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首页> 外文期刊>Surgical Endoscopy >Biomechanical analyses of mesh fixation in TAPP and TEP hernia repair.
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Biomechanical analyses of mesh fixation in TAPP and TEP hernia repair.

机译：TAPP和TEP疝修补术中网孔固定的生物力学分析。

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摘要

BACKGROUND: Reliable laparoscopic fixation of meshes prior to their fibrous incorporation is intended to minimize recurrences following transabdominal preperitoneal hernia repair (TAPP) and totally extraperitoneal repair (TEP) repair of inguinal hernias. However, suture-, tack- and staple-based fixation systems are associated with postoperative chronic inguinal pain. Initial fixation with fibrin sealant offers an atraumatic alternative, but there is little data demonstrating directly whether fibrin-based mesh adhesion provides adequate biomechanical stability for repair of inguinal hernia by TAPP and TEP. METHODS: Using a newly developed, standardized simulation model for abdominal wall hernias, sublay repairs were performed with six different types of commercially available hernia mesh. The biomechanical stability achieved, and the protection afforded by the mesh-hernia overlap, were compared for three different techniques: nonfixation, point-by-point suture fixation, and fibrin sealant fixation. RESULTS: Mesh dislocation from the repaired hernia defect was consistently seen with nonfixation. This was reliably prevented with all six mesh types when fixed using either sutures or fibrin sealant. The highest stress resistance across the whole abdominal wall was found following superficial fixation with fibrin sealant across the mesh types. There was a highly statistically significant improvement in fixation stability with fibrin sealant versus fixation using eight single sutures (p = 0.008), as assessed by the range of achievable peak pressure stress up to 200 mmHg. CONCLUSIONS: To ensure long-term freedom from recurrence, intraoperative mesh-hernia overlap must be retained. This can be achieved with fibrin sealant up to the incorporation of the mesh - without trauma and with biomechanical stability.
机译：背景：网状纤维的可靠腹腔镜固定术旨在将腹股沟疝的经腹前腹膜疝修补术（TAPP）和完全腹膜外修补术（TEP）修复后的复发率降至最低。然而，基于缝合线，钉子和钉书钉的固定系统与术后慢性腹股沟痛有关。最初用纤维蛋白密封剂固定可提供无创伤的替代方法，但几乎没有数据直接证明基于纤维蛋白的网状粘连是否为TAPP和TEP修复腹股沟疝提供了足够的生物力学稳定性。方法：使用新开发的标准化腹壁疝模拟模型，用六种不同类型的市售疝气网进行了基底修复。比较了三种不同技术的生物力学稳定性以及网状疝的重叠所提供的保护作用：非固定，逐点缝合固定和纤维蛋白密封胶固定。结果：未固定的患者始终可见修复疝缺损引起的网状脱位。当使用缝线或纤维蛋白密封剂固定时，所有六种网格类型均可靠地防止了这种情况。在用不同类型的网状纤维蛋白密封剂进行浅层固定后，发现整个腹壁的抗应力性最高。与通过八根单缝线进行固定相比，使用纤维蛋白密封剂的固定稳定性在统计学上有显着改善（p = 0.008），这可以通过达到200 mmHg的峰值压力应力范围进行评估。结论：为确保长期无复发，必须保留术中网膜疝气重叠。这可以通过使用纤维蛋白密封剂直至网状物并入而实现-无创伤且具有生物力学稳定性。

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