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Evaluation of fibrin sealant for biologic mesh fixation at the hiatus in a porcine model

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Abstract

Background

The ideal method to secure biologic mesh during laparoscopic hiatal hernia repair remains uncertain. Suture or tack fixation can be technically difficult, and serious cardiovascular complications have been reported. Fibrin sealant (FS) offers a potential solution to this problem. We hypothesized that FS provides comparable mesh fixation to suture repair during laparoscopic mesh hiatoplasty.

Study design

Using a porcine model, laparoscopic hiatal hernia repair was performed with suture reapproximation of the crura and reinforcement with an acellular porcine dermal matrix. Prior to repair, animals were randomized to mesh fixation with sutures (S) or FS. After 30-day survival, an esophagram was performed, the diaphragm harvested, and mesh position, fixation, and incorporation were evaluated histologically and biomechanically using a T-peel test.

Results

Twenty (10 S and 10 FS) laparoscopic hiatal hernia repairs were performed. Total operative time was significantly less in the FS group (74.7 versus 127.0 min, p < 0.01). There were no instances of mesh migration in any animal. Mean peel force did not differ significantly between the S and FS groups (0.21 vs. 0.18 N/mm, respectively; p = 0.49). There was no significant difference in cellular repopularization or inflammatory changes around the mesh.

Conclusions

Fibrin sealant offers a reasonable alternative to suturing biologic mesh during laparoscopic hiatal hernia repair with equivalent mesh fixation. At 30 days it provides adhesive strength similar to suture fixation, while significantly reducing operative time.

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Acknowledgments

This study was performed with the assistance of a research grant provided by Baxter Healthcare.

Disclosures

Drs. Krpata, Blatnik, Harth, Phillips, Novitsky, and Rosen disclose that this research was performed with the assistance of a research grant provided by Baxter Healthcare (grant # BS10-000426). Additionally, Dr. Novitsky is a speaker for Lifecell and Davol and consultant for Davol and Kensey Nash. Dr. Rosen is a speaker for Covidien and Lifecell and has research support from Lifecell, Davol, W. L. Gore, and Cook.

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Authors and Affiliations

  1. Case Comprehensive Hernia Center, University Hospitals Case Medical Center, Cleveland, OH, USA

    David M. Krpata, Jeffrey A. Blatnik, Karem C. Harth, Melissa S. Phillips, Yuri W. Novitsky & Michael J. Rosen

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  1. David M. Krpata
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  2. Jeffrey A. Blatnik
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  3. Karem C. Harth
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  4. Melissa S. Phillips
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  5. Yuri W. Novitsky
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  6. Michael J. Rosen
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Correspondence to Michael J. Rosen.

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Krpata, D.M., Blatnik, J.A., Harth, K.C. et al. Evaluation of fibrin sealant for biologic mesh fixation at the hiatus in a porcine model. Surg Endosc 26, 3120–3126 (2012). https://doi.org/10.1007/s00464-012-2302-8

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  • DOI: https://doi.org/10.1007/s00464-012-2302-8

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