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Slow-absorbing Sutures for Mesh Fixation in Laparoscopic Ventral Hernia Repair

Jamry Andrzej, Gzik Marek, Jaski Marek, Wolanski Wojciech, Brocki Marian

Introduction: Laparoscopic ventral hernia repair (LVHR) is associated with chronic pain caused by the formation of tension between gradually shrinking mesh and non-absorbable points of its attachment. Therefore, the use of slow-absorbing sutures perhaps can reduce this problem.

Methods: To assess the feasibility of using slow-absorbing sutures, we evaluated mesh stability in experimental model (pigs), after the sutures lost their supportive capability. DynaMesh IPOM implants were fixed laparoscopically with trans fascial sutures (PDS II or Maxon) placed 4 cm apart. The force necessary for mesh detachment was measured, and the force required to detach 1 of mesh was calculated. Finally, we compared the total fixing forces (based the results for this study) and the forces generated by intra-abdominal pressure (based on the mathematical model developed in other studies) for hernias 2.5 to 10 cm in diameter.

Results: The mean force required to detach one of all mesh fragments was 0.68 [N/] with sd2 = 0.243 [N/] ( Maxon 0.62 N/ ]; PDS II 0.73 [N/]). The calculated differences between the fixing forces for meshes and the forces exerted by intra-abdominal pressure indicating that the examined sutures ensure proper mesh fixation. Additionally, a differences for meshes fixed with PDS II and Maxon was no statistically significant (p=0.273).

Conlusion: 1. Six weeks after surgery, the stabilization forces generated by slowabsorbing sutures and DynaMesh IPOM adhesion to the abdominal wall appear to provide adequate mesh fixation.

2. Maxon and PDSII stitches appeared to have similar properties with respect to LVHR.