Different Methods of Mesh Fixation in Open Retromuscular Incisional Hernia Repair: a Comparative Study in Pigs

Overview

Journal Hernia

Publisher Springer

Date 2010 Sep 14

PMID 20835908

Citations 4

Authors

J Grommes

M Binnebosel

C D Klink

K T von Trotha

K Junge

J Conze

Affiliations

Soon will be listed here.

Abstract

Purpose: Reinforcement of the abdominal wall with alloplastic mesh material in incisional hernia repair is well established. To avoid dislocation and migration of the prostheses, mesh fixation is recommended. However, there seems to be a correlation between postoperative pain and mesh fixation. Furthermore, it remains unclear whether mesh fixation is necessary at all.

Methods: A retromuscular mesh implantation was performed in 36 pigs using a polypropylene-polyglecaprone 25 composite mesh (Ultrapro(®), 12 × 18 cm). In group 1, the mesh was fixed to the posterior rectus sheet with non absorbable single sutures (Prolene(®) 2-0), in group 2 fixation was with absorbable sutures (Vicryl(®) 2-0), in group 3 mesh fixation was with 5 ml fibrin sealant (Quixil(®)), and, as a control, there was no fixation in group 4. The abdominal wall was explanted on postoperative day 7, 14 and 56. Mesh size and position was measured, and pull-out force of the mesh was analysed mechanically by tensiometry. The ratio of collagen type I/III was analysed to determine the quality of mesh integration.

Results: Neither mesh dislocation nor mesh migration was detected. Mesh size showed no significant differences, whether comparing time points or groups. No significant differences in the tensile strength of mesh integration were found when comparing the groups (group 1: 155 ± 17 mmHg; group 2: 175 ± 9 mmHg; group 3: 166 ± 24 mmHg; group 4: 172 ± 28 mmHg). Though the type I/III collagen ratio increased over time, no significant differences according to the type of fixation used were detected.

Conclusion: Mesh fixation in open incisional hernia repair with retromuscular mesh augmentation to avoid mesh dislocation or migration in the early postoperative period appears to be unnecessary.

Citing Articles

Chronic abdominal pain after ventral hernia due to mesh migration and erosion into the sigmoid colon from a distant site: a case report and review of literature.

Millas S, Mesar T, Patel R Hernia. 2013; 19(5):849-52.

PMID: 24253380 DOI: 10.1007/s10029-013-1182-8.

[Operative therapy of secondary ventral hernia: technical principles].

Berger D, Lux A Chirurg. 2013; 84(11):1001-12.

PMID: 24218095 DOI: 10.1007/s00104-011-2245-y.

A systematic review of randomised control trials assessing mesh fixation in open inguinal hernia repair.

Sanders D, Waydia S Hernia. 2013; 18(2):165-76.

PMID: 23649403 DOI: 10.1007/s10029-013-1093-8.

Differences in biomechanical stability using various fibrin glue compositions for mesh fixation in endoscopic inguinal hernia repair.

Schug-Pass C, Jacob D, Lippert H, Kockerling F Surg Endosc. 2012; 26(11):3282-6.

PMID: 22648108 DOI: 10.1007/s00464-012-2339-8.

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