Adhesions to sutures, tackers, and glue for intraperitoneal mesh fixation: an experimental study

PURPOSE: Intraperitoneal mesh fixation for hernia repair is associated with adhesion formation. In this experimental study, adhesions against absorbable and non-absorbable fixation methods were compared. METHODS: Six commercially available fixation methods were placed intraperitoneally in rats with a small pore polypropylene mesh coated on one side with ePTFE (Intramesh T1((R))). Two non-absorbable fixation methods: Prolene((R)) (polypropylene) sutures and Protack((R)) (titanium) tackers. Four absorbable methods: Vicryl((R)) sutures (polyglactin), Absorbatack((R)) and Permasorb((R)) tackers (both mixes of lactic and glycolic acids) and Tisseel Duo((R)) (fibrin glue). Adhesions and histology were studied at 7 and 90 days follow-up. In addition, fixation methods were placed without mesh, in order to study the reaction to the fixation method per se. RESULTS: No adhesion formation, but also inadequate mesh fixation was found with Tisseel Duo((R)), which had been completely resorbed at 7 days follow-up. Vicryl((R)) sutures could no longer be detected at 90 days follow-up and were associated with a favorable adhesion profile. All other fixation methods were still intact 90 days after implantation. When placed without mesh, adhesion formation was significantly less than placed with a mesh (18 vs. 93 %, P < 0.001). Without mesh, adhesions were worst with Permasorb((R)) tackers. CONCLUSIONS: Absorbable fixation methods such as polyglactin sutures and fibrin glue show a favorable adhesion profile compared to longer-term absorbable or non-absorbable fixation methods. However, before using fibrin glue as a single fixation method more research is required.