Reynvoet E, Van Cleven S, Van Overbeke I, Chiers K, De Baets P, Troisi R, Berrevoet F
Department of General and Hepatobiliary Surgery and Liver Transplantation Service, Ghent University Hospital and Medical School, Ghent, Belgium,
Hernia. 2015 Aug;19(4):661-70. doi: 10.1007/s10029-015-1347-8. Epub 2015 Feb 3.
The use of glue as mesh fixation in laparoscopic ventral hernia repair (LVHR) significantly reduces fixation associated morbidity. This experiment evaluates the intraperitoneal use of synthetic glue as single mesh fixation.
A total of 21 sheep were operated using a hernia model with two fascial defects of 2 cm(2) at the linea alba. One week later two polypropylene meshes (Dynamesh®) were implanted laparoscopically, using cyanoacrylate glue (Ifabond®) or conventional fixation (Securestrap®). In half of the animals the fascial defect was closed before mesh placement. After 1 day (n = 6), 2 weeks (n = 8) and 6 months (n = 6), a second laparoscopy was performed at which hernia recurrence, mesh integration and adhesion formation were evaluated. After euthanasia, burst strength testing and histopathology were evaluated.
One animal died due to intestinal incarceration. In 20 surviving animals, no hernias were diagnosed and mesh placement was satisfying. Adhesions could hardly be observed after 1 day but were omnipresent in both groups at 2 weeks and 6 months. Burst strength testing exceeded 100 N in all samples, independent of the fixation device used. Not after 1 day, but after 2 weeks the inflammatory cell response was significantly higher in the glue group. At 6 months minor inflammation was seen, as was foreign body reaction (FBR).
Using a standardized biomechanical testing system, synthetic glue can be considered an effective fixation tool in LVHR. The possible tissue toxicity of cyanoacrylates does not lead to an increased FBR. No difference in burst strength was observed for closing or not closing the defect.
在腹腔镜腹疝修补术（LVHR）中使用胶水进行补片固定可显著降低与固定相关的发病率。本实验评估腹腔内使用合成胶水作为单一补片固定方法的效果。
使用白线处有两个2 cm²筋膜缺损的疝模型对21只绵羊进行手术。一周后，通过腹腔镜植入两片聚丙烯补片（Dynamesh®），一片使用氰基丙烯酸酯胶水（Ifabond®）固定，另一片采用传统固定方法（Securestrap®）。半数动物在放置补片前关闭筋膜缺损。在术后1天（n = 6）、2周（n = 8）和6个月（n = 6）时，进行第二次腹腔镜检查，评估疝复发、补片整合及粘连形成情况。安乐死后，评估破裂强度测试和组织病理学结果。
1只动物因肠管嵌顿死亡。在20只存活动物中，未诊断出疝，补片放置情况良好。术后1天几乎未观察到粘连，但在2周和6个月时两组均出现广泛粘连。所有样本的破裂强度测试均超过100 N，与使用的固定装置无关。并非术后1天，而是术后2周时，胶水组的炎症细胞反应明显更高。6个月时可见轻微炎症及异物反应（FBR）。
使用标准化生物力学测试系统，合成胶水可被视为LVHR中一种有效的固定工具。氰基丙烯酸酯可能的组织毒性并未导致FBR增加。闭合或不闭合缺损在破裂强度方面未观察到差异。
