title: Mesh fixation with a barbed anchor suture results in significantly less strangulation of the abdominal wall.
abstract: BACKGROUND
  Laparoscopic ventral hernia repair using an underlay mesh frequently requires suture fixation across the abdominal wall, which results in significant postoperative pain. This study investigates the utility of a novel mesh fixation technique to reduce the strangulation force on the abdominal wall.
  
  
  METHODS
  Multiple 2-cm(2) pieces of polyester mesh (Parietex Composite, Covidien) were placed as an underlay against a porcine abdominal wall. Fixation was accomplished using either the standard 0-polyglyconate or the 0-polyglyconate barbed anchor suture designed to hold in tissue without the need to tie a knot (V-Loc 180; Covidien). Suture fixation began with a stab wound incision in the skin. A suture-passing device then was used to pass the suture across the abdominal wall and through the mesh. The suture passer was removed and reintroduced through the same stab wound incision but at a different fascial entry point 1.5 cm away. The tail of the suture was grasped and pulled up through both the mesh and the abdominal wall, creating a full-thickness U-stitch. One tail of the suture was attached to a tensiometer, and the strangulation force on the abdominal wall was measured while the suture was tied (standard) or looped (barbed). To compare pullout force, the tensiometer was attached to either the mesh or the suture, and traction was applied until material failure or suture pull through. Results are expressed as mean ± standard deviation. Comparisons were performed using Student's t-test.
  
  
  RESULTS
  Eight pieces of mesh were placed for each suture. The average force required to secure the barbed suture (0.59 ± 0.08 kg) was significantly less than the force needed to secure the standard suture (2.17 ± 0.58 kg) (P < 0.0001). Table 1 compares the suture pullout forces with the mesh failure forces. Although the pullout force for the standard suture is significantly greater than for the barbed suture, both sutures have a pullout strength significantly greater than the mesh failure force. Table 1 Suture fixation forces for standard and barbed sutures Suture fixation force (kg) Standard suture 2.17 ± 0.58 Barbed suture 0.59 ± 0.08 P < 0.0001
  
  
  CONCLUSIONS
  A barbed anchor suture used to secure mesh to the abdominal wall requires nearly 75% less strangulation force than a standard monofilament suture while still providing significantly greater pullout force than that required for the mesh to tear and fail. This method of mesh fixation should result in less postoperative pain and warrants a clinical trial.
authors.affiliation: Department of Surgery, Methodist Institute for Technology Innovation and Education (MITIE), The Methodist Hospital, 6670 Bertner Ave, Houston, TX 77030, USA. Clyons@tmhs.org
authors.forename: Calvin
authors.initials: C
authors.lastname: Lyons
authors.forename: Rohan
authors.initials: R
authors.lastname: Joseph
authors.forename: Nilson
authors.initials: N
authors.lastname: Salas
authors.forename: Patrick R
authors.initials: PR
authors.lastname: Reardon
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Bass
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Dunkin
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D000818:Animals; D004867:Equipment Design; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D010149:Postoperative Pain / Q000517:prevention & control; D013526:Surgical Mesh; D034421:Sus scrofa; D013536:Suture Techniques / Q000295:instrumentation*; D013537:Sutures
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