Eliad Karin, MD1, Yoni Epstein, CEO2. 1Ichilov, 2Anchora Medical
The rationale for defect closure is to restore the integrity of the abdominal wall and enhance its thickness in order to facilitate better mesh overlap and fixation. It allows the usage of smaller mesh prosthetics and eliminates the dead space resulting in fewer seromas, bulging and recurrences. By restoring the anatomy structure, it improves abdominal wall functionality and cosmetics.
While in open repair, closure of the defect is a routine, in laparoscopy this is not the case. Traditional repair still relies on bridged defect with mesh prosthetic which causes friction and shear force with higher pressure in the center of the mesh leading to mesh instability, stretching of the sutures causing increased postoperative pain bulging and migration of the mesh.
Tandon et al recently published a meta-analysis of 16 studies involving 3,638 patients – 2,963 in the closure of fascial defect (CFD) group and 675 in the non-closure of fascial defect group.significantly fewer adverse events were noted following CFD than non-closure.
Laparoscopic closure of a mid-sized defect (3-6 cm) is not simple and there is no standard laparoscopic defect closure technique. Issues of suture strength and excessive tissue tension call for several combinations of open or transcutaneous passage of sutures and ties. When using regular sutures, tissue tension may hinder the healing process and may even cause tissue necrosis and recurrence of the hernia.
The Anchora Defect Closer suturing device is a novel suturing technique in which tissue is sutured laparoscopically in a continuous fashion via threaded friction free T-tag tissue anchors.
It is an automatic single trigger operation device. The tissue anchors are 7 mm in width and are designed for transfascial deployment with varied depth and adjustable distance between the anchors. The unique suture design prevents ischemia and nerve entrapment as it is based on an open loop design (vs. closed loop design which can be over tightened). The atraumatic anchor has a wide anchoring surface area thus applies less force to the tissue when tension increases
The device pushes the anchors through the peritoneum and the transversalis fascia to lie several mm deep within the fascia surrounding the defect. By placing several such anchors in a zigzag or rectangular pattern, we can then tighten the thread to close the defect in a shoe-lace technique. The repair is completed with the placement of the IPOM mesh, which is also fixated with the Anchora suturing device. The procedure is quick and simple and resembles to a tacker operation.
We have investigated this approach in four female pigs (30-70 kg) with an umbilical hernia defect width of 3-7 cm. The pigs were sacrificed after 5 weeks and the wound healing was studied both clinically and histologically. The result was a complete healing of the hernia defect.
We think that the Anchora suturing device is a promising suturing technique that allows tissue approximation despite high tissue tension, with less tissue damage and ischemia.
Further studies are needed in order to evaluate the efficacy and safety of this novel tissue approximation device
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Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 91234
Program Number: ETP880
Presentation Session: Emerging Technology iPoster Session (Non CME)
Presentation Type: Poster