Surgical Endoscopy

, Volume 24, Issue 6, pp 1318–1324 | Cite as

Tensile strength and adhesion formation of mesh fixation systems used in laparoscopic incisional hernia repair

  • Christian HollinskyEmail author
  • Thomas Kolbe
  • Ingrid Walter
  • Anja Joachim
  • Simone Sandberg
  • Thomas Koch
  • Thomas Rülicke
  • Albert Tuchmann



Mesh tearoff from the tissue is the most common reason for hernia recurrence after hernia surgery involving the use of a synthetic mesh. Various fixation systems were critically compared in terms of their retention strength and the formation of adhesions.


In a prospective study with 25 Sprague–Dawley rats, two pieces of Parietex composite meshes measuring 2 × 3 cm were fixed intraperitoneally in a paramedian location. The randomized mesh fixation groups included transfascial fixed suture, ProTack, AbsorbaTack, and I-Clip. Of the 25 rats, 12 were killed and analyzed 1 week after implantation, with the remaining 13 rats killed and analyzed after 2 months. Adhesions observed at the time of mesh removal were measured according to an adhesion scoring system, and the fixation strengths of the individual fixation systems were tested. Additionally, the foreign body reaction to the mesh and fixation systems was measured as well as their potential degradation.


After 1 week, the retention strength of transfascial fixed suture was significantly higher (8.7 N/cm2) than that of ProTack (5.6 N/cm2) or AbsorbaTack (5.7 N/cm2). After 2 months, the retention strength had increased to 13.2 N/cm2 in the transfascial fixed suture group, which was significantly higher than in the ProTack (9.7 N/cm2) or AbsorbaTack (8.7 N/cm2) groups. In contrast, the mesh could be fixed with the I-Clip only in 56% of the cases, and then achieved rather poor retention strength. Adhesion was significantly greater in the ProTack group than in any of the other groups (p < 0.001). At 2 months, scanning electron microscopy showed only marginal degradation of the absorbable elements.


Suture fixation led to satisfactory attachment of the prosthesis. Additional widespread anchorage of the mesh was achieved with ProTack or AbsorbaTack. The feasibility and retention strength of the I-Clip were poor.


Absorbable fixation devices Hernia recurrence Laparoscopic hernia repair Mesh fixation 



Christian Hollinsky, Thomas Kolbe, Ingrid Walter, Anja Joachim, Simone Sandberg, Thomas Koch, Thomas Rülicke, and Albert Tuchmann have no conflicts of interest or financial ties to disclose.


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Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Christian Hollinsky
    • 1
    Email author
  • Thomas Kolbe
    • 2
    • 3
  • Ingrid Walter
    • 4
  • Anja Joachim
    • 5
  • Simone Sandberg
    • 1
  • Thomas Koch
    • 6
  • Thomas Rülicke
    • 7
  • Albert Tuchmann
    • 1
  1. 1.Department of SurgerySMZ FloridsdorfViennaAustria
  2. 2.Department of BiomodelsUniversity of Veterinary MedicineViennaAustria
  3. 3.Institut for Agrobiotechnology, University of Natural Resources and Applied Life SciencesTullnAustria
  4. 4.Vetomics Core Facility for ResearchInstitute of Histology and VetBioBank, University of Veterinary MedicineViennaAustria
  5. 5.Department of PathobiologyInstitute of Parasitology and Zoology, University of Veterinary MedicineViennaAustria
  6. 6.Institute of Materials Science and Technology, Vienna University of TechnologyViennaAustria
  7. 7.Institute of Laboratory Animal Science and Biomodels, University of Veterinary MedicineViennaAustria

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