Static Calculations for Mesh Fixation by Intraabdominal Pressure in Laparoscopic Extraperitoneal Herniorrhaphy

Acute tensile strength analysis of collagen solder for mesh fixation to the peritoneal surface

“…Acute tensile strengths of 200-500 g/cm 2 have been reported for staple and suture closure of the peritoneum [6][7][8]18]. Similar tensile strength values have been reported by other investigators in studies of acute peritoneal and wound strength [18].…”

“…The ability to cover the mesh and attach it to the peritoneal surface with a hydrophilic absorbable material is likely to facilitate intraperitoneal onlay mesh repair strategies and reduce or eliminate intraabdominal adhesion formation, along with its attendant morbidity [2,6,8]. Several composite materials-including Parietex (Sofradim, Wrentham, MA, USA) and Sepramesh (Genzyme, Cambridge, MA, USA), as well as biological grafts such as Surgisis (Cook Surgical, Bloomington, IN, USA) and Alloderm (Life Cell, Branchburg, NJ, USA)-are currently available and marketed specifically for this purpose [13].…”

Fibrin glue for securing the mesh in laparoscopic totally extraperitoneal inguinal hernia repair

“…The immediate tensile strength was obviously weaker than that of stapling. On the other hand, the fixation strength of five to six spiral tacks far exceeds the shear forces necessary to detach an adequate-sized mesh [8]. In 2001, Katkhouda et al [11], reporting an animal study using a randomized controlled porcine model, showed that fibrin glue fixation of the TEP prosthesis is feasible and prevents mesh migration by the soft fixation obtained with Tisseel combined with the natural adherence achieved in the extraperitoneal position by intraabdominal pressure transmitted through the peritoneum onto the mesh.…”

“…Mainly, fibrin glue enhances the natural biologic fixation of polypropylene mesh with host tissue, which is achieved within minutes by the endogenous fibrin glue of the host tissue [2] Some authors have suggested that mesh fixation may be unnecessary. This probably is true in many cases, although it often requires larger or more complex meshes [3,7,8,12,15,19]. The problem is that to date no accurate means exists for predicting recurrence risk and the need for mesh fixation in the individual patient [13,17].…”

Anatomical changes after inguinal hernia treatment: a reason for chronic pain and recurrent hernia?

“…Notably, the Bassini technique tends to destabilize the inguinal region because abdominal muscles and the transverse fascia are removed and reconstructed with just a few sutures. Consequently, peak loads are concentrated at the suture site and surrounding tissues [25]. Tension is supposed to be highest at the inner angle of the MPO, which favors direct recurrence in the first instance [26].…”