Biomechanical analyses of mesh fixation in TAPP and TEP hernia repair

Abstract

To ensure long-term freedom from recurrence, intraoperative mesh-hernia overlap must be retained. This can be achieved with fibrin sealant up to the incorporation of the mesh - without trauma and with biomechanical stability.

Primary mesh augmentation with fibrin glue for abdominal wall closure—investigations on a biomechanical model

“…Mesh fixation with fibrin glue is a quick and reliable method, as borne out not only by the biomechanical results of our tests [35,36]. While it was not possible to obtain essentially higher tensile strength values for suture reinforcement with fibrin glue alone, the specified retention force value was significantly exceeded through the additional use of a mesh.…”

“…But, once again, the question arises as to how such meshes are to be fixed so that they can assume an effective prophylactic role. By means of other models of hernia repair, it was possible to demonstrate that mesh fixation with fibrin glue could be equated with sutureor staples-based fixation [35][36][37] and that this could even expedite mesh integration into the surrounding tissue.…”

Mesh fixation with fibrin glue (Tissucol/Tisseel®) in hernia repair dependent on the mesh structure—is there an optimum fibrin–mesh combination?—Investigations on a biomechanical model

“…However, our model was able to show that fixation is absolutely essential when extreme forces arise (32 N according to a model by Klinge [18]) that have a direct effect on the hernial orifice. All meshes dislocated far below the required 32 N. It is undoubtedly true that our model does not fully represent reality, since neither the elasticity of the abdominal wall nor the forces that also arise there are taken into account, as is the case in a publication by Schwab with a corresponding model [21]. In this model, a significant advantage was seen for fibrin glue over staple fixation.…”

Fixation of mesh to the peritoneum using a fibrin glue: investigations with a biomechanical model and an experimental laparoscopic porcine model

“…All meshes become dislocated at forces well below the required value of 32 N. No doubt, our model does not reflect the entire actual reality because neither the elasticity of the abdominal wall nor the forces exerted there are taken into account, as was the case in a publication by Schwab using a similar model [34]. In that model, fibrin gluing conferred a significant advantage over staple-based fixation.…”