Evaluation of acute fixation strength of absorbable and nonabsorbable barrier coated mesh secured with fibrin sealant

Abstract

Introduction: The purpose of this study was to evaluate the acute fixation strength of fibrin sealant as an alternative fixation method for laparoscopic ventral hernia repair (LVHR) when utilized with absorbable and nonabsorbable barrier meshes.

Methods: Representative mesh types for LVHR included one nonabsorbable barrier mesh (Bard Composix) and three absorbable barrier meshes (Sepramesh, Proceed, and Parietex Composite Mesh). Macroporous polypropylene mesh (Prolite Ultra) served as a control. An associated pilot study demonstrated that acute fixation was not achieved with C-Qur or Dualmesh, thus these meshes were not subjected to further analysis. Two fibrin sealants varying in thrombin concentration (TISSEEL 500 IU/ml or ARTISS 4 IU/ml) were each utilized to secure a 3 x 4 cm piece of mesh to the peritoneal surface of harvested abdominal wall from New Zealand white rabbits. Ten samples were prepared for each mesh and fibrin sealant combination. The resulting mesh-tissue interface (3 x 3 cm) underwent lap shear testing at a rate of 0.42 mm/s using a tensiometer (Instron 5542, Norwood, MA). The maximum load sustained by the construct was recorded as the acute fixation strength in units of Newtons (N). Data are given as means +/- SEM. Statistical significance (P < 0.05) was determined using a two-way ANOVA and Bonferroni post-test.

Results: There was no significant difference (P > 0.05) in the acute fixation strength achieved by ARTISS versus TISSEEL with Composix, Sepramesh, Proceed, and Parietex Composite Mesh. However, Prolite Ultra fixed with ARTISS (7.099 +/- 1.01 N) had a significantly higher tensile strength (P < 0.001) than Prolite Ultra fixed with TISSEEL (3.405 +/- 0.72 N). Among meshes fixed with TISSEEL, Parietex Composite (3.936 +/- 0.73 N) was significantly stronger than Sepramesh (1.760 +/- 0.33 N) (P < 0.05).

Conclusions: Acute fixation strength is equivalent for TISSEEL and ARTISS fibrin sealants for selected nonabsorbable (Composix) and absorbable barrier-coated (Sepramesh, Proceed, and Parietex Composite Mesh) meshes. Previous evaluations in this model indicated fibrin sealant alone did not appear to be a suitable method of fixation with C-Qur or DualMesh against the peritoneum. Long-term evaluation is needed to evaluate the efficacy of this method of fixation using absorbable and nonabsorbable barrier-coated meshes in a model of LVHR.