title: Evaluation of fibrin sealant for biologic mesh fixation at the hiatus in a porcine model.
abstract: BACKGROUND
  The ideal method to secure biologic mesh during laparoscopic hiatal hernia repair remains uncertain. Suture or tack fixation can be technically difficult, and serious cardiovascular complications have been reported. Fibrin sealant (FS) offers a potential solution to this problem. We hypothesized that FS provides comparable mesh fixation to suture repair during laparoscopic mesh hiatoplasty.
  
  
  METHODS
  Using a porcine model, laparoscopic hiatal hernia repair was performed with suture reapproximation of the crura and reinforcement with an acellular porcine dermal matrix. Prior to repair, animals were randomized to mesh fixation with sutures (S) or FS. After 30-day survival, an esophagram was performed, the diaphragm harvested, and mesh position, fixation, and incorporation were evaluated histologically and biomechanically using a T-peel test.
  
  
  RESULTS
  Twenty (10 S and 10 FS) laparoscopic hiatal hernia repairs were performed. Total operative time was significantly less in the FS group (74.7 versus 127.0 min, p < 0.01). There were no instances of mesh migration in any animal. Mean peel force did not differ significantly between the S and FS groups (0.21 vs. 0.18 N/mm, respectively; p = 0.49). There was no significant difference in cellular repopularization or inflammatory changes around the mesh.
  
  
  CONCLUSIONS
  Fibrin sealant offers a reasonable alternative to suturing biologic mesh during laparoscopic hiatal hernia repair with equivalent mesh fixation. At 30 days it provides adhesive strength similar to suture fixation, while significantly reducing operative time.
authors.affiliation: Case Comprehensive Hernia Center, University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Krpata
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Blatnik
authors.forename: Karem C
authors.initials: KC
authors.lastname: Harth
authors.forename: Melissa S
authors.initials: MS
authors.lastname: Phillips
authors.forename: Yuri W
authors.initials: YW
authors.lastname: Novitsky
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Rosen
mesh_terms: D000818:Animals; D015718:Fibrin Tissue Adhesive; D006551:Hernia, Hiatal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D010535:Laparoscopy; D023421:Models, Animal; D013526:Surgical Mesh; D013552:Swine; D014014:Tissue Adhesives
chemical_list: D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives