Differences in biomechanical stability using various fibrin glue compositions for mesh fixation in endoscopic inguinal hernia repair.
BACKGROUND
In hernia surgery, mesh fixation with fibrin glue instead of tacks and sutures can demonstrably reduce postoperative morbidity without increasing recurrence rates. In some cases there are significant differences in the biomechanical properties, depending on the functional structure of the meshes. Furthermore, there are various fibrin glue products on the market and these are used for mesh fixation. This study compared the fixation strength of fibrin glues in combination with various meshes.


METHODS
Three different lightweight polypropylene meshes (TiMESH™ light, ULTRAPRO™, Optilene(®) LP) were tested. All meshes were fixed using 2 ml of each of the three different fibrin glues (TISSUCOL(®), QUIXIL(®), EVICEL(®)) and tested for their biomechanical stability. The defect in the muscle tissue used was 45 mm for a mesh size of 10 × 15 cm. Measurements were conducted using a standardized stamp penetration test, while aiming not to use a fixation strength of less than 32 N.


RESULTS
With TISSUCOL, the fixation of Optilene LP proved to be significantly better than that of TiMESH or ULTRAPRO (97.3 vs. 47.9 vs. 34.9 N, p < 0.001). With EVICEL, it was possible to also achieve good tissue fixation for the ULTRAPRO mesh, while the results obtained for Optilene and TiMESH were relatively poorer [114.7 vs. 92.4 N (p = 0.056), vs. 64.3 N (p < 0.001)]. With QUIXIL, satisfactory results were obtained only for Optilene LP (43.6 N).


CONCLUSIONS
This study showed that there were significant differences in the fixation strength of different polypropylene meshes in combination with various fibrin glues. Experiments demonstrated that for each mesh there is an optimum combination with a particular fibrin glue with respect to the fixation strength. It must now be verified whether these results can be extrapolated to clinical practice.
Department of Surgery, Center for Minimally Invasive Surgery, Vivantes Hospital Spandau, Neue Bergstrasse 6, 13585, Berlin, Germany.
Christine
C
Schug-Pass
Dietmar A
DA
Jacob
Hans
H
Lippert
Ferdinand
F
Köckerling
D001696:Biomechanical Phenomena; D004724:Endoscopy; D015718:Fibrin Tissue Adhesive; D006552:Hernia, Inguinal / Q000601:surgery; D059685:Herniorrhaphy / Q000379:methods; D008422:Materials Testing; D011126:Polypropylenes; D013526:Surgical Mesh; D014014:Tissue Adhesives
D015718:Fibrin Tissue Adhesive; D011126:Polypropylenes; D014014:Tissue Adhesives