Nevler Avinoam, Gutman Mordechai, Lebedyev Alexander
Department of Surgery and Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Israel (affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel).
JSLS. 2014 Oct-Dec;18(4). doi: 10.4293/JSLS.2014.001154.
Mesh hernia repair is one of the most frequently performed procedures in general surgery. Recently, use of the self-gripping mesh demonstrated a beneficial effect on postoperative pain in inguinal hernia repairs. However, in intra-abdominal placement, the use of this novel mesh requires greater laparoscopic skill and dexterity because of the mesh's tendency to fold and adhere to itself and to any surrounding tissues. We hypothesized that gel-like coverage of a self-gripping mesh with a water-soluble film would allow delaying the immediate surface adhesion of the mesh to the tissue, which may allow greater freedom and ease in mesh placement for laparoscopic surgeons.
In this ex vivo animal study, gel-coated self-gripping mesh (ProGrip) was compared with a control uncoated mesh in bovine and porcine tissue specimens and assessed for dislodgement shear forces before and after dissolving of the gel.
Gel coating of the mesh reduced preperitoneal dislodgement forces in a porcine abdominal wall specimen by 81% (8.05 ± 0.66 vs 1.53 ± 0.82 N, P < .01). Dissolving the gel markedly increased the anchoring forces (10.62 ± 3.70 vs 1.53 ± 0.82 N, P < .0001), and after dissolving the gel, the mesh shear dislodgement forces were similar and noninferior to the control mesh (8.05 ± 0.66 vs 10.62 ± 3.70 N, P = NS).
We believe that water-soluble gel coating does not impair the adhesive features of the self-gripping mesh and may simplify its use in open and laparoscopic procedures by allowing controlled activation of the self-gripping mechanism.
疝修补术是普通外科最常开展的手术之一。近来，自固定补片在腹股沟疝修补术中的应用显示出对术后疼痛有有益影响。然而，在腹腔内放置时，由于这种新型补片易于折叠并与自身及周围任何组织粘连，使用它需要更高的腹腔镜操作技巧和灵活性。我们推测，用水溶性薄膜对自固定补片进行凝胶样覆盖可延缓补片与组织的即刻表面粘连，这可能会使腹腔镜外科医生在放置补片时更自由、轻松。
在这项离体动物研究中，将凝胶涂层自固定补片（ProGrip）与对照未涂层补片在牛和猪的组织标本中进行比较，并在凝胶溶解前后评估其移位剪切力。
补片的凝胶涂层使猪腹壁标本中的腹膜前移位力降低了81%（8.05±0.66对1.53±0.82 N，P<.01）。凝胶溶解后显著增加了锚定力（10.62±3.70对1.53±0.82 N，P<.0001），并且在凝胶溶解后，补片的剪切移位力相似且不劣于对照补片（8.05±0.66对10.62±3.70 N，P=无显著性差异）。
我们认为，水溶性凝胶涂层不会损害自固定补片的粘附特性，并且通过允许对自固定机制进行可控激活，可能会简化其在开放手术和腹腔镜手术中的使用。
