Adhesions to sutures, tackers, and glue for intraperitoneal mesh fixation: an experimental study

被引:14
|
作者
Schreinemacher, M. H. F. [1 ]
van Barneveld, K. W. Y. [1 ]
Peeters, E. [2 ]
Miserez, M. [2 ]
Gijbels, M. J. J. [3 ,4 ]
Greve, J. -W. M. [5 ]
Bouvy, N. D. [1 ]
机构
[1] Maastricht Univ, Med Ctr, Dept Gen Surg, NL-6202 AZ Maastricht, Netherlands
[2] Katholieke Univ Leuven, Dept Abdominal Surg, Louvain, Belgium
[3] Maastricht Univ, Med Ctr, Dept Mol Genet, NL-6202 AZ Maastricht, Netherlands
[4] Maastricht Univ, Med Ctr, Dept Pathol, NL-6202 AZ Maastricht, Netherlands
[5] Atrium Med Ctr, Dept Gen Surg, Heerlen, Netherlands
关键词
Abdomen; Ventral hernia repair; Surgical mesh; Fixation; Adhesions; INCISIONAL HERNIA REPAIR; POLYTETRAFLUOROETHYLENE MESH; FIBRIN SEALANT; METAANALYSIS; STRENGTH; PREVENTION; TRIAL;
D O I
10.1007/s10029-013-1192-6
中图分类号
R61 [外科手术学];
学科分类号
摘要
Intraperitoneal mesh fixation for hernia repair is associated with adhesion formation. In this experimental study, adhesions against absorbable and non-absorbable fixation methods were compared. Six commercially available fixation methods were placed intraperitoneally in rats with a small pore polypropylene mesh coated on one side with ePTFE (Intramesh T1(A (R))). Two non-absorbable fixation methods: Prolene(A (R)) (polypropylene) sutures and Protack(A (R)) (titanium) tackers. Four absorbable methods: Vicryl(A (R)) sutures (polyglactin), Absorbatack(A (R)) and Permasorb(A (R)) tackers (both mixes of lactic and glycolic acids) and Tisseel Duo(A (R)) (fibrin glue). Adhesions and histology were studied at 7 and 90 days follow-up. In addition, fixation methods were placed without mesh, in order to study the reaction to the fixation method per se. No adhesion formation, but also inadequate mesh fixation was found with Tisseel Duo(A (R)), which had been completely resorbed at 7 days follow-up. Vicryl(A (R)) sutures could no longer be detected at 90 days follow-up and were associated with a favorable adhesion profile. All other fixation methods were still intact 90 days after implantation. When placed without mesh, adhesion formation was significantly less than placed with a mesh (18 vs. 93 %, P < 0.001). Without mesh, adhesions were worst with Permasorb(A (R)) tackers. Absorbable fixation methods such as polyglactin sutures and fibrin glue show a favorable adhesion profile compared to longer-term absorbable or non-absorbable fixation methods. However, before using fibrin glue as a single fixation method more research is required.
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页码:865 / 872
页数:8
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