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Laparoscopic fixation of biologic mesh at the hiatus with fibrin or polyethylene glycol sealant in a porcine model

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Abstract

Background

The objective of this study was to determine the acute and chronic fixation strengths achieved by fibrin or polyethylene glycol (PEG) sealants to secure biologic mesh at the esophageal hiatus in a porcine model.

Methods

For this study, 32 female domestic pigs were divided into four groups of 8 each. The four groups respectively received acute fibrin sealant, acute PEG sealant, chronic fibrin sealant, and chronic PEG sealant. Laparoscopically, a 5.5 × 8.5-cm piece of Biodesign Surgisis Hiatal Hernia Graft (porcine small intestine submucosa) was oriented with the U-shaped cutout around the gastroesophageal junction and the short axis in the craniocaudal direction to simulate hiatal reinforcement with a biologic mesh. The mesh then was secured with 2 ml of either fibrin sealant or PEG sealant. The pigs in the acute groups were maintained alive for 2 h to allow for complete polymerization of the sealants, and the pigs in the chronic group were maintained alive for 14 days. After the pigs were euthanized, specimens of the mesh–tissue interface were subjected to lap shear testing to determine fixation strength, and hematoxylin and eosin (H&E) stained slides were evaluated for evidence of remodeling.

Results

No significant differences were observed between the acute and chronic fixation strengths or the remodeling characteristics of the two sealants. However, fixation strength increased significantly over time for both types of sealant. Evidence of remodeling also was significantly more pronounced in the chronic specimens than in the acute specimens.

Conclusions

This study demonstrated the feasibility of using fibrin or PEG sealants to secure biologic mesh at the hiatus in a porcine model.

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Acknowledgments

This study was funded by a 2010 Research Grant from the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) and the Washington University Institute for Minimally Invasive Surgery (WUIMIS). The authors thank J. Esteban Varela, MD, of Washington University in St. Louis for his efforts related to this study, Cook Biotech, Inc. (West Lafayette, IN, USA) for donating the Biodesign Surgisis Hiatal Hernia Graft materials evaluated in this study, and Baxter Healthcare Corporation (Deerfield, IL, USA) for donating the Tisseel fibrin sealant, the DUPLOJECT Easy Prep System, and the DUPLOTIP applicators used in this study.

Disclosures

Corey R. Deeken is a consultant for Atrium Medical Corporation and Davol, Inc. Brent D. Matthews is a consultant for Atrium Medical Corporation and Ethicon, Inc. He also receives honoraria as well as research and equipment support from Atrium Medical Corporation, Ethicon EndoSurgery, Karl Storz Endoscopy, Stryker Endoscopy, and W.L. Gore & Associates, Inc. Eric D. Jenkins, Sopon Lerdsirisopon, Kevin P. Costello, Lora Melman, Suellen C. Greco, and Margaret M. Frisella have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8109, St. Louis, MO, 63110, USA

    Eric D. Jenkins, Sopon Lerdsirisopon, Kevin P. Costello, Lora Melman, Margaret M. Frisella, Brent D. Matthews & Corey R. Deeken

  2. Division of Comparative Medicine, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8109, St. Louis, MO 63110, USA

    Suellen C. Greco

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  1. Eric D. Jenkins
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Correspondence to Corey R. Deeken.

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Jenkins, E.D., Lerdsirisopon, S., Costello, K.P. et al. Laparoscopic fixation of biologic mesh at the hiatus with fibrin or polyethylene glycol sealant in a porcine model. Surg Endosc 25, 3405–3413 (2011). https://doi.org/10.1007/s00464-011-1741-y

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