Skip to main content
SpringerLink
Log in

A comparison of a bovine albumin/glutaraldehyde glue versus fibrin sealant for hernia mesh fixation in experimental onlay and IPOM repair in rats

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Research in hernia repair has targeted new atraumatic mesh fixation to reduce major complications such as chronic pain and adhesion formation. The efficacy and safety of two surgical adhesives, viz. Artiss® (FS, fibrin sealant containing 4 IU thrombin) and Bioglue® (AGG, bovine serum albumin/glutaraldehyde glue), were evaluated in this study. Primary study endpoints were tissue integration, dislocation, and adhesion formation. Foreign-body reaction formed the secondary study endpoint.

Methods

Twenty-four polypropylene meshes (VM, Vitamesh®) were randomized to four groups (n = 6): two groups of onlay hernia repair (two meshes per animal) with mesh fixation by FS (O-FS) or by AGG (O-AGG), and two groups of IPOM repair (one mesh per animal) with mesh fixation by four sutures and FS (I-FS) or AGG (I-AGG). Eighteen rats underwent surgery. Follow-up was 30 days. Tissue integration, dislocation, seroma formation, inflammation, adhesion formation, and foreign-body reaction were assessed.

Results

Meshes fixed with FS (O-FS, I-FS) showed good tissue integration. No dislocation, seroma formation, or macroscopic signs of inflammation were detectable. Adhesion formation of I-FS was significantly milder compared with I-AGG (P = 0.024). A moderate foreign-body reaction without active inflammation was seen histologically in O-FS and I-FS groups. Samples fixed with AGG (O-AGG, I-AGG) showed extensive scar formation. No dislocation and no seroma formation were observed. All of these samples showed moderate to severe signs of inflammation with abscess formation in the six meshes of O-AGG. Histology underlined these findings.

Conclusions

The fibrin sealant adhesive showed very good overall results of the primary and secondary outcome parameters. FS is a recommendable atraumatic fixation tool for the surgical onlay technique. AGG provides high adhesive strength, but shows low biocompatibility. Persisting active inflammation was seen in both the O-AGG and I-AGG groups, not favoring its use for these indications.

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

    Article  PubMed  Google Scholar 

  2. Kuhry E, Schwenk WF, Gaupset R, Romild U, Bonjer HJ (2008) Long-term results of laparoscopic colorectal cancer resection. Cochrane Database Syst Rev CD003432

  3. Penttinen R, Gronroos JM (2008) Mesh repair of common abdominal hernias: a review on experimental and clinical studies. Hernia 12:337–344

    Article  CAS  PubMed  Google Scholar 

  4. Weyhe D, Belyaev O, Muller C, Meurer K, Bauer KH, Papapostolou G, Uhl W (2007) Improving outcomes in hernia repair by the use of light meshes—a comparison of different implant constructions based on a critical appraisal of the literature. World J Surg 31:234–244

    Article  PubMed  Google Scholar 

  5. Chelala E, Thoma M, Tatete B, Lemye AC, Dessily M, Alle JL (2007) The suturing concept for laparoscopic mesh fixation in ventral and incisional hernia repair: mid-term analysis of 400 cases. Surg Endosc 21:391–395

    Article  CAS  PubMed  Google Scholar 

  6. Fujita F, Lahmann B, Otsuka K, Lyass S, Hiatt JR, Phillips EH (2004) Quantification of pain and satisfaction following laparoscopic and open hernia repair. Arch Surg 139:596–600

    Article  PubMed  Google Scholar 

  7. Fortelny RH, Schwab R, Glaser KS, Puchner KU, May C, Konig F, Redl H, Petter-Puchner AH (2008) The assessment of quality of life in a trial on lightweight mesh fixation with fibrin sealant in transabdominal preperitoneal hernia repair. Hernia 12:499–505

    Article  CAS  PubMed  Google Scholar 

  8. Vuilleumier H, Hubner M, Demartines N (2009) Neuropathy after herniorrhaphy: indication for surgical treatment and outcome. World J Surg 33:841–845

    Article  PubMed  Google Scholar 

  9. Delikoukos S, Fafoulakis F, Christodoulidis G, Theodoropoulos T, Hatzitheofilou C (2008) Re-operation due to severe late-onset persisting groin pain following anterior inguinal hernia repair with mesh. Hernia 12:593–595

    Article  CAS  PubMed  Google Scholar 

  10. Lovisetto F, Zonta S, Rota E, Mazzilli M, Bardone M, Bottero L, Faillace G, Longoni M (2007) Use of human fibrin glue (Tissucol) versus staples for mesh fixation in laparoscopic transabdominal preperitoneal hernioplasty: a prospective, randomized study. Ann Surg 245(2):222–231

    Article  PubMed  Google Scholar 

  11. Chastan P (2009) Tension-free open hernia repair using an innovative self-gripping semi-resorbable mesh. Hernia 13:137–142

    Article  CAS  PubMed  Google Scholar 

  12. Fortelny RH, Petter-Puchner AH, Walder N, Mittermayr R, Ohlinger W, Heinze A, Redl H (2007) Cyanoacrylate tissue sealant impairs tissue integration of macroporous mesh in experimental hernia repair. Surg Endosc 21:1781–1785

    Article  CAS  PubMed  Google Scholar 

  13. Petter-Puchner A, Fortelny R, Mittermayr R, Öhinger W, Redl H (2005) Fibrin sealing vs. stapling of hernia meshes in an onlay model in the rat. Hernia 9:322–329

    Article  PubMed  Google Scholar 

  14. Petter-Puchner AH, Walder N, Redl H, Schwab R, Ohlinger W, Gruber-Blum S, Fortelny RH (2008) Fibrin sealant (Tissucol) enhances tissue integration of condensed polytetrafluoroethylene meshes and reduces early adhesion formation in experimental intraabdominal peritoneal onlay mesh repair. J Surg Res 150:190–195

    Article  CAS  PubMed  Google Scholar 

  15. Eriksen JR, Bech JI, Linnemann D, Rosenberg J (2008) Laparoscopic intraperitoneal mesh fixation with fibrin sealant (Tisseel) vs. titanium tacks: a randomised controlled experimental study in pigs. Hernia 12:483–491

    Article  CAS  PubMed  Google Scholar 

  16. Morales-Conde S, Cadet H, Cano A, Bustos M, Martin J, Morales-Mendez S (2005) Laparoscopic ventral hernia repair without sutures–double crown technique: our experience after 140 cases with a mean follow-up of 40 months. Int Surg 90:S56–S62

    PubMed  Google Scholar 

  17. Vandendael A, Struwig D, Nel JT, Kruger TF, Lombard CJ (1996) Efficacy of fibrin sealant in prevention of adhesion formation on ovar surgical wounds in rabbit model. Gyn End 169–172

  18. Schwab R, Schumacher O, Junge K, Binnebosel M, Klinge U, Becker HP, Schumpelick V (2008) Biomechanical analyses of mesh fixation in TAPP and TEP hernia repair. Surg Endosc 22:731–738

    Article  CAS  PubMed  Google Scholar 

  19. Sidle DM, Maas CS (2008) Determination of shear strength of periosteum attached to bone with BioGlue surgical adhesive. Arch Facial Plast Surg 10:316–320

    Article  PubMed  Google Scholar 

  20. Lamsa T, Jin HT, Sand J, Nordback I (2008) Tissue adhesives and the pancreas: biocompatibility and adhesive properties of 6 preparations. Pancreas 36:261–266

    Article  PubMed  Google Scholar 

  21. Alexander SM, Mitalas LE, Gosselink MP, Oom DM, Zimmerman DD, Schouten WR (2008) Obliteration of the fistulous tract with BioGlue adversely affects the outcome of transanal advancement flap repair. Tech Coloproctol 12:225–228

    Article  CAS  PubMed  Google Scholar 

  22. Furst W, Banerjee A (2005) Release of glutaraldehyde from an albumin-glutaraldehyde tissue adhesive causes significant in vitro and in vivo toxicity. Ann Thorac Surg 79:1522–1528

    Article  PubMed  Google Scholar 

  23. Klosterhalfen B, Junge K, Klinge U (2005) The lightweight and large porous mesh concept for hernia repair. Expert Rev Med Devices 2:103–117

    Article  PubMed  Google Scholar 

  24. Conze J, Junge K, Klinge U, Weiss C, Polivoda M, Oettinger AP, Schumpelick V (2005) Intraabdominal adhesion formation of polypropylene mesh. Influence of coverage of omentum and polyglactin. Surg Endosc 19:798–803

    Article  CAS  PubMed  Google Scholar 

  25. Kingsnorth AN, Shahid MK, Valliattu AJ, Hadden RA, Porter CS (2008) Open onlay mesh repair for major abdominal wall hernias with selective use of components separation and fibrin sealant. World J Surg 32:26–30

    Article  PubMed  Google Scholar 

  26. Baer A, Sauer T, Bohnert N, Gortezki PE, Lammers BJ (2009) Less pain intensity after Liechtenstein-repair by using biolgue for mesh fixation. Surg Technol Int 18:125–128

    Google Scholar 

  27. Fisher WE, Chai C, Hodges SE, Wu MF, Hilsenbeck SG, Brunicardi FC (2008) Effect of BioGlue on the incidence of pancreatic fistula following pancreas resection. J Gastrointest Surg 12:882–890

    Article  PubMed  Google Scholar 

  28. Ray G (2008) Wound complications associated with the use of bovine serum albumin-glutaraldehyde surgical adhesive in pediatric patients. Neurosurgery 63:E820

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We thank Erika Johnson-Froneberg for reviewing the paper. Thanks are due to Claudia Keibl for support in veterinary causes as well as to Karin Brenner for the outstanding animal care. Furthermore, we thank our technical engineer Karl Kropik for maintenance of technical equipment.

Disclosures

H. Redl is a consultant to Baxter Innovations. Authors S. Gruber-Blum, A. Petter-Puchner, K. Mika, J. Brand, W. Öhlinger, T. Benesch, and R. Fortelny have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Donaueschingenstrasse 13, 1200, Vienna, Austria

    S. Gruber-Blum, K. Mika, J. Brand, H. Redl & W. Öhlinger

  2. Department of General Surgery, Wilhelminenspital der Stadt Wien, Montleartstrasse 37, 1171, Vienna, Austria

    A. H. Petter-Puchner & R. H. Fortelny

  3. Department of Medical Statistics, University of Vienna, Vienna, Austria

    T. Benesch

Authors
  1. S. Gruber-Blum
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. H. Petter-Puchner
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K. Mika
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Brand
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. H. Redl
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. W. Öhlinger
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. T. Benesch
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. R. H. Fortelny
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. H. Petter-Puchner.

Additional information

S. Gruber-Blum and A. H. Petter-Puchner contributed equally to this manuscript.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gruber-Blum, S., Petter-Puchner, A.H., Mika, K. et al. A comparison of a bovine albumin/glutaraldehyde glue versus fibrin sealant for hernia mesh fixation in experimental onlay and IPOM repair in rats. Surg Endosc 24, 3086–3094 (2010). https://doi.org/10.1007/s00464-010-1094-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-010-1094-y

Keywords

Search

Navigation