Department of Surgery, Wilhelminenspital, Vienna, Austria.
J Surg Res. 2011 Dec;171(2):576-81. doi: 10.1016/j.jss.2010.06.001. Epub 2010 Jun 29.
The atraumatic fixation of meshes by fibrin sealant (FS) has been established for both open and laparoscopic techniques of hernia repair. This study was performed to evaluate the use of FS in hernia mesh fixation with different polymerization speed (thrombin concentrations), using commercial hernia meshes, and in two techniques, transabdominal preperitoneal mesh placement (TAPP) and intraperitoneal mesh placement (IPOM).
A median laparotomy was performed in a pig model and hernia meshes were placed in IPOM and TAPP techniques. After mesh fixation with FS using thrombin concentrations of 4 and 500 IU/mL, maximum shear force before failure was measured at 5, 60, and 120 min.
At both thrombin concentrations and in all meshes in which the technique was used, the TAPP method tended to show higher maximum force levels at failure than did the IPOM method. In both TAPP and IPOM techniques and in all meshes, the 4 IU/mL thrombin concentration FS was superior to the 500 IU/mL thrombin concentration sealant.
Although both thrombin concentrations are suitable for mesh fixation, lower concentrations allow slower polymerization and better sealant diffusion leading to higher maximum force levels at failure. The TAPP method was biomechanically superior to the IPOM method. There were no major differences between mesh products.
纤维蛋白胶（FS）在开放性和腹腔镜疝修补术中均可实现对网片的无创伤固定。本研究旨在评估不同聚合速度（凝血酶浓度）、两种技术（经腹腹膜前疝修补术[TAPP]和腹腔内疝修补术[IPOM]）中 FS 在疝网片固定中的应用。
在猪模型中进行中腹部切开术，并在 IPOM 和 TAPP 技术中放置疝网片。在使用凝血酶浓度为 4 和 500 IU/mL 的 FS 固定网片后，在 5、60 和 120 分钟时测量失效前的最大剪切力。
在两种凝血酶浓度和所有使用的网片中，TAPP 方法在失效时的最大力水平均高于 IPOM 方法。在 TAPP 和 IPOM 技术以及所有网片中，凝血酶浓度为 4 IU/mL 的 FS 优于凝血酶浓度为 500 IU/mL 的 FS。
尽管两种凝血酶浓度均适用于网片固定，但较低浓度允许聚合速度较慢，密封剂扩散更好，从而在失效时达到更高的最大力水平。TAPP 方法在生物力学上优于 IPOM 方法。网片产品之间没有明显差异。
