The influence of the number of endoclips and of mesh incorporation on the strength of an experimental hernia patch repair

Abstract

The strength conferred to a mesh by fixing it with laparoscopic staples and the effects of tissue incorporation have never been quantified. Eighteen dogs were divided into three groups sacrificed at 2 days (5 dogs), 2 weeks (6 dogs), and 2 months (7 dogs). One 3.5- by 5-cm piece of abdominal wall was removed from each side through a median laparotomy, leaving the skin intact. A polypropylene mesh (5 by 7 cm) was fixed over one defect with four Endopath EMS staples (Ethicon Endo-surgery) and over the other with 16 EMS staples. At sacrifice, bursting strength (BS) was measured with an Instron tester and specimens were studied histologically. One-way analysis of variance and the Newmann-Keuls multiple-comparison test were used. BS tests showed that for each period studied, the strength of the repair performed with 16 staples was significantly higher than that obtained when four staples were applied. They also showed that tensile strength increased significantly in both groups as time elapsed. Light microscopy supported the conclusion that the initial strength of the repair was related to the number of clips and was significantly increased by cellular infiltration at 2 weeks and significantly more by collagen deposition at 2 months. At 2 months, BS was significantly higher in the 16-staples group, suggesting that initial fixation still plays a significant role.

Laparoscopic inguinal hernia repair without mesh fixation, early results of a large randomised clinical trial

“…At the same time it is widely acknowledged that this need for surgical fixation is only temporary, as tissue incorporation into the mesh, characterized by significant cellular ingrowth by two weeks and collagen deposition within two months, achieves effective permanent fixation [17]. It was not the intention of the present study to investigate the long-term recurrence rate of TEP; this has been previously determined to be approximately 1% after five years [3].…”

Laparoscopic Total Extraperitoneal Inguinal Hernia Repair Without Mesh Fixation: Report of Early Outcomes

“…[11] Within the first postoperative 2 weeks, mesenchymal cells proliferate in the mesh, and within the first 2 months, tissue is incorporated into the mesh and adequate amount of collagen develops. [12] Accumulation of collagen strengthens permanent stabilization of mesh in the preperitoneal area. For early fixation sandwich effect, and for long-term mesh stabilization and permanent fixation, tissue incorporation is necessary.…”

Use of Fibrin Sealant for Prosthetic Mesh Fixation in Laparoscopic Extraperitoneal Inguinal Hernia Repair

“…Dion et al 27 studied the effects of staple placement on bursting strength in a dog model and demonstrated that stapled fixation is critical to prevent displacement, folding, or invagination of the prosthesis into the hernia defect in the first 2 weeks, before cellular infiltration and collagen deposition anchor the graft in place. The enhanced fibroblastic proliferation and incorporation into the mesh interstices found with FS fixation is probably responsible for its tensile strength, which was comparable to that achieved with staples even in the early phase of wound healing and significantly stronger than in the nonfixed group.…”