Adhesions to sutures, tackers, and glue for intraperitoneal mesh fixation: an experimental study.

Abstract

PURPOSE: Intraperitoneal mesh fixation for hernia repair is associated with adhesion formation. In this experimental study, adhesions against absorbable and non-absorbable fixation methods were compared. METHODS: Six commercially available fixation methods were placed intraperitoneally in rats with a small pore polypropylene mesh coated on one side with ePTFE (Intramesh T1(&#xae;)). Two non-absorbable fixation methods: Prolene(&#xae;) (polypropylene) sutures and Protack(&#xae;) (titanium) tackers. Four absorbable methods: Vicryl(&#xae;) sutures (polyglactin), Absorbatack(&#xae;) and Permasorb(&#xae;) tackers (both mixes of lactic and glycolic acids) and Tisseel Duo(&#xae;) (fibrin glue). Adhesions and histology were studied at 7 and 90&#xa0;days follow-up. In addition, fixation methods were placed without mesh, in order to study the reaction to the fixation method per se. RESULTS: No adhesion formation, but also inadequate mesh fixation was found with Tisseel Duo(&#xae;), which had been completely resorbed at 7&#xa0;days follow-up. Vicryl(&#xae;) sutures could no longer be detected at 90&#xa0;days follow-up and were associated with a favorable adhesion profile. All other fixation methods were still intact 90&#xa0;days after implantation. When placed without mesh, adhesion formation was significantly less than placed with a mesh (18 vs. 93&#xa0;%, P&#xa0;<&#xa0;0.001). Without mesh, adhesions were worst with Permasorb(&#xae;) tackers. CONCLUSIONS: Absorbable fixation methods such as polyglactin sutures and fibrin glue show a favorable adhesion profile compared to longer-term absorbable or non-absorbable fixation methods. However, before using fibrin glue as a single fixation method more research is required.