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Evaluation of absorbable mesh fixation devices at various deployment angles

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Abstract

Background

Hernia repair failure may occur due to suboptimal mesh fixation by mechanical constructs before mesh integration. Construct design and acute penetration angle may alter mesh-tissue fixation strength. We compared acute fixation strengths of absorbable fixation devices at various deployment angles, directions of loading, and construct orientations.

Methods

Porcine abdominal walls were sectioned. Constructs were deployed at 30°, 45°, 60°, and 90° angles to fix mesh to the tissue specimens. Lap-shear testing was performed in upward, downward, and lateral directions in relation to the abdominal wall cranial–caudal axis to evaluate fixation. Absorbatack™ (AT), SorbaFix™ (SF), and SecureStrap™ in vertical (SSV) and horizontal (SSH) orientations in relation to the abdominal wall cranial–caudal axis were tested. Ten tests were performed for each combination of device, angle, and loading direction. Failure types and strength data were recorded. ANOVA with Tukey–Kramer adjustments for multiple comparisons and χ 2 tests were performed as appropriate (p < 0.05 considered significant).

Results

At 30°, SSH and SSV had greater fixation strengths (12.95, 12.98 N, respectively) than SF (5.70 N; p = 0.0057, p = 0.0053, respectively). At 45°, mean fixation strength of SSH was significantly greater than SF (18.14, 11.40 N; p = 0.0002). No differences in strength were identified at 60° or 90°. No differences in strength were noted between SSV and SSH with different directions of loading. No differences were noted between SS and AT at any angle. Immediate failure was associated with SF (p < 0.0001) and the 30° tacking angle (p < 0.01).

Conclusions

Mesh-tissue fixation was stronger at acute deployment angles with SS compared to SF constructs. The 30° angle and the SF device were associated with increased immediate failures. Varying construct and loading direction did not generate statistically significant differences in the fixation strength of absorbable fixation devices in this study.

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References

  1. Turner, P.L., A.E. Park (2008) Laparoscopic repair of ventral incisional hernias: pros and cons. Surg Clin North Am 88(1):85–100, viii

  2. Stoikes, N., G.R. Voeller new developments in hernia repair: a 2013 update. Surg Technol Int XXIII

  3. Sanchez LJ, Bencini L, Moretti R (2004) Recurrences after laparoscopic ventral hernia repair: results and critical review. Hernia 8(2):138–143

    Article  CAS  PubMed  Google Scholar 

  4. Pierce RA et al (2007) Pooled data analysis of laparoscopic vs. open ventral hernia repair: 14 years of patient data accrual. Surg Endosc 21(3):378–386

    Article  PubMed  Google Scholar 

  5. Ramshaw B.J. et al. (1999) Comparison of laparoscopic and open ventral herniorrhaphy. Am Surg 65(9):827–31; discussion 831–2

  6. Kingsnorth A, LeBlanc K (2003) Hernias: inguinal and incisional. Lancet 362(9395):1561–1571

    Article  PubMed  Google Scholar 

  7. Awad ZT et al (2005) Mechanisms of ventral hernia recurrence after mesh repair and a new proposed classification. J Am Coll Surg 201(1):132–140

    Article  PubMed  Google Scholar 

  8. Ethicon Endo-Surgery, I. ETHICON SECURESTRAP™ Fixation Device. [Webpage] 2013 6/5/2013 [cited 2013 6/6/2013] http://www.ethicon.com/healthcare-professionals/products/hernia-solutions/ethicon-securestrap-fixation-device

  9. Sadava EE et al (2013) Laparoscopic mechanical fixation devices: does firing angle matter? Surg Endosc 27(6):2076–2081

    Article  PubMed  Google Scholar 

  10. Cardinale M.e.a. (2011) Comparison of Acute Holding Strength of an Absorbable Strap Fixation Device in Porcine Flank at Various Implantation Angles. (Report No. SEC-339-11-8/13). Ethicon. PDF File

  11. Carbonell A.M. et al. (2003) Local injection for the treatment of suture site pain after laparoscopic ventral hernia repair. Am Surg 69(8):688–91; discussion 691–2

  12. Asencio F et al (2009) Open randomized clinical trial of laparoscopic versus open incisional hernia repair. Surg Endosc 23(7):1441–1448

    Article  PubMed  Google Scholar 

  13. Carbajo MA et al (1999) Laparoscopic treatment vs open surgery in the solution of major incisional and abdominal wall hernias with mesh. Surg Endosc 13(3):250–252

    Article  CAS  PubMed  Google Scholar 

  14. Eriksen JR et al (2009) Pain, quality of life and recovery after laparoscopic ventral hernia repair. Hernia 13(1):13–21

    Article  CAS  PubMed  Google Scholar 

  15. Byrd JF et al (2011) Evaluation of absorbable and permanent mesh fixation devices: adhesion formation and mechanical strength. Hernia 15(5):553–558

    Article  CAS  PubMed  Google Scholar 

  16. Hollinsky C et al (2010) Tensile strength and adhesion formation of mesh fixation systems used in laparoscopic incisional hernia repair. Surg Endosc 24(6):1318–1324

    Article  PubMed  Google Scholar 

  17. Reynvoet E et al (2012) Tensile strength testing for resorbable mesh fixation systems in laparoscopic ventral hernia repair. Surg Endosc 26(9):2513–2520

    Article  PubMed  Google Scholar 

  18. Melman L et al (2010) Evaluation of acute fixation strength for mechanical tacking devices and fibrin sealant versus polypropylene suture for laparoscopic ventral hernia repair. Surg Innov 17(4):285–290

    Article  PubMed  Google Scholar 

  19. Cobb WS et al (2005) Normal intraabdominal pressure in healthy adults. J Surg Res 129(2):231–235

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank Mr. JB for statistical analyses. This study utilized the Research Electronic Data Capture® (REDCap®) application for data maintenance, which is supported at our institution by a Clinical and Translational Science Award (CTSA) (UL1TR000448), and a National Cancer Institute (NCI) Cancer Center Support Grant (P30CA091842). JC is supported by a KM1 Comparative Effectiveness Research (CER) Career Development Award (KM1CA156708) through the NCI of the National Institutes of Health (NIH); and our institutional CTSA program (UL1TR000448) through the National Center for Advancing Translational Sciences (NCATS) of the NIH. The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official views of the NCI, the NCATS, or the NIH.

Disclosures

This study was supported by a research grant from Ethicon®, Inc. (Somerville, NJ). AZ has received research grant funding for unrelated studies from the National Institutes of Health. JC has received research grant funding for unrelated studies from the National Institutes of Health, the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), and the American Hernia Society in collaboration with Davol® Incorporated; and has served as a one-time consultant for Guidepoint Global® Incorporated. MF has received funding from Atrium Medical Corporation® and W. L. Gore and Associates® Incorporated for unrelated service contracts; and research grant funding for unrelated studies from the Foundation for Barnes-Jewish Hospital. BM has served on advisory boards for Musculoskeletal Transplant Foundation, Covidien® Incorporated, and Synthes® Incorporated; has served as a consultant for Atrium Medical Corporation®; has received speaking fess or honoraria from Atrium Medical Corporation®, Davol® Incorporated, Ethicon® Incorporated, W.L. Gore and Associates® Incorporated; has received payments for authorship of an unrelated publication from McMahon Group® Incorporated; has received research grant funding for unrelated research studies from Covidien® Incorporated, Ethicon® Incorporated, Karl Storz Endoscopy America® Incorporated, Kensey Nash Corporation®, Musculoskeletal Transplant Foundation, Synovis Surgical Innovations®, the Society of American Gastrointestinal and Endoscopic Surgeons, the National Institutes of Health, and the Foundation for Barnes-Jewish Hospital; and research funding for this study from Ethicon®, Incorporated. CD has served as a consultant for Atrium Medical Corporation® and Davol® Incorporated; has received speaking fess or honoraria from Atrium Medical Corporation®, Covidien® Incorporated and Musculoskeletal Transplant Foundation; has received research grant funding for unrelated research studies from Atrium Medical Corporation®, Covidien® Incorporated, Kensey Nash Corporation®, Musculoskeletal Transplant Foundation, OBI Biologics Incorporated®, and the Society of American Gastrointestinal and Endoscopic Surgeons; and research funding for this study from Ethicon®, Incorporated. DT and NC have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8109, St. Louis, MO, 63110, USA

    Ahmed M. Zihni, Jaime A. Cavallo, Dominic M. Thompson Jr., Nabeel H. Chowdhury, Margaret M. Frisella, Brent D. Matthews & Corey R. Deeken

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  1. Ahmed M. Zihni
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  2. Jaime A. Cavallo
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  3. Dominic M. Thompson Jr.
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  4. Nabeel H. Chowdhury
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  5. Margaret M. Frisella
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  6. Brent D. Matthews
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  7. Corey R. Deeken
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Correspondence to Corey R. Deeken.

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Zihni, A.M., Cavallo, J.A., Thompson, D.M. et al. Evaluation of absorbable mesh fixation devices at various deployment angles. Surg Endosc 29, 1605–1613 (2015). https://doi.org/10.1007/s00464-014-3850-x

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  • DOI: https://doi.org/10.1007/s00464-014-3850-x

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