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

Abstract

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. Six commercially available fixation methods were placed intraperitoneally in rats with a small pore polypropylene mesh coated on one side with ePTFE (Intramesh T1(®)). Two non-absorbable fixation methods: Prolene(®) (polypropylene) sutures and Protack(®) (titanium) tackers. Four absorbable methods: Vicryl(®) sutures (polyglactin), Absorbatack(®) and Permasorb(®) tackers (both mixes of lactic and glycolic acids) and Tisseel Duo(®) (fibrin glue). Adhesions and histology were studied at 7 and 90days follow-up. In addition, fixation methods were placed without mesh, in order to study the reaction to the fixation method per se. No adhesion formation, but also inadequate mesh fixation was found with Tisseel Duo(®), which had been completely resorbed at 7days follow-up. Vicryl(®) sutures could no longer be detected at 90days follow-up and were associated with a favorable adhesion profile. All other fixation methods were still intact 90days after implantation. When placed without mesh, adhesion formation was significantly less than placed with a mesh (18 vs. 93%, P<0.001). Without mesh, adhesions were worst with Permasorb(®) tackers. 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.