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Frankfurt Surgeons Pioneer Novel Hernia Repair Using Patient’s Own Tendon, Potentially Offering safer Alternative to Mesh
FRANKFURT, Germany – In a groundbreaking progress that could revolutionize hernia and uterine prolapse surgery, doctors at the Frankfurt Citizens’ Hospital have successfully performed the world’s first hernia repair using a patient’s own thigh tendon instead of synthetic mesh. The innovative procedure, developed collaboratively between gynecological surgeon Amadeus Hornemann and general surgeon Fabian Helfritz, offers a potentially safer, more biocompatible alternative to customary mesh repairs, which have been linked to complications such as chronic pain, infection, and even autoimmune reactions.
The serendipitous collaboration began in 2020,when Hornemann and Helfritz crossed paths at a Frankfurt playground. Hornemann, then a senior physician at the University Clinic Mannheim, had already pioneered a procedure called Hott-Stapp (Hornemann Tendon Transplantation) for uterine prolapse repair, utilizing a thigh tendon to support the uterus without the use of mesh.“At the sight of the tendon on the operating table, the gynecologist came up with the thought of using such a tendon as a support even when lowering a uterus and thus replacing the controversial plastic nets used so far,” Hornemann explained.He has as performed the Hott procedure on over 600 women.
During the playground meeting, Hornemann wondered weather the tendon technique could be applied to hernia repair, a field where Helfritz, chief physician of the Clinic for General and Visceral Surgery at the Bürgerhospital, has extensive experience. Every year, more than 1,000 break operations are carried out at the Frankfurt Citizens’ Hospital
Hernias, characterized by the protrusion of tissue through weak spots in the abdominal wall, affect millions globally. Inguinal hernias, specifically, are a common ailment, with the risk factors including weakness of binding tissue and muscles in the abdominal wall, heavy wear or chronic cough. “Most of them notice in the shower or if it suddenly makes a strenuous job, which is a very unpleasant feeling. This is usually only the last moment when the rest tears,” helfritz said.
Helfritz embraced the idea, leading to Hornemann’s transfer to the Bürgerhospital to head the newly established Clinic for Operative Gynecology. Together, they refined the technique for hernia repair. On October 30, 2024, they performed the first-of-its-kind surgery, utilizing a patient’s own thigh tendon to reinforce the weakened abdominal wall.
The procedure involves harvesting a 25-30 centimeter tendon from the patient’s thigh through a small incision. the tendon is then processed to create a mesh-like structure. “Here the treatment of burns or larger wounds served as a model in which the lack of skin through skin transplants of healthy parts of the body – technical concept: split skin – can be replaced,which is rotated through a roller knife roller and thus brings into a network structure,” Helfritz explains. This “tendon-mesh” is then implanted during a minimally invasive procedure to buttress the hernia defect. To provide initial support,a resorbable plastic mesh is also used,which dissolves over several months as the tendon tissue integrates into the surrounding tissue and provides long-term strength.The key advantage of the tendon-based approach lies in its biocompatibility. “Tendons are of their own tissue, which is much better tolerated by the body than plastic nets, which, along with foreign body feeling or pain, can also lead to fistula formation, infections or smoldering inflammation,” Hornemann notes. He also suggests that “rheumatism appears significantly more often in people with implanted plastic networks.”
While the Frankfurt team is eager about the potential of this new method,they acknowledge that further research is needed to fully evaluate its long-term efficacy and safety. The procedure is currently being studied as part of a Dr.Senckenbergische Foundation-funded medical study at the Bürgerhospital. The hospital continues to offer traditional mesh repair options.
One potential counterargument is the learning curve and complexity associated with harvesting and processing the tendon. Surgeons need to be skilled in both tendon harvesting and minimally invasive hernia repair techniques.This could limit the initial adoption of the procedure until more surgeons are trained. However, the potential benefits of reduced complications and improved patient outcomes may incentivize wider adoption over time.
The development comes at a time of increasing scrutiny of synthetic mesh in surgical procedures.In the United States, the FDA has issued warnings about potential complications associated with mesh used in hernia repair, and numerous lawsuits have been filed by patients alleging injuries related to mesh implants. Should tendon-based repairs prove superior long-term, it could signal a paradigm shift in surgical approaches to hernia and prolapse treatment.
FAQ: Tendon-Based Hernia Repair
What are the benefits of using a tendon instead of mesh for hernia repair? the primary benefit is improved biocompatibility, reducing the risk of foreign body reactions, chronic pain, and infection. “Tendons are of their own tissue, which is much better tolerated by the body than plastic nets,” says Hornemann.
Is the procedure minimally invasive? Yes,the tendon is shaped to the network and then used for a minimal invasive intervention for the treatment of the break.
Will I experience any functional limitations after having a tendon removed from my thigh? No, according to Hornemann, “the lack of tissue in the thigh is independently regenerated that the loss of the tendon does not lead to restrictions.”
Can women get inguinal hernias too? Yes, but an inguinal hernia is more common among men.
* Is this procedure widely available in the United States? Not yet. The procedure is pioneered and being studied in Frankfurt; however,with additional study and training,it may someday be adopted in the U.S.
