title: The use of cyanoacrylate sealant as simple mesh fixation in laparoscopic ventral hernia repair: a large animal evaluation.
abstract: OBJECTIVE
  The use of glue as mesh fixation in laparoscopic ventral hernia repair (LVHR) significantly reduces fixation associated morbidity. This experiment evaluates the intraperitoneal use of synthetic glue as single mesh fixation.
  
  
  METHODS
  A total of 21 sheep were operated using a hernia model with two fascial defects of 2 cm(2) at the linea alba. One week later two polypropylene meshes (Dynamesh®) were implanted laparoscopically, using cyanoacrylate glue (Ifabond®) or conventional fixation (Securestrap®). In half of the animals the fascial defect was closed before mesh placement. After 1 day (n = 6), 2 weeks (n = 8) and 6 months (n = 6), a second laparoscopy was performed at which hernia recurrence, mesh integration and adhesion formation were evaluated. After euthanasia, burst strength testing and histopathology were evaluated.
  
  
  RESULTS
  One animal died due to intestinal incarceration. In 20 surviving animals, no hernias were diagnosed and mesh placement was satisfying. Adhesions could hardly be observed after 1 day but were omnipresent in both groups at 2 weeks and 6 months. Burst strength testing exceeded 100 N in all samples, independent of the fixation device used. Not after 1 day, but after 2 weeks the inflammatory cell response was significantly higher in the glue group. At 6 months minor inflammation was seen, as was foreign body reaction (FBR).
  
  
  CONCLUSIONS
  Using a standardized biomechanical testing system, synthetic glue can be considered an effective fixation tool in LVHR. The possible tissue toxicity of cyanoacrylates does not lead to an increased FBR. No difference in burst strength was observed for closing or not closing the defect.
authors: Department of General and Hepatobiliary Surgery and Liver Transplantation Service, Ghent University Hospital and Medical School, Ghent, Belgium, emmelie.reynvoet@ugent.be.
authors: E
authors: E
authors: Reynvoet
authors: S
authors: S
authors: Van Cleven
authors: I
authors: I
authors: Van Overbeke
authors: K
authors: K
authors: Chiers
authors: P
authors: P
authors: De Baets
authors: R
authors: R
authors: Troisi
authors: F
authors: F
authors: Berrevoet
mesh_terms: D034861:Abdominal Wall / Q000601:surgery; D000818:Animals; D003487:Cyanoacrylates / Q000008:administration & dosage*; D004195:Disease Models, Animal; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D010535:Laparoscopy; D010537:Peritoneum / Q000601:surgery; D012756:Sheep; D013526:Surgical Mesh; D014014:Tissue Adhesives / Q000008:administration & dosage*
chemical_list: D003487:Cyanoacrylates; D014014:Tissue Adhesives
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