title: Short-term strength of non-penetrating mesh fixation: LifeMesh™, Tisseel™, and ProGrip™.
abstract: Non-penetrating mesh fixation is becoming widely accepted even though little is known about the short-term fixation strength of these techniques. Although clinical outcomes are the ultimate measure of effectiveness, ex vivo biomechanical evaluation provides insights about the load-carrying capacity of the mesh-tissue complex in vivo. As such, the purpose of this study was to compare the short-term fixation strength of three unique non-penetrating methods of fixation: LifeMesh™, ProGrip™, and Tisseel™. Among these, LifeMesh™ is a novel technology where large-pore, mid-weight polypropylene mesh is embedded in a dry matrix of porcine gelatin and microbial transglutaminase enzyme, providing self-fixation without the need for a separate adhesive application.
  
  
  
  Seven mongrel swine underwent implantation of two 4 × 7 cm pieces of either LifeMesh™, ProGrip™, or polypropylene mesh fixated with 2 mL of Tisseel™; 10 min after application, the samples were excised with the abdominal wall and stored for immediate biomechanical testing. The samples underwent lap shear testing to determine the short-term fixation strength of these three technologies.
  
  
  
  ProGrip™ demonstrated mean fixation strength of 1.3 N/cm (±STE 0.2). Mean fixation for mesh fixated with Tisseel™ was 2.6 N/cm (±STE 0.5). LifeMesh™ samples had mean fixation strength of 8.0 N/cm (±STE 2.1). Analysis of variance testing showed that interfacial strength of LifeMesh™ was significantly greater than that of either ProGrip™ or Tisseel™. ProGrip™ and Tisseel™ were not significantly different from each other (p = 0.06).
  
  
  
  Short-term strength of mesh fixation is an undescribed factor in hernia repair, but could have significant implications for early recurrence and mesh contraction. While further investigation is needed to define adequate interfacial strength, this comparison of non-penetrating mesh fixation methods shows that the novel LifeMesh™ technology exhibits greater strength than other non-penetrating fixation techniques.
authors.affiliation: Department of Surgery, University of Tennessee Health Science Center, 910 Madison Ave, Suite 223, Second Floor, Memphis, TN, 38163, USA. cshahan@uthsc.edu.
authors.forename: Charles P
authors.initials: CP
authors.lastname: Shahan
authors.affiliation: Department of Surgery, University of Tennessee Health Science Center, 910 Madison Ave, Suite 223, Second Floor, Memphis, TN, 38163, USA.
authors.forename: Nathaniel N
authors.initials: NN
authors.lastname: Stoikes
authors.affiliation: Department of Biomedical Engineering, University of Memphis, 330 Engineering Tech Bldg., Memphis, TN, 38152, USA.
authors.forename: Esra
authors.initials: E
authors.lastname: Roan
authors.affiliation: Department of Biomedical Engineering, University of Memphis, 330 Engineering Tech Bldg., Memphis, TN, 38152, USA.
authors.forename: James
authors.initials: J
authors.lastname: Tatum
authors.affiliation: Department of Surgery, University of Tennessee Health Science Center, 910 Madison Ave, Suite 223, Second Floor, Memphis, TN, 38163, USA.
authors.forename: David L
authors.initials: DL
authors.lastname: Webb
authors.affiliation: Department of Surgery, University of Tennessee Health Science Center, 910 Madison Ave, Suite 223, Second Floor, Memphis, TN, 38163, USA.
authors.forename: Guy R
authors.initials: GR
authors.lastname: Voeller
mesh_terms: D000818:Animals; D001696:Biomechanical Phenomena; D059685:Herniorrhaphy / Q000295:instrumentation* / Q000379:methods*; D008422:Materials Testing; D023421:Models, Animal; D011126:Polypropylenes; D013526:Surgical Mesh; D013552:Swine
chemical_list: D011126:Polypropylenes
keywords: Biomechanics; Fibrin sealants; Hernia; Mesh fixation