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Stapled fascial suture: ex vivo modeling and clinical implications

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Abstract

Background

Recently, in the field of abdominal wall repair surgery, some minimally invasive procedures introduced the use of staplers to provide a retromuscular prosthetic repair. However, to the knowledge of the authors, there are little data in the literature about the outcomes of stapled sutures adoption for midline reconstruction. This study aims to investigate the biomechanics of stapled sutures, simple (stapled), or oversewn (hybrid), in comparison with handsewn suture. From the results obtained, we tried to draw indications for their use in a clinical context.

Methods

Human cadaver fascia lata specimens, sutured (handsewn, stapled, or hybrid) or not, underwent tensile tests. The data on strength (maximal stress), ultimate strain (deformability), Young’s modulus (rigidity), and dissipated specific energy (ability to absorb mechanical energy up to the breaking point) were recorded for each type of specimens and analyzed.

Results

Stapled and hybrid suture showed a significantly higher strength (handsewn 0.83 MPa, stapled 2.10 MPa, hybrid 2.68 MPa) and a trend toward a lower ultimate strain as compared to manual sutures (handsewn 344%, stapled 249%, hybrid 280%). Stapled and hybrid sutures had fourfold higher Young’s modulus as compared to handsewn sutures (handsewn 1.779 MPa, stapled 7.374 MPa, hybrid 6.964 MPa). Handsewn and hybrid sutures showed significantly higher dissipated specific energy (handsewn 0.99 mJ-mm3, stapled 0.73 mJ-mm3, hybrid 1.35 mJ-mm3).

Conclusion

Stapled sutures can resist high loads, but are less deformable and rigid than handsewn suture. This suggests a safer employment in case of small defects or diastasis (< W1 in accord to EHS classification), where the presumed tissutal displacement is minimal.

Oversewing a stapled suture improves its efficiency, becoming crucial in case of larger defects (> W1 in accord to EHS classification) where the expected tissutal displacement is maximal. Hybrid sutures seem to be a good compromise.

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Acknowledgements

The authors thank the University of Trento and the San Camillo Hospital of Trento for their support. The authors also thank the Treviso Tissue Bank Foundation (FBTV) for providing the anatomic specimens. Special thanks to Prof. Davide Lomanto of the National University of Singapore for his valuable advice.

Funding

No funding was received for this study.

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Author notes

  1. Ilaria Corridori

    Present address: BIOtech Center for Biomedical Technologies, Department of Industrial Engineering, University of Trento, Trento, Italy

  2. Enrico Lauro and Ilaria Corridori have contributed equally to this work.

Authors and Affiliations

  1. Department of General Surgery, St. Maria Del Carmine Hospital, Rovereto, Italy

    Enrico Lauro & Giovanni Scudo

  2. Laboratory for Bioinspired, Bionic, Nano, Meta Materials and Mechanics, Department of Civil, Environmental and Mechanical Engineering, University of Trento, Trento, Italy

    Ilaria Corridori & Nicola M. Pugno

  3. Robotic Unit and Department of Urology, Santa Chiara Hospital, Trento, Italy

    Lorenzo Luciani

  4. Department of General Surgery, San Camillo Hospital, Trento, Italy

    Alberto Di Leo

  5. Department of General Surgery, Montebelluna-Castelfranco Veneto Hospital, Treviso, Italy

    Alberto Sartori

  6. Department of General Surgery 2^, ASST Spedali Civili di Brescia, Brescia, Italy

    Jacopo Andreuccetti

  7. Fondazione Banca dei Tessuti Treviso FBTV, Treviso, Italy

    Diletta Trojan

  8. BIOtech Center for Biomedical Technologies, Department of Industrial Engineering, University of Trento, Trento, Italy

    Antonella Motta

  9. School of Engineering and Material Science, Queen Mary University of London, London, UK

    Nicola M. Pugno

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The corresponding authors confirm that each author named in the by-line qualify by having participated actively and sufficiently in the study.

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Correspondence to Enrico Lauro or Nicola M. Pugno.

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Enrico Lauro, Ilaria Corridori, Lorenzo Luciani, Alberto Di Leo, Alberto Sartori, Jacopo Andreuccetti, Diletta Trojan, Giovanni Scudo, Antonella Motta, and Nicola M. Pugno have no conflict of interest or financial ties to disclose.

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Lauro, E., Corridori, I., Luciani, L. et al. Stapled fascial suture: ex vivo modeling and clinical implications. Surg Endosc 36, 8797–8806 (2022). https://doi.org/10.1007/s00464-022-09304-9

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