Skip to main content
SpringerLink
Log in

Laparoscopic mechanical fixation devices: does firing angle matter?

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

A variety of permanent and absorbable tacks are available for mesh fixation during laparoscopic hernia repairs. Although manufacturers recommend deploying tacks perpendicular to the tissue, achieving this can sometimes be challenging. This study aimed to analyze comparatively the effects of angled deployment among commonly used tacks.

Methods

A piece of composite mesh was fixed to the peritoneal surface of a pig with a single tack fired at either a perpendicular (90°) or acute (30°) angle. A lap-shear test was performed to determine fixation strength. Two permanent tacks (a titanium spiral tack: Protack [PT]; and a hollow screw fastener: PermaFix [PF]) and three absorbable tackers (a solid screw: Absorbatack [AT]; a hollow screw fastener: SorbaFix [SF]; and a strap: SecurStrap [SS]) were challenged. A total of 16 samples were performed for each device at each angle. A nonabsorbable transfascial suture was used as a control condition.

Results

Transabdominal sutures had the maximum acute tensile strength (ATS) (29.9 ± 5.5 N). Protack at both 90° and 30° performed significantly better than absorbable tacks (p < 0.01). No significant difference was found among absorbable tacks at 90°. When the same construct was compared at different angles, SS and SF performance was not affected (p = 0.07 and 0.2, respectively). In contrast, PT and AT had significantly reduced fixation strength (p = 0.003 and 0.004, respectively). However, PT fired at an acute angle had fixation equal to that of absorbable tacks fired perpendicularly.

Conclusion

Transabdominal sutures performed better than tacks in the acute setting. No absorbable fixation device demonstrated superior efficacy within its class. Spiral titanium tacks provided better fixation than absorbable tacks at both perpendicular and acute angles. Moreover, titanium spiral tacks deployed at 30° performed equal to or better than absorbable tacks fired perpendicularly to the tissue. It appears that spiral titanium tacks should be strongly considered for cases in which perpendicular tack deployment cannot be achieved.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Mudge M, Hughes LE (1985) Incisional hernia: a 10 year prospective study of incidence and attitudes. Br J Surg 72:70–71

    Article  PubMed  CAS  Google Scholar 

  2. Millennium Research Group (2008) U.S. markets for soft tissue repair 2009. Millennium Research Group, Inc., Toronto

    Google Scholar 

  3. Ramshaw BJ, Esartia P, Schwab J, Mason EM, Wilson RA, Duncan TD, Miller J, Lucas GW, Promes J (1999) Comparison of laparoscopic and open ventral herniorrhaphy. Am Surg 65:827–831 (discussion 31–32)

    PubMed  CAS  Google Scholar 

  4. Pierce RA, Spitler JA, Frisella MM, Matthews BD, Brunt LM (2007) Pooled data analysis of laparoscopic vs open ventral hernia repair: 14 years of patient data accrual. Surg Endosc 21:378–386

    Article  PubMed  Google Scholar 

  5. Heniford BT, Park A, Ramshaw BJ, Voeller G (2000) Laparoscopic ventral and incisional hernia repair in 407 patients. J Am Coll Surg 190:645–650

    Article  PubMed  CAS  Google Scholar 

  6. Awad ZT, Puri V, LeBlanc K, Stoppa R, Fitzgibbons RJ Jr, Igbal A, Filipi CJ (2005) Mechanisms of ventral hernia recurrence after mesh repair and a new proposed classification. J Am Coll Surg 201:132–140

    Article  PubMed  Google Scholar 

  7. LeBlanc KA (2007) Laparoscopic incisional hernia repair: are transfascial sutures necessary? A review of the literature. Surg Endosc 21:508–513

    Article  PubMed  CAS  Google Scholar 

  8. Carbonell AM, Harold KL, Mahmutovic AJ, Hassan R, Matthews BD, Kercher KW, Sing RF, Heniford BT (2003) Local injection for the treatment of suture-site pain after laparoscopic ventral hernia repair. Am Surg 69:688–691 (discussion 91–92)

    PubMed  Google Scholar 

  9. Greenstein AJ, Nguyen SQ, Buch KE, Chin EH, Weber KJ, Divino CM (2008) Recurrence after laparoscopic ventral hernia repair: a prospective pilot study of suture versus tack fixation. Am Surg 74:227–231

    PubMed  Google Scholar 

  10. Wassenaar E, Schoenmaeckers E, Raymakers J, van der Palen J, Rakic S (2010) Mesh-fixation method and pain and quality of life after laparoscopic ventral or incisional hernia repair: a randomized trial of three fixation techniques. Surg Endosc 24:1296–1302

    Article  PubMed  Google Scholar 

  11. Melman L, Jenkins ED, Deeken CR, Brodt MD, Brown SR, Brunt LM, Eagon JC, Frisella M, Matthews BD (2010) Evaluation of acute fixation strength for mechanical tacking devices and fibrin sealant versus polypropylene suture for laparoscopic ventral hernia repair. Surg Innov 17:285–290

    Article  PubMed  Google Scholar 

  12. Byrd JF, Agee N, Swan RZ, Lau KN, Heath JJ, Mckillop IH, Sindram D, Martinie JB, Iannitti DA (2011) Evaluation of absorbable and permanent mesh fixation devices: adhesion formation and mechanical strength. Hernia 15:553–558

    Article  PubMed  CAS  Google Scholar 

  13. Cobb W, Carbonell AM, Novitsky YW, Matthews BD (2009) Central mesh failure with lightweight mesh: a cautionary note. In: Presented at the European Hernia Society annual meeting, Berlin, Germany, 2009

  14. Lerdsirisopon S, Frisella MM, Matthews BD, Deeken CR (2011) Biomechanical evaluation of potential damage to hernia repair materials due to fixation with helical titanium tacks. Surg Endosc 25:3890–3897

    Article  PubMed  Google Scholar 

  15. Cobb WS, Burns JM, Kercher KW, Matthews BD, Norton HJ, Heniford BT (2005) Normal intraabdominal pressure in healthy adults. J Surg Res 129:231–235

    Article  PubMed  Google Scholar 

  16. Heniford BT, Park A, Ramshaw BJ, Voeller G (2003) Laparoscopic repair of ventral hernias: nine years’ experience with 850 consecutive hernias. Ann Surg 238:391–399

    PubMed  Google Scholar 

  17. Sugerman H, Windsor A, Bessos M, Wolfe L (1997) Intraabdominal pressure, sagittal abdominal diameter, and obesity comorbidity. J Intern Med 241:71–79

    Article  PubMed  CAS  Google Scholar 

  18. Majercik S, Tsikitis V, Iannitti DA (2006) Strength of tissue attachment to mesh after ventral hernia repair with synthetic composite mesh in a porcine model. Surg Endosc 20:1671–1674

    Article  PubMed  CAS  Google Scholar 

  19. Reynvoet E, Berrevoet F, De Somer F, Vercauteren G, Vonoverbeke I, Chiers K, Troisi R (2012) Tensile strength testing for resorbable mesh fixation systems in laparoscopic ventral hernia repair. Surg Endosc. doi:10.1007/s00464-012-2224-4

    PubMed  Google Scholar 

Download references

Disclosures

Yuri W. Novitsky is a speaker for Lifecell and Davol and serves as a Consultant for Davol and Kensey Nash. Michael J. Rosen is a Speaker for Lifecell, and receives research support from Lifecell, Davol, W. I. Gore, and Cook. Emmanuel E. Sadava, David M. Krpata, Yue Gao, and Steve Schomisch have no conflicts of interest or financial ties to declare.

Author information

Authors and Affiliations

  1. Case Comprehensive Hernia Center, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106-5047, USA

    Emmanuel E. Sadava, David M. Krpata, Yue Gao, Steve Schomisch, Michael J. Rosen & Yuri W. Novitsky

Authors
  1. Emmanuel E. Sadava
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David M. Krpata
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yue Gao
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Steve Schomisch
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michael J. Rosen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yuri W. Novitsky
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yuri W. Novitsky.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sadava, E.E., Krpata, D.M., Gao, Y. et al. Laparoscopic mechanical fixation devices: does firing angle matter?. Surg Endosc 27, 2076–2081 (2013). https://doi.org/10.1007/s00464-012-2713-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-012-2713-6

Keywords

Search

Navigation