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Tensile strength testing for resorbable mesh fixation systems in laparoscopic ventral hernia repair

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Abstract
In an attempt to improve patient outcome and quality of life after laparoscopic ventral hernia repair, resorbable fixation devices have been developed to allow adequate mesh fixation while minimizing accompanying side-effects as tack erosion and adhesion formation. In experimental set-up, 24 pigs were treated by laparoscopic mesh placement. Two different meshes (PP/ORC and PP/ePTFE) and four fixation devices were evaluated: a 6.4 mm poly(D,L)-lactide pushpin (tack I), a 6.8 mm poly(D,L)-lactide with blunt tip (tack II), a 4.1 mm poly(glycolide-co-L-lactide) (tack III) and one titanium tack (control tack). A first group of animals (n = 12) was euthanized after 2 weeks survival and a second group (n = 12) after 6 months. At euthanasia, a relaparoscopy was performed to assess adhesion formation followed by laparotomy with excision of the entire abdominal wall. Tensile strength of the individual fixation systems was tested with the use of a tensiometer by measuring the force to pull the tack out of the mesh. Additionally, the foreign body reaction to the fixation systems was evaluated histologically as was their potential degradation. At 2 weeks the tensile strength was significantly higher for the control tack (31.98 N/cmA(2)) compared to the resorbable devices. Except for tack II, the tensile strength was higher when the devices were fixed in a PP/ePTFE mesh compared to the PP/ORC mesh. After 6 months only tack III was completely resorbed, while tack I (9.292 N/cmA(2)) had the lowest tensile strength. At this time-point similar tensile strength was observed for both tack II (29.56 N/cmA(2)) and the control tack (27.77 N/cmA(2)). Adhesions seem to be more depending on the type of mesh, in favor of PP/ePTFE. At long term, the 4.1 mm poly(glycolide-co-L-lactide) tack was the only tack completely resorbed while the 6.8 mm poly(D,L)-lactide tack with blunt tip reached equal strengths to the permanent tack.
Keywords
PAIN, ADHESION FORMATION, ABDOMINAL-WALL, SPIRAL TACKS, POLYPROPYLENE, MODEL, METAANALYSIS, INGROWTH, INCISIONAL HERNIA, Ventral hernia, Laparoscopy, Mesh, Resorbable fixation

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Citation

Please use this url to cite or link to this publication:

Chicago
Reynvoet, Emmelie, Frederik Berrevoet, Filip De Somer, Griet Vercauteren, Ingrid Vanoverbeke, Koen Chiers, and Roberto Troisi. 2012. “Tensile Strength Testing for Resorbable Mesh Fixation Systems in Laparoscopic Ventral Hernia Repair.” Surgical Endoscopy and Other Interventional Techniques 26 (9): 2513–2520.
APA
Reynvoet, E., Berrevoet, F., De Somer, F., Vercauteren, G., Vanoverbeke, I., Chiers, K., & Troisi, R. (2012). Tensile strength testing for resorbable mesh fixation systems in laparoscopic ventral hernia repair. SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, 26(9), 2513–2520.
Vancouver
1.
Reynvoet E, Berrevoet F, De Somer F, Vercauteren G, Vanoverbeke I, Chiers K, et al. Tensile strength testing for resorbable mesh fixation systems in laparoscopic ventral hernia repair. SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES. 2012;26(9):2513–20.
MLA
Reynvoet, Emmelie, Frederik Berrevoet, Filip De Somer, et al. “Tensile Strength Testing for Resorbable Mesh Fixation Systems in Laparoscopic Ventral Hernia Repair.” SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES 26.9 (2012): 2513–2520. Print.
@article{3124345,
  abstract     = {In an attempt to improve patient outcome and quality of life after laparoscopic ventral hernia repair, resorbable fixation devices have been developed to allow adequate mesh fixation while minimizing accompanying side-effects as tack erosion and adhesion formation. 
In experimental set-up, 24 pigs were treated by laparoscopic mesh placement. Two different meshes (PP/ORC and PP/ePTFE) and four fixation devices were evaluated: a 6.4 mm poly(D,L)-lactide pushpin (tack I), a 6.8 mm poly(D,L)-lactide with blunt tip (tack II), a 4.1 mm poly(glycolide-co-L-lactide) (tack III) and one titanium tack (control tack). A first group of animals (n = 12) was euthanized after 2 weeks survival and a second group (n = 12) after 6 months. At euthanasia, a relaparoscopy was performed to assess adhesion formation followed by laparotomy with excision of the entire abdominal wall. Tensile strength of the individual fixation systems was tested with the use of a tensiometer by measuring the force to pull the tack out of the mesh. Additionally, the foreign body reaction to the fixation systems was evaluated histologically as was their potential degradation. 
At 2 weeks the tensile strength was significantly higher for the control tack (31.98 N/cmA(2)) compared to the resorbable devices. Except for tack II, the tensile strength was higher when the devices were fixed in a PP/ePTFE mesh compared to the PP/ORC mesh. After 6 months only tack III was completely resorbed, while tack I (9.292 N/cmA(2)) had the lowest tensile strength. At this time-point similar tensile strength was observed for both tack II (29.56 N/cmA(2)) and the control tack (27.77 N/cmA(2)). Adhesions seem to be more depending on the type of mesh, in favor of PP/ePTFE. 
At long term, the 4.1 mm poly(glycolide-co-L-lactide) tack was the only tack completely resorbed while the 6.8 mm poly(D,L)-lactide tack with blunt tip reached equal strengths to the permanent tack.},
  author       = {Reynvoet, Emmelie and Berrevoet, Frederik and De Somer, Filip and Vercauteren, Griet and Vanoverbeke, Ingrid and Chiers, Koen and Troisi, Roberto},
  issn         = {0930-2794},
  journal      = {SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES},
  keyword      = {PAIN,ADHESION FORMATION,ABDOMINAL-WALL,SPIRAL TACKS,POLYPROPYLENE,MODEL,METAANALYSIS,INGROWTH,INCISIONAL HERNIA,Ventral hernia,Laparoscopy,Mesh,Resorbable fixation},
  language     = {eng},
  number       = {9},
  pages        = {2513--2520},
  title        = {Tensile strength testing for resorbable mesh fixation systems in laparoscopic ventral hernia repair},
  url          = {http://dx.doi.org/10.1007/s00464-012-2224-5},
  volume       = {26},
  year         = {2012},
}

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