Optimal incorporation of the mesh
Following in-vivo incorporation, mesh implants have a tendency to “shrinkage”.DynaMesh®-CICAT has a high effective porosity of 61 %, enabling excellent incorporation of the mesh implant.Moreover, in the course of incorporation the use of the proven and highly biocompatible polymer PVDF contributes to a low degree of scarring.The optimal incorporation of the DynaMesh®-CICAT implant post-operatively,reduces the risk of shrinkage and recurrence.
The MILOS technique to repair abdominal wall and umbilical hernias with DynaMesh®-CICAT and EndoTORCH
- Skin incision 2 to max. 5 cm via hernial orifice (Fig. A).
- Display of hernial defect and preparation of the hernia sac.
- Optional: minimal opening of the hernia sac allowing for manual probing, followed by open or laparoscopic adhesiolysis.
- The peritoneum is freed up approx. 2 cm from the linea alba in a circular pattern and the posterior layer of the rectus muscle is freed.
- The posterior layer of the rectus muscle is opened laterally on both sides (instrument: EndoTORCH ) (Fig. B) about 1 cm from the medial border of the rectus muscle (Fig. C).
- Using long slim retractors and under endoscopic monitoring, the posterior layer of the rectus sheath is freed laparoscopically from the rectus muscle. In the midline endoscopically assisted dissection is performed in the preperitoneal plane: The peritoneum is freed up from the linea alba.
- The further totally extraperitoneal preparation is performed through the hernia, either under direct vision with laparoscopic instruments or with endoscopic assistance.
- The posterior layer of the rectus sheath generally remains open with a completely closed midline peritoneum.
- Placement and spreading of the DynaMesh®-CICAT mesh implant in the extraperitoneal cavity as a double roll and without skin contact.
- Closure of the hernia defect over the mesh implant under minimal tension (Fig. D).11. Fixation of the DynaMesh®-CICAT me
- Fixation of the DynaMesh®-CICAT mesh implant is only required if the hernia defect cannot be completely closed and there is bridging of the hernia defect.
more Information: https://milos-hernia-repair.com
Animation and video of entire procedure:
(en) – Animation & Operation:
MILOS OPERATION with DynaMesh®-CICAT (Dr. Reinpold)
Optimal handling
- The special anti-slip surface of the DynaMesh®-CICAT ensures the mesh stays in position and enables optimal handling.
- DynaMesh®-CICAT is marked with green lines, which indicate the required orientation (cranio-caudal)
- The light tube for the MILOS technique (Mini Less Open Sublay technique) was developed with Mr Wolfgang Reinpold, consultant at the Wilhelmsburger Groß-Sand Hospital, Hamburg, specially for laparoscopic-assisted treatment of abdominal wall hernias.
EndoTorch® – Light tube for MILOS technique (Mini Less Open Sublay technique)
Abdominal wall hernia
For repair and prophylaxis of abdominal wall hernia with extraperitoneal mesh position.
Umbilical hernia
For repair of umbilical hernia with extraperitoneal mesh position.
Umbilical hernia in PUMP technique with DynaMesh®-CICAT
– Preperitoneal Umbilical Mesh Plasty –
- Semi-circular infraumbilical skin incision
- The hernia sac or base of navel is dissected and encircled with a tape (Fig.2)
- Detachment of base of navel approx. 1 cm above the fascia by circular division of the hernia sac (Fig.3) – ATTENTION: Check contents of hernia sac
- Circular dissection of the peritoneum from the fascia (Fig.4)
- Closure of the peritoneum with continuous absorbable suture
- Adequate dissection of the preperitoneal cavity in all directions (Fig. 6)
- Digital check of the preperitoneal cavity
- Insertion and positioning of mesh on the peritoneum (subfascia) (Fig. 8)
- Digital check that the mesh position is fold-free
- Closure of the midline with continuous absorbable suture
- Fixation of the base of the navel to the fascia with absorbable interrupted suture
- Skin closure with absorbable interrupted sutures subcutaneously and intracutaneously
- Wound closure with steristrips
Animation and video of entire procedur:
(en) Animation & Operation:
Umbilical hernia in PUMP technique (Dr. Volmer)
A Danish register study was able to demonstrate that the risk of recurrence of small mesh-repaired umbilical hernias with hernia gaps ≤ 2 cm is 50% lower compared to repair with sutures.*
Preperitoneal Umbilical Mesh Plasty (PUMP technique) combined with the new DynaMesh®-CICAT 05 cm x 06 cm enables safe and efficient repair of small umbilical hernias with hernia gaps up to approximately 2 cm. The PUMP technique can also be used for larger defects with up to 4 cm hernia gap. DynaMesh®-CICAT 10 cm x 10 cm is available for such cases, cut to size during the procedure to fit the hernia gap.
* Christoffersen MW, Helgstrand F, Rosenberg J, Kehlet H, Strandfelt P, Bisgaard T:
Long-term recurrence and chronic pain after repair for small umbilical or epigastric hernias: a regional cohort study.
Am J Surg 2014. DOI: 10.1016/j.amjsurg.2014.05.021
| Product | DynaMesh®-CICAT | DynaMesh®-CICAT |
| Field of application | abdominal wal | umbilicus |
| Surgical approach | open / mini-open | open / mini-open |
| Surgical technique | MILOS | PUMP / MILOS |
| Mesh position | extraperitoneal (sublay/onlay/inlay) | extraperitoneal (subfascial / sublay) |
| Fixation | suture / bonding | none / suture / bonding |
| Optimal handling |
 |
|
| Optimal patient safety |
|
|
| Optimal patient comfort |
|
|
| Green line marker |
|
|
| Tri-elasticity |
|
|
| visible technology |
 |
|
Applies to all product sizes
Only applies to selected product sizes
| Polymer (monofilament) | PVDF |
| Excellent biocompatibility |
|
| Minimal foreign body reaction |
|
| Reduced bacterial adherence |
|
| High ageing resistance |
|
| Optimal dynamometrie |
|
| No scar plate formation |
|
| Reactive surface (a) [m²/m²] | 2.14 |
| Maximum stability (b) [N/cm] | 46 |
| Elasticity (b) at 16 N/cm [%] | 57 |
| Tear propagation resistance (c) [N] | 28 |
| Textile porosity (d) [%] | 66 |
| Effective porosity (d) [%] | 61 |
| Effective porosity at 2.5 N/cm (d) [%] | 57 |
| Classification (e) | 1a |
Applies to all product sizes
Legends for the technical data
(a) Ratio of implant reactive surface area (thread surface) to implant surface area (b) measured in the strip tensile test (c) modified trouser tear test (d) the Mühl method [6] (e) Klinge’s classification [8]
