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Strength of Tissue Attachment to Mesh After Ventral Hernia Repair With Synthetic Composite Mesh in a Porcine Model

Sarah Majercik, Vassiliki Tsikitis, David A Iannitti, Sr.
Brown Medical School, Rhode Island Hospital, Providence, RI

Objectives:
Measure strength of tissue attachment to mesh at various time points after laparoscopic ventral hernia repair in a porcine model.
Design:
Prospective animal study.
Setting:
Academic medical center.
Participants:
Twelve female swine.
Interventions:
Each animal had two 10x16cm sheets of polypropylene/ePTFE composite mesh (Composix E/X, Davol, Cranston, RI) laparoscopically fixated to the abdominal wall. No transfascial sutures were used. Animals were euthanized at 2, 4, 6, and 12 weeks after surgery, and the abdominal walls were resected en bloc with the patches. Each patch was cut into 2x7cm strips, and each strip was independently analyzed.
Main Outcome Measures:
Strength of tissue attachment to the mesh was measured using a lap-shear method. Each strip was placed into a servo-hydraulic tensile testing frame (Instron Corporation, Canton, MA), and the abdominal wall pulled from the mesh. Data is reported as mean force in pounds.
Results:
Mean lap-shear force was 0.81±0.1, 1.08±0.1, 0.89±0.1, and 1.13±0.1 lbs at 2, 4, 6, and 12 weeks, respectively. Mean force at 12 weeks was higher than at 2 weeks. (p<0.05) No other time periods were significantly different from any other.
Conclusion:
This study demonstrates that 72% of tissue ingrowth and strength occurs by 2 weeks postoperatively after laparoscopic placement of a composite hernia prosthesis. Strength gradually increases until 12 weeks after surgery. This has clinical implications for human ventral hernia repair. Specifically, it questions the necessity of trans-fascial sutures to secure polypropylene-based prostheses to the abdominal wall during ventral hernia surgery.

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