title: Tensile strength of mesh fixation methods in laparoscopic incisional hernia repair.
abstract: BACKGROUND
  Fixation of the mesh is crucial for the successful laparoscopic repair of incisional hernias. In the present experimental study, we used a pig model to compare the tensile strengths of mesh fixation with helical titanium coils (tackers) and transabdominal wall sutures.
  
  
  METHODS
  Thirty-six full-thickness specimens (5 x 7 cm) of the anterior abdominal wall of nine pig cadavers were randomized for fixation of a polypropylene mesh (7 x 7 cm) by either tackers or transabdominal wall sutures. The number of fixation points varied from one to five per 7-cm tissue length, with distances between fixation points of 2.3, 1.8, 1.4, and 1.2 cm, respectively. The force required to disrupt the mesh fixation (tensile strength) was measured by a dynamometer. Statistical analysis was performed using the Wilcoxon test and the Spearman rank correlation test.
  
  
  RESULTS
  The mean tensile strength of mesh fixation by transabdominal sutures was significantly greater than that by tackers for each number of fixation points: 67 N vs 28 N for a single fixation point (p <0.001), 115 N vs 42 N for two fixation points (p <0.001), 150 N vs 63 N for three fixation points (p <0.05), 151 N vs 73 N for four fixation points (p <0.05), and 150 N vs 82 N for five fixation points (p <0.05). Increasing the number of fixation points over three per 7 cm (distance between fixation points of 1.8 cm) did not improve tensile strength.
  
  
  CONCLUSIONS
  The tensile strength of transabdominal sutures is up to 2.5 times greater than the tensile strength of tackers. Therefore, the use of transabdominal sutures for mesh fixation appears to be preferable for laparoscopic incisional hernia repair.
authors.affiliation: Department of General Surgery, Erasmus University Medical Centre Rotterdam-Dijkzigt, Rotterdam, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: van't Riet
authors.forename: P J
authors.initials: PJ
authors.lastname: de Vos van Steenwijk
authors.forename: G J
authors.initials: GJ
authors.lastname: Kleinrensink
authors.forename: E W
authors.initials: EW
authors.lastname: Steyerberg
authors.forename: H J
authors.initials: HJ
authors.lastname: Bonjer
mesh_terms: D034861:Abdominal Wall / Q000601:surgery; D000818:Animals; D004195:Disease Models, Animal; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods* / Q000592:standards; D008297:Male; D011126:Polypropylenes / Q000378:metabolism / Q000627:therapeutic use; D011897:Random Allocation; D055502:Secondary Prevention; D013526:Surgical Mesh / Q000592:standards; D017792:Surgical Stapling / Q000379:methods / Q000592:standards; D013536:Suture Techniques / Q000592:standards; D013537:Sutures / Q000592:standards; D013552:Swine; D013718:Tensile Strength
chemical_list: D011126:Polypropylenes