Introduction: A conventional method of mesh fixation in laparoscopic ventral hernia repair is transfascial sutures with tacks. This method has been associated with low recurrence rates, but yields significant morbidity from pain and bleeding. Fibrin glue has been used successfully in inguinal hernia repairs with decreased incidence of chronic pain without an increase in recurrence rates, but its utility is unknown for laparoscopic ventral hernia repairs. Our aim is to evaluate the efficacy of fibrin glue for laparoscopic mesh fixation to the anterior abdominal wall compared to other fixation methods.
Methods and Procedures: Four different laparoscopic mesh fixation methods were randomly assigned to midline positions along the abdominal wall of 12 female pigs and compared: 1. fibrin glue only (GO), 2. transfascial sutures with tacks (ST), 3. fibrin glue with tacks (GT), and 4. tacks only (TO). At four weeks post-implantation, tensile strength, adhesions, migration, contraction, and buckling/folding were assessed using the Kruskal-Wallis one-way analysis by ranks test.
Results: There were no significant differences in tensile strength, adhesions,
or buckling/folding among the four fixation methods. A significant increase in mean migration (3.3 vs. 0.0mm, p=0.03) and percent contraction (28 vs. 14%, p=0.02) were identified in the GO group when compared to ST.
| GO | GT | TO | ST | p-value |
||
| Tensile Stress | NS | |||||
| N/m2x104 | 5.2 (1.8) | 5.0 (2.0) | 6.4 (2.2) | 6.8 (1.3) | ||
| mmHg | 393 (132) | 373 (149) | 478 (165) | 514 (99.0) | ||
| Migration (mm) | 3.3 (4.4) |
0.8 (2.9) | 0.4 (1.4) | 0 | p=0.03* | |
| Contraction (%) | 28.0 (12.5) |
18.9 (11.9) | 17.2 (11.3) | 14.2 (8.10) | p=0.02* | |
| Buckling Score | 0.42 (0.67) | 0.75 (0.62) | 0.58 (0.51) | 0.50 (0.52) | NS | |
| Adhesion Score |
4.7 (4.0) | 1.8 (3.0) | 4.3 (3.7) | 4.1 (4.3) | NS | |
All values are reported as mean (standard deviation); *p-value comparing GO to ST
Conclusion: Mesh fixation using fibrin glue has comparable tensile strength and adhesion rate to sutures with tacks in the swine model. Increased contraction and migration rates associated with fibrin glue alone may be an issue and warrants further study. On the other hand, the GT group showed similar biomechanical characteristics as the other groups and may represent a reasonable alternative to the use of transfascial sutures.
Session: Podium Presentation
Program Number: S066