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Langenbeck's Archives of Surgery

Published in:

01-06-2010

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

Authors: Christine Schug-Pass, Hans Lippert, Ferdinand Köckerling

Published in: Langenbeck's Archives of Surgery | Issue 5/2010

Abstract

Background

Because of its hemostatic and adhesive properties, fibrin glue has been used in many areas of surgical treatment in recent years. One example is hernia repair, where fibrin gluing has become increasingly established as an alternative method for mesh fixation. Clinically, fixation with fibrin glue shows a reduced postoperative complication rate compared to other fixation methods (staples, sutures), particularly with regard to pain.

Materials and methods

Six different lightweight meshes were tested: TiMesh light, TiMesh extralight, Parietene light, Ultrapro, Optilene LP, and BARD Soft Mesh. Two millimeters Tissucol was used for fixation. Five meshes from each group were tested on muscular tissue with and without fibrin glue. The defined defect was 4.5 cm in diameter. The biomechanical measurements were taken in a standardized way using a materials testing machine. The minimum fixation strength required was 32 N, calculated from a corresponding model.

Results

The fixation strength measurements without fibrin glue gave a mean value for all 30 meshes of 2.98 N with a SD of 0.92 N. This was far below the 32 N required. With fibrin glue, the mean of all the measurements (30 meshes) was 61.86 ± 23.0 N (min 34.9 N, max 97.3 N). The lowest value was recorded for Ultrapro (34.9 ± 12.5 N). All the other meshes had a significantly higher fixation strength when fixed with fibrin glue than Ultrapro (p = 0.001). The best results were found for Optilene LP, and this was significantly better than all the other meshes (97.3 ± 8.9 N; p < 0.001).

Conclusion

Given the adequate stability and superior biocompatibility of lightweight large pore monofilament polypropylene meshes, heavyweight polypropylene meshes should no longer be used. It is possible to achieve adequate fixation of the meshes using fibrin glue. However, careful consideration should be given to the particular structure of the mesh in each case. Not every mesh is equally suitable for this purpose.

Cuschieri A (2001) Tissue adhesives in endosurgery. Semin Laparosc Surg 8:63–68CrossRefPubMed

Lee MG, Jones D (2005) Applications of Fibrin sealant in surgery. Surg Innov 12:203–213CrossRefPubMed

Katkhouda N, Mavor E, Friedlander MH, Mason RJ, Kiyabu M, Grant SW, Achanta K, Kirkman EL, Narayanan K, Essani R (2001) Use of fibrin sealant for prosthetic mesh fixation in laparoscopic extraperitoneal inguinal hernia repair. Ann Surg 233:18–25CrossRefPubMed

Katkhouda N (2004) A new technique for laparoscopic hernia repair using fibrin sealant. Surg Technol Int 12:120–126PubMed

Olmi S, Addis A, Domeneghini C, Scaini A, Croce E (2007) Experimental comparison of type of tissucol dilution and composite mesh (Parietex) for laparoscopic repair of groin and abdominal hernia: observational study conducted in a university laboratory. Hernia 11:211–215CrossRefPubMed

ten Hallers EJ, Jansen JA, Marres HA, Rakhorst G, Verkerke GJ (2007) Histological assessment of titanium and polypropylene fiber mesh implantation with and without fibrin tissue glue. J Biomed Mater Res A 80:372–380PubMed

Topart P, Vandenbroucke F, Lozach P (2005) Tisseel versus tack staples as mesh fixation in totally extraperitoneal laparoscopic repair of groin hernias: a retrospective analysis. Surg Endosc 19:724–727CrossRefPubMed

Schwab R, Willms A, Kröger A, Becker HP (2006) Less chronic pain following mesh fixation using a fibrin sealant in TEP inguinal hernia repair. Hernia 10:272–277CrossRefPubMed

Lovisetto F, Zonta S, Rota E, Mazzilli M, Bardone M, Bottero L, Faillance G, Longoni M (2007) Use of human fibrin glue (Tissucol) versus staples for mesh fixation in laparoscopic transabdominal preperitoneal hernioplasty. Ann Surg 245:222–231CrossRefPubMed

10.

Olmi S, Scaini A, Erba L, Guaglio M, Croce E (2007) Quantification of pain in laparoscopic transabdominal preperitoneal (TAPP) inguinal hernioplasty identifies marked differences between prosthesis fixation systems. Surgery 142:40–46CrossRefPubMed

11.

Lau H (2005) Fibrin sealant versus mechanical stapling for mesh fixation during endoscopic extraperitoneal inguinal hernioplasty. Ann Surg 242:670–675CrossRefPubMed

12.

Klinge U, Klosterhalfen B, Birkenhauer V, Junge K, Conze J, Schumpelick V (2002) Impact of polymer pore size on the interface scar formation in a rat model. J Surg Res 103:208–214CrossRefPubMed

13.

Scheidbach H, Tamme C, Tannapfel A, Lippert H, Köckerling F (2004) In vivo studies comparing the biocompatibility of various polypropylene meshes and their handling properties during endoscopic total extraperitoneal (TEP) patchplasty: an experimental study in pigs. Surg Endosc 18:211–220CrossRefPubMed

14.

Weyhe D, Belyaev O, Müller C, Meurer K, Bauer KH, Papapostolou G, Uhl W (2007) Improving outcomes in hernia repair by the use of light meshes—a comparison of different implant constructions based on a critical appraisal of the literature. World J Surg 31:234–244CrossRefPubMed

15.

Schug-Paß C, Tamme C, Sommerer F, Tannapfel A, Lippert H, Köckerling F (2008) A lightweight, partially absorbable mesh (Ultrapro) for endoscopic hernia repair: experimental biocompatibility results obtained in a porcine model. Surg Endosc 22:1100–1106CrossRefPubMed

16.

Nienhujs S, Staal E, Strobbe L, Rosman C, Groenewoud H, Bleichrodt R (2007) Chronic pain after mesh repair of inguinal hernia: a systematic review. Am J Surg 194:394–400CrossRef

17.

Tamme C, Garde N, Klingler A, Hampe C, Wunder R, Köckerling F (2005) Totally extraperitoneal inguinal hernioplasty with titanium—coated lightweight polypropylene mesh: early results. Surg Endosc 19:1125–1129CrossRefPubMed

18.

Klinge U, Conze J, Limberg W, Brücker C, Ottinger AP, Schumpelick V (1996) Pathophysiology of the abdominal wall. Chirurg 67:229–233PubMed

19.

Koch CA, Greenlee SM, Larson DR, Harrington JR, Farley DR (2006) Randomized prospective study of totally extraperitoneal inguinal hernia repair: fixation versus no fixation of mesh. ISLS 10:457–460

20.

Scheidbach H, Tannapfel A, Schmidt U, Lippert H, Köckerling F (2004) Influence of titanium coating on the biocompatibility of heavyweight polypropylene mesh. An animal experimental model. Eur Surg Res 36:313–317

21.

Schwab R, Schumacher O, Junge K, Binnebösel M, Klinge U, Becker HP, Schumpelick V (2008) Biomechanical analysis of mesh fixation in TAPP and TEP hernia repair. Surg Endosc 22:731–738CrossRefPubMed

22.

Binnebösel M, Rosch R, Junge K, Flanagan TC, Schwab R, Schumpelick V, Klinge U (2007) Biomechanical analyses of overlap and mesh dislocation in an incisional hernia model in vitro. Surgery 142:365–371CrossRefPubMed

23.

Knook MTT, van Rosmalen AC, Yoder BE, Kleinrensink GJ, Snijders CJ, Looman CWN, van Steesel CJ (2001) Optimal mesh size for endoscopic inguinal hernia repair. Surg Endosc 15:1471–1477CrossRefPubMed

24.

Petter-Puchner AH, Fortelny R, Mittermayr R, Öhlinger W, Redl H (2005) Fibrin sealing versus stapling of hernia meshes in an onlay model in the rat. Hernia 9:322–329CrossRefPubMed

Title: 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
Authors: Christine Schug-Pass
Hans Lippert
Ferdinand Köckerling
Publication date: 01-06-2010
Publisher: Springer-Verlag
Published in: Langenbeck's Archives of Surgery / Issue 5/2010
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-009-0466-z

At a glance: The STEP trials

Springer Medicine

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

Abstract

Background

Materials and methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Materials and methods

Results

Conclusion

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