title: Evaluation of absorbable and permanent mesh fixation devices: adhesion formation and mechanical strength.
abstract: OBJECTIVE
  Laparoscopic ventral hernia repair is commonly performed with mesh prostheses; however, there is no standard for fixation devices used to secure mesh to the abdominal wall. This study is a functional comparison of novel, screw-type absorbable and permanent fixation devices with a traditional titanium fixation device.
  
  
  METHODS
  Fifteen pigs each underwent the laparoscopic placement of two 11 × 14-cm mesh prostheses and were randomized for mesh fixation with either titanium spiral tacks (TS), absorbable screw-type fasteners (SF), or permanent screw-type fasteners (PF) (n = 10 mesh prostheses for each fixation group). Adhesions were assessed laparoscopically at 4 weeks. The fixation devices were also embedded in porcine abdominal rectus muscle for ex vivo mechanical testing along with partial thickness polypropylene suture (PR) as a control group (n = 40 for each group). Maximum pull-off forces were measured. All statistical tests were two-tailed, and a P-value < 0.05 was considered to be significant.
  
  
  RESULTS
  The mean tenacity adhesion scores were 1.40 ± 0.52 (PF), 1.7 ± 0.82 (SF), and 2.6 ± 1.07 (TS). Adhesions in the PF group were significantly less tenacious compared with the TS group (P = 0.01). Quantitative adhesion scores were not significantly different among groups. The maximum pull-off forces, measured in Newtons, were 28.61 N ± 4.89 N (TS), 22.71 N ± 7.86 N (SF), 16.98 N ± 7.59 N (PF), and 20.83 N ± 6.25 N (PR). The pull-off force in the TS group was higher than all of the other groups (P < 0.001). The SF group also had a higher pull-off force compared with the PF group (P < 0.001).
  
  
  CONCLUSIONS
  The screw-type absorbable and permanent fixation devices provided adequate fixation and were associated with decreased adhesions in this porcine model.
authors: Section of Hepatopancreatobiliary Surgery, Department of General Surgery, Carolinas Medical Center, Morehead Medical Plaza, Suite 300, 1000 Blythe Blvd., Charlotte, NC 28203, USA.
authors: J F
authors: JF
authors: Byrd
authors: N
authors: N
authors: Agee
authors: R Z
authors: RZ
authors: Swan
authors: K N
authors: KN
authors: Lau
authors: J J
authors: JJ
authors: Heath
authors: I H
authors: IH
authors: Mckillop
authors: D
authors: D
authors: Sindram
authors: J B
authors: JB
authors: Martinie
authors: D A
authors: DA
authors: Iannitti
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