Department of Surgery, SMZ Floridsdorf, Hinaysgasse 1, Vienna 1210, Austria.
Surg Endosc. 2010 Jun;24(6):1318-24. doi: 10.1007/s00464-009-0767-x. Epub 2009 Dec 24.
Mesh tearoff from the tissue is the most common reason for hernia recurrence after hernia surgery involving the use of a synthetic mesh. Various fixation systems were critically compared in terms of their retention strength and the formation of adhesions.
In a prospective study with 25 Sprague-Dawley rats, two pieces of Parietex composite meshes measuring 2 x 3 cm were fixed intraperitoneally in a paramedian location. The randomized mesh fixation groups included transfascial fixed suture, ProTack, AbsorbaTack, and I-Clip. Of the 25 rats, 12 were killed and analyzed 1 week after implantation, with the remaining 13 rats killed and analyzed after 2 months. Adhesions observed at the time of mesh removal were measured according to an adhesion scoring system, and the fixation strengths of the individual fixation systems were tested. Additionally, the foreign body reaction to the mesh and fixation systems was measured as well as their potential degradation.
After 1 week, the retention strength of transfascial fixed suture was significantly higher (8.7 N/cm(2)) than that of ProTack (5.6 N/cm(2)) or AbsorbaTack (5.7 N/cm(2)). After 2 months, the retention strength had increased to 13.2 N/cm(2) in the transfascial fixed suture group, which was significantly higher than in the ProTack (9.7 N/cm(2)) or AbsorbaTack (8.7 N/cm(2)) groups. In contrast, the mesh could be fixed with the I-Clip only in 56% of the cases, and then achieved rather poor retention strength. Adhesion was significantly greater in the ProTack group than in any of the other groups (p < 0.001). At 2 months, scanning electron microscopy showed only marginal degradation of the absorbable elements.
Suture fixation led to satisfactory attachment of the prosthesis. Additional widespread anchorage of the mesh was achieved with ProTack or AbsorbaTack. The feasibility and retention strength of the I-Clip were poor.
在涉及使用合成网片的疝修补术后，网片从组织上撕裂是疝复发的最常见原因。各种固定系统在保留强度和粘连形成方面进行了严格比较。
在一项涉及 25 只斯普拉格-道利大鼠的前瞻性研究中，将两块 2x3cm 的 Parietex 复合网片以腹膜内中线位置固定。随机分组的网片固定方式包括经筋膜缝合固定、ProTack、AbsorbaTack 和 I-Clip。其中 12 只大鼠在植入后 1 周处死并进行分析，其余 13 只大鼠在 2 个月后处死并进行分析。根据粘连评分系统测量网片去除时的粘连程度，并测试各个固定系统的固定强度。此外，还测量了对网片和固定系统的异物反应及其潜在降解情况。
术后 1 周时，经筋膜缝合固定的保留强度（8.7N/cm(2)）明显高于 ProTack（5.6N/cm(2)）或 AbsorbaTack（5.7N/cm(2)）。术后 2 个月时，经筋膜缝合固定的保留强度增加至 13.2N/cm(2)，明显高于 ProTack（9.7N/cm(2)）或 AbsorbaTack（8.7N/cm(2)）。相比之下，I-Clip 仅能固定 56%的网片，且固定强度较差。ProTack 组的粘连明显大于其他组（p<0.001）。术后 2 个月时，扫描电子显微镜显示可吸收元件仅有轻微降解。
缝合固定可使假体得到满意的附着。ProTack 或 AbsorbaTack 可进一步广泛固定网片。I-Clip 的可行性和保留强度较差。
Zotero 插件