title: Titanium versus absorbable tacks comparative study (TACS): a multicenter, non-inferiority prospective evaluation during laparoscopic repair of ventral and incisional hernia: study protocol for randomized controlled trial.
abstract: BACKGROUND
  Laparoscopic repair of ventral and incisional hernias has gained popularity since many studies have reported encouraging results in terms of outcomee and recurrence. Choice of mesh and fixation methods are considered crucial issues in preventing recurrences and complications. Lightweight meshes are considered the first choice due to their biomechanical properties and the ability to integrate into the abdominal wall. Titanium helicoidal tacks still represent the "gold standard" for mesh fixation, even if they have been suggested to be involved in the genesis of post-operative pain and complications. Recently, absorbable tacks have been introduced, under the hypothesis that there will be no need to maintain a permanent fixation device after mesh integration. Nevertheless, there is no evidence that absorbable tacks may guarantee the same results as titanium tacks in terms of strength of fixation and recurrence rates. The primary end point of the present trial is to test the hypothesis that absorbable tacks are non-inferior to titanium tacks in laparoscopic incisional and ventral hernia repair (LIVHR) by lightweight polypropylene mesh, in terms of recurrence rates at 3-year follow-up. Surgical complications, post-operative stay, comfort and pain are secondary end points to be assessed.
  
  
  METHODS
  Two hundred and twenty patients with ventral hernia will be randomized into 2 groups: Group A (110) patients will be submitted to LIVHR by lightweight polypropylene mesh fixed by titanium tacks; Group B (110) patients will be submitted to LIVHR by lightweight polypropylene mesh fixed by absorbable tacks.
  
  
  CONCLUSIONS
  A few retrospective studies have reported similar results when comparing absorbable versus non-absorbable tacks in terms of intraoperative and early post-operative outcomes. These studies have the pitfalls to be retrospective evaluation of small series of patients, and the reported results still need to be validated by larger series and prospective studies. The aim of the present trial is to investigate and test the non-inferiority of absorbable versus non-absorbable tacks in terms of hernia recurrence rates, in order to assess whether the use of absorbable tacks may achieve the same results as non-absorbable tacks in mid-term and long-term settings.
  
  
  BACKGROUND
  NCT02076984: 5 June 2014 (ClinicalTrials.gov).
authors.affiliation: Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy. gianfranco.silecchia@uniroma1.it.|General Surgery Unit, ICOT Hospital, Latina, LT, Italy. gianfranco.silecchia@uniroma1.it.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Silecchia
authors.affiliation: Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy. giuseppe.cavallaro@uniroma1.it.|General Surgery Unit, ICOT Hospital, Latina, LT, Italy. giuseppe.cavallaro@uniroma1.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cavallaro
authors.affiliation: General Surgery Unit, GB Grassi Hospital, Ostia, RM, Italy. luigi.raparelli@hotmail.com.
authors.forename: Luigi
authors.initials: L
authors.lastname: Raparelli
authors.affiliation: General Surgery Unit, Gruppo Ospedaliero San Donato, Milan, Italy. stefano.olmi@gmail.com.
authors.forename: Stefano
authors.initials: S
authors.lastname: Olmi
authors.affiliation: General and Mini-Invasive Surgery Unit, Abano Terme Hospital, Abano Terme, PD, Italy. gbaldazzi@casacura.it.
authors.forename: Gianandrea
authors.initials: G
authors.lastname: Baldazzi
authors.affiliation: General Surgery Unit, Andosilla Hospital, Civita Castellana, VT, Italy. campanile@surgical.net.
authors.forename: Fabio Cesare
authors.initials: FC
authors.lastname: Campanile
mesh_terms: D020341:Absorbable Implants; D002985:Clinical Protocols; D004867:Equipment Design; D006555:Hernia, Ventral / Q000175:diagnosis / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D000069290:Incisional Hernia / Q000175:diagnosis / Q000601:surgery*; D007558:Italy; D010535:Laparoscopy / Q000009:adverse effects / Q000295:instrumentation*; D011126:Polypropylenes; D011446:Prospective Studies; D012107:Research Design; D013526:Surgical Mesh; D013997:Time Factors; D014025:Titanium; D016896:Treatment Outcome
chemical_list: D011126:Polypropylenes; D014025:Titanium