Biomechanical Comparison of the Immediate Fixation Strength of Non-traumatic Mesh Fixation Methods: Lifemesh(tm), Tisseel(tm), and Progrip(tm)

Charles P Shahan, MD1, Nathaniel Stoikes, MD1, Esra Roan, PhD2, James Tatum, BS2, David Webb, MD1, Guy R Voeller, MD1. 1University of Tennessee Health Science Center, 2University of Memphis

BACKGROUND:  LifeMesh™ is a novel self-fixating mesh adhesive technology where large-pore, lightweight polypropylene mesh is embedded in a dry matrix of porcine gelatin and microbial transglutaminase enzyme. Non-traumatic mesh fixation is becoming more widely accepted, however little is known about the immediate fixation strength of these techniques. The purpose of this study was to compare the immediate strength of fixation for LifeMesh™, ProGrip™, and Tisseel™.

METHODS: 7 Mongrel swine underwent implantation of two 4x7cm pieces of either Lifemesh™, ProGrip™, or polypropylene mesh fixated with 2mL of Tisseel™. 10 minutes after application, the samples were excised with the abdominal wall and stored for immediate biomechanical testing. The samples underwent lap shear testing to determine the immediate fixation strength of these three technologies.

RESULTS: ProGrip™ demonstrated mean fixation strength of 1.3 N/cm (± STE 0.2). Mean fixation for mesh fixated with Tisseel™ was 2.6 N/cm (± STE 0.5). LifeMesh™ samples had mean fixation strength of 8.0 N/cm (± STE 2.1). Analysis of variance testing showed that immediate fixation strength of LifeMesh™ was significantly greater than that of either ProGrip™ or Tisseel™ (p=0.0004). ProGrip™ and Tisseel™ were not significantly different from each other (p=0.06).

CONCLUSIONS: Immediate strength of mesh fixation is an undescribed factor in hernia repair, but could have significant implications for early recurrence and mesh contraction. While further investigation is needed to define adequate interface strength, this comparison of non-traumatic mesh fixation methods shows that the novel LifeMesh™ technology exhibits greater strength than other non-traumatic fixation techniques.

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