Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA.
Hernia. 2010 Oct;14(5):505-9. doi: 10.1007/s10029-010-0670-3. Epub 2010 May 9.
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.
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.
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).
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.
本研究旨在评估纤维蛋白胶作为腹腔镜腹疝修补术（LVHR）中替代固定方法的急性固定强度，当与可吸收和不可吸收屏障网片一起使用时。
LVHR 的代表性网片类型包括一种不可吸收屏障网片（Bard Composix）和三种可吸收屏障网片（Sepramesh、Proceed 和 Parietex Composite Mesh）。大孔聚丙烯网片（Prolite Ultra）用作对照。一项相关的初步研究表明，C-Qur 或 Dualmesh 无法实现急性固定，因此这些网片未进行进一步分析。两种不同凝血酶浓度的纤维蛋白胶（TISSEEL 500 IU/ml 或 ARTISS 4 IU/ml）分别用于将 3 x 4 cm 网片固定在新西兰白兔收获的腹壁腹膜表面上。每种网片和纤维蛋白胶组合制备 10 个样本。然后使用拉力计（Instron 5542，Norwood，MA）以 0.42 mm/s 的速率对所得的网片-组织界面（3 x 3 cm）进行搭接剪切测试。记录构建物承受的最大负载作为以牛顿（N）为单位的急性固定强度。数据以平均值 +/- SEM 表示。使用双向方差分析和 Bonferroni 后检验确定统计学意义（P < 0.05）。
ARTISS 与 TISSEEL 在固定 Composix、Sepramesh、Proceed 和 Parietex Composite Mesh 时的急性固定强度无显著差异（P > 0.05）。然而，用 ARTISS 固定的 Prolite Ultra（7.099 +/- 1.01 N）的拉伸强度明显高于用 TISSEEL 固定的 Prolite Ultra（3.405 +/- 0.72 N）（P < 0.001）。在用 TISSEEL 固定的网片中，Parietex Composite（3.936 +/- 0.73 N）的强度明显高于 Sepramesh（1.760 +/- 0.33 N）（P < 0.05）。
对于选定的不可吸收（Composix）和可吸收屏障涂层（Sepramesh、Proceed 和 Parietex Composite Mesh）网片，TISSEEL 和 ARTISS 纤维蛋白胶的急性固定强度相当。该模型中的先前评估表明，单独使用纤维蛋白胶似乎不是一种适合用 C-Qur 或 DualMesh 固定到腹膜上的固定方法。需要进行长期评估，以评估在 LVHR 模型中使用可吸收和不可吸收屏障涂层网片的这种固定方法的效果。
