title: Evaluation of adhesion formation, mesh fixation strength, and hydroxyproline content after intraabdominal placement of polytetrafluoroethylene mesh secured using titanium spiral tacks, nitinol anchors, and polypropylene suture or polyglactin 910 suture.
abstract: BACKGROUND
  The purpose of this study is to evaluate fixation methods for polytetrafluoroethylene (ePTFE) mesh with an in vivo model of laparoscopic ventral hernia repair.
  
  
  METHODS
  In 40 New Zealand white rabbits, a 4 x 4-cm ePTFE mesh (n = 80, two per animal) was attached to an intact peritoneum with polyglactin 910 (PG 910) (n = 20) or polypropylene (PP) (n = 20) suture, titanium spiral tacks (TS) (n = 20), or nitinol anchors (NA) (n = 20). Mesh was harvested at 8 and 16 weeks for fixation strength testing, adhesion assessment, and collagen (hydroxyproline) content. Fixation strength on day 0 was determined with mesh attached to harvested abdominal wall. Statistical significance was determined as p < 0.05.
  
  
  RESULTS
  There was no difference in fixation strength between PP (39.1 N) and PG 910 (40.0 N) sutures at time zero. At week 8, PP (25.7 N) was significantly stronger (p < 0.05) than PG 910 (11.4 N) suture, but not at week 16. The fixation strength of TS and NA (day 0, 15.4 vs 7.4 N; week 8, 17.5 vs 15.3 N; week 16, 19.1 vs 13.8 N) was not significantly different. Fixation with PP suture was significantly (p < 0.05) stronger than that with TS and NA at day 0 (39.1, 15.4, and 7.4 N, respectively) but not at weeks 8 or 16. The fixation strength of suture decreased significantly (p < 0.05) from day 0 to week 16 (PP: day 0 = 39.1 N, week 8 = 25.7 N, week 16 = 21.4 N; PG 910: day 0 = 40.0 N, week 8 = 11.4 N, week 16 = 12.8 N). The fixation strength of NA and TS did not change significantly (NA: day 0 = 7.4 N, week 8 = 15.3 N, week 16 = 13.8 N; TS: week 0 = 15.4 N, week 8 = 17.5 N, week 16 = 19.1 N). There were no differences in adhesion area based on fixation device used; however, there were more (p < 0.05) mesh samples using NA with adhesions compared to TS and adhesion tenacity was greater (p < 0.05) compared to that of TS, PP, and PG. Hydroxyproline content at weeks 8 and 16 was similar for all fixation devices.
  
  
  CONCLUSIONS
  The initial fixation strength for nonabsorbable suture is significantly greater than that of the metallic fixation devices, but after 8 weeks there is no difference. Laparoscopic ventral hernia repair without transabdominal suture fixation may be predisposed to acute failure. The metallic devices have similar fixation strength, although the incidence of adhesions and tenacity of adhesions appear to be greater with the nitinol anchors. Since these devices have similar fixation strengths and most likely provide adequate supplementation to transabdominal sutures for mesh fixation after laparoscopic ventral hernia repair, their use should be based on other factors, such as their propensity for adhesions, ease of application, and cost.
authors.affiliation: Department of General Surgery, Carolinas Medical Center, 1000 Blythe Boulevard, Charlotte, NC 28203, USA.
authors.forename: C S
authors.initials: CS
authors.lastname: Joels
authors.forename: B D
authors.initials: BD
authors.lastname: Matthews
authors.forename: K W
authors.initials: KW
authors.lastname: Kercher
authors.forename: C
authors.initials: C
authors.lastname: Austin
authors.forename: H J
authors.initials: HJ
authors.lastname: Norton
authors.forename: T C
authors.initials: TC
authors.lastname: Williams
authors.forename: B T
authors.initials: BT
authors.lastname: Heniford
mesh_terms: D000497:Alloys; D000818:Animals; D004867:Equipment Design; D006555:Hernia, Ventral / Q000601:surgery*; D006909:Hydroxyproline; D010535:Laparoscopy; D011098:Polyglactin 910; D011126:Polypropylenes; D011138:Polytetrafluoroethylene; D011183:Postoperative Complications / Q000517:prevention & control*; D011817:Rabbits; D013526:Surgical Mesh; D013537:Sutures; D000267:Tissue Adhesions / Q000517:prevention & control*; D014025:Titanium
chemical_list: D000497:Alloys; D011126:Polypropylenes; C013616:nitinol; D011098:Polyglactin 910; D011138:Polytetrafluoroethylene; D014025:Titanium; D006909:Hydroxyproline