Medtronic, Sofradim Production, Trévoux, France.
Hernia. 2024 Feb;28(1):75-84. doi: 10.1007/s10029-023-02915-8. Epub 2023 Nov 14.
Sutures or tacks are commonly used to secure a mesh in intraperitoneal onlay mesh (IPOM) hernia repair, but such penetrating fixations can cause local damage, that can be associated with pain. The use of an adhesive could be an alternative to reduce complications. However, a risk associated with this approach has been identified, particularly when the defect cannot be closed. A mesh glued to the peritoneum only might not provide as much mechanical reinforcement to the abdominal wall (AW) as a mesh anchored to the myofascial structure with penetrating fixations, which could lead to an increased recurrence rate. Additionally, the high elasticity of the peritoneum may increase mesh bulging. Leveraging an ex vivo approach, the objective of this study was to investigate the impact of mesh fixation using glue versus barbed sutures, on its biomechanical response for IPOM surgery.
An experimental method was developed using ex vivo porcine abdominal wall samples (n = 12). A 4-cm centered circular defect was created by dissecting the skin and the subcutaneous tissue and removing muscle and extraperitoneal fat, while keeping the peritoneum intact. A 14-cm diameter mesh was secured (Dermabond™ cyanoacrylate adhesive or V-Loc™ barbed sutures) to the AW. The mesh was placed on the peritoneum to remain consistent with the IPOM placement. The sample was then subjected to some inflation tests to simulate increased levels of intra-abdominal pressure (IAP) representing daily activities. For each test, mesh bulging into the defect was assessed as a function of the pressure using Digital Image Correlation (DIC) analysis.
Mesh bulging was studied for 2 configurations: suture fixation and glue. Glued meshes exhibited significantly higher bulging values than when sutured with a significant difference (p = 0.013) observed at 252 mmHg and a certain trend for statistical difference (p < 0.1) for stair climbing or coughing activities. Additionally, the stiffness of the repair was also significantly higher when the mesh was sutured compared to when it was glued to the peritoneum (p < 0.05).
This study demonstrated that a mesh glued to the peritoneum exhibited higher bulging and a behavior of the repair less stiff compared to when it was sutured to the myofascial structure of the AW, particularly for high intra-abdominal pressures. However, the impact of these differences remains to be evaluated over time. Further preclinical investigations are needed to quantify their impact post-operatively.
在腹腔内补片修补术（IPOM）中，缝线或钉通常用于固定网片，但这些穿透性固定会造成局部损伤，可能与疼痛有关。使用粘合剂可能是一种减少并发症的替代方法。然而，已经发现这种方法存在风险，尤其是在无法关闭缺损的情况下。与穿透性固定将网片锚定在肌肉筋膜结构上相比，仅将网片粘接到腹膜上可能无法为腹壁（AW）提供足够的机械加固，这可能导致复发率增加。此外，腹膜的高弹性可能会增加网片隆起。利用离体方法，本研究的目的是研究使用胶水与带倒钩缝线固定网片对 IPOM 手术中其生物力学反应的影响。
使用离体猪腹壁样本（n=12）开发了一种实验方法。通过解剖皮肤和皮下组织并去除肌肉和腹膜外脂肪，同时保持腹膜完整，创建一个 4 厘米中心的圆形缺损。将一个 14 厘米直径的网片（Dermabond™氰基丙烯酸酯粘合剂或 V-Loc™带倒钩缝线）固定在 AW 上。将网片放置在腹膜上，以与 IPOM 放置保持一致。然后对样本进行一些充气测试，以模拟代表日常活动的不同水平的腹腔内压（IAP）。对于每个测试，使用数字图像相关（DIC）分析评估网片向缺损内的隆起程度作为压力的函数。
研究了两种固定方式下的网片隆起情况：缝线固定和胶水固定。与缝线固定相比，胶水固定的网片隆起值明显更高，在 252mmHg 时存在显著差异（p=0.013），在爬楼梯或咳嗽等活动时存在一定的统计学差异趋势（p<0.1）。此外，与粘接到腹膜上相比，网片缝合时修复的刚度也明显更高（p<0.05）。
本研究表明，与缝合到 AW 的肌肉筋膜结构相比，粘接到腹膜上的网片表现出更高的隆起和修复的刚性较低，尤其是在高腹腔内压力下。然而，这些差异的影响仍有待随着时间的推移进行评估。需要进一步的临床前研究来量化术后的影响。
