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

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

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Disclosures

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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Authors and Affiliations

  1. Department of Surgery, SMZ Floridsdorf, Hinaysgasse 1, Vienna, 1210, Austria

    Christian Hollinsky, Simone Sandberg & Albert Tuchmann

  2. Department of Biomodels, University of Veterinary Medicine, Vienna, Austria

    Thomas Kolbe

  3. Institut for Agrobiotechnology, University of Natural Resources and Applied Life Sciences, Tulln, Austria

    Thomas Kolbe

  4. Vetomics Core Facility for Research, Institute of Histology and VetBioBank, University of Veterinary Medicine, Vienna, Austria

    Ingrid Walter

  5. Department of Pathobiology, Institute of Parasitology and Zoology, University of Veterinary Medicine, Vienna, Austria

    Anja Joachim

  6. Institute of Materials Science and Technology, Vienna University of Technology, Vienna, Austria

    Thomas Koch

  7. Institute of Laboratory Animal Science and Biomodels, University of Veterinary Medicine, Vienna, Austria

    Thomas Rülicke

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  1. Christian Hollinsky
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  2. Thomas Kolbe
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  3. Ingrid Walter
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  8. Albert Tuchmann
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Correspondence to Christian Hollinsky.

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Hollinsky, C., Kolbe, T., Walter, I. et al. Tensile strength and adhesion formation of mesh fixation systems used in laparoscopic incisional hernia repair. Surg Endosc 24, 1318–1324 (2010). https://doi.org/10.1007/s00464-009-0767-x

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  • DOI: https://doi.org/10.1007/s00464-009-0767-x

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