title: Tensile strength testing for resorbable mesh fixation systems in laparoscopic ventral hernia repair.
abstract: BACKGROUND
  In an attempt to improve patient outcome and quality of life after laparoscopic ventral hernia repair, resorbable fixation devices have been developed to allow adequate mesh fixation while minimizing accompanying side-effects as tack erosion and adhesion formation.
  
  
  METHODS
  In experimental set-up, 24 pigs were treated by laparoscopic mesh placement. Two different meshes (PP/ORC and PP/ePTFE) and four fixation devices were evaluated: a 6.4 mm poly(D,L: )-lactide pushpin (tack I), a 6.8 mm poly(D,L: )-lactide with blunt tip (tack II), a 4.1 mm poly(glycolide-co-L-lactide) (tack III) and one titanium tack (control tack). A first group of animals (n = 12) was euthanized after 2 weeks survival and a second group (n = 12) after 6 months. At euthanasia, a relaparoscopy was performed to assess adhesion formation followed by laparotomy with excision of the entire abdominal wall. Tensile strength of the individual fixation systems was tested with the use of a tensiometer by measuring the force to pull the tack out of the mesh. Additionally, the foreign body reaction to the fixation systems was evaluated histologically as was their potential degradation.
  
  
  RESULTS
  At 2 weeks the tensile strength was significantly higher for the control tack (31.98 N/cm²) compared to the resorbable devices. Except for tack II, the tensile strength was higher when the devices were fixed in a PP/ePTFE mesh compared to the PP/ORC mesh. After 6 months only tack III was completely resorbed, while tack I (9.292 N/cm²) had the lowest tensile strength. At this time-point similar tensile strength was observed for both tack II (29.56 N/cm²) and the control tack (27.77 N/cm²). Adhesions seem to be more depending on the type of mesh, in favor of PP/ePTFE.
  
  
  CONCLUSIONS
  At long term, the 4.1 mm poly(glycolide-co-L-lactide) tack was the only tack completely resorbed while the 6.8 mm poly(D,L: )-lactide tack with blunt tip reached equal strengths to the permanent tack.
authors.affiliation: Department of General and Hepatobiliary Surgery and Liver Transplantation Service, Ghent University Hospital and Medical School, De Pintelaan 185, 2K12-IC, 9000 Ghent, Belgium. emmelie.reynvoet@ugent.be
authors.forename: Emmelie
authors.initials: E
authors.lastname: Reynvoet
authors.forename: Frederik
authors.initials: F
authors.lastname: Berrevoet
authors.forename: Filip
authors.initials: F
authors.lastname: De Somer
authors.forename: Griet
authors.initials: G
authors.lastname: Vercauteren
authors.forename: Ingrid
authors.initials: I
authors.lastname: Vanoverbeke
authors.forename: Koen
authors.initials: K
authors.lastname: Chiers
authors.forename: Roberto
authors.initials: R
authors.lastname: Troisi
mesh_terms: D020341:Absorbable Implants; D000818:Animals; D002483:Cellulose, Oxidized; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000295:instrumentation* / Q000379:methods*; D007249:Inflammation / Q000209:etiology; D010535:Laparoscopy; D011138:Polytetrafluoroethylene; D011474:Prosthesis Design; D013526:Surgical Mesh / Q000009:adverse effects; D013552:Swine; D013718:Tensile Strength; D000267:Tissue Adhesions / Q000209:etiology
chemical_list: D002483:Cellulose, Oxidized; D011138:Polytetrafluoroethylene