Fixation Tacks Add Significant Weight to Hernia Repair

Thomas Cook, Karl A LeBlanc, MD, MBA. Our Lady of the Lake Regional Medical Center

INTRODUCTION: The purpose of this study is to assess the amount of foreign body introduced by different hernia mesh fixation devices in relation to hernia meshes. While there is an abundance of scientific data on HW and LW meshes and their impact there is no corresponding data on HW and LW hernia tacks (the other major source of implanted foreign body in hernia repair). In the majority of the LVHR procedures 30-60 tacks are implanted. This study was undertaken to evaluate the weight of foreign material of the deployed tacks in relation to hernia meshes. Additionally the study will analyze the different fixation devices based upon their strength of fixation as it relates to foreign body ratio.

METHODS AND PROCEDURES: The total weight of 45 tacks from each type was calculated and compared to the weight of several available hernia meshes of the size 15 X 20cm, the meshes weight was measured or calculated based on their density and manufacturer data.

In addition sheer force strength of each hernia tack was measured, (n=50) on a porcine abdominal muscle wall sample.

Although not fully available at the time of this abstract submission, comprehensive tack weight and fixation measurements will be presented on the majority of marketed fixation devices; the measurement will be done according to acceptable testing protocols.

RESULTS: The weight of various meshes is shown in the table below. Tacks, in particular, helical & screw-like tacks are in many cases the main source of foreign body in hernia repair.

Fixation strength to foreign body suggests wide variation in this factor between different fixation products.  The suture-like design has a fixation strength of 3[N/mg] compared to the screw-like design, which is approximately 0.5[N/mg]. This suggest that suture-like devices are stronger per same amount of foreign body than screw-like devices.

CONCLUSION(S): it appears that utilizing a light weight hernia doesn’t necessarily correspond to light weight hernia as tacks are responsible to significant amount of implanted foreign, sometimes representing more than half of the overall implanted foreign body.