Calvin Lyons, MD, Rohan Joseph, MD, Nilson Salas, MD, Patrick R Reardon, MD, Barbara L Bass, MD, Brian J Dunkin, MD. The Methodist Hospital
Introduction: Laparoscopic ventral hernia repair using an underlay mesh frequently requires suture fixation across the abdominal wall which results in significant postoperative pain. This study investigated the utility of a novel mesh fixation technique to reduce the strangulation force on the abdominal wall.
Methods: Multiple 2cm2 pieces of polyester mesh (ParietexTM Composite, Covidien, USA) were placed as an underlay against a porcine abdominal wall. Fixation was accomplished using either standard 0-Polyglyconate (Standard) or 0-Polyglyconate barbed anchor suture (Barbed) designed to hold in tissue without the need to tie a knot (V-Loc 180, Covidien, USA). Suture fixation began with a stab wound incision in the skin. A suture passing device was then used to pass the suture across the abdominal wall and through the mesh. The suture passer was removed and reintroduced thru the same stab would incision but a different fascial entry point 1.5cm away. The tail of the suture was grasped and pulled up thru the mesh and the abdominal wall creating a full thickness U-stitch. One tail of the suture was attached to a tensiometer and the strangulation force on the abdominal wall measured while tying (Standard) or looping (Barbed) the suture. To compare pull-out force, the tensiometer was attached to either the mesh or suture and traction applied until material failure or suture pull through. Results expressed as mean ± SD. Comparisons by t-test.
Results: Eight pieces of mesh were placed for each suture. The average force required to secure the Barbed suture was significantly less than that for the Standard (0.59 ± 0.08kg vs 2.20 ± 0.41kg p < 0.0001). Table 1 compares the suture pull out forces with the mesh failure forces. While the suture pull out force for Standard is significantly higher than Barbed, both sutures have pull-out strength significantly higher than the mesh failure force.
|Suture pull-out (n=8)||Mesh failure (n=8)|
|Standard||10.21 ± 1.62 kg||3.77 ± 0.53 kg||p<0.0001|
|Barbed||5.26 ± 1.09 kg*||3.51 +/1 0.65 kg||p=0.0125|
*p=0.0001 compared to standard
Conclusions: Use of a barbed anchor suture to secure mesh to the abdominal wall requires nearly 75% less strangulation force than a standard monofilament suture while still providing significantly greater pull-out force than that required for the mesh to tear and fail. This method of mesh fixation should result in less postoperative pain and warrants a clinical trial.
Program Number: S081