Abstract:

Laparoscopic ventral hernia repair (LVHR) has undergone significant change during the past two decades. Most surgeons perform the operation in a similar manner, and some procedures are standard: Careful access to the abdomen, dissection of adhesions and choice of overlap. The choice of biomaterial and the method of fixation, however, are still areas of great controversy. Primarily the mesh and fixation device should be compatible. Prosthetic meshes are divided into macro- and micro porous according to pore size. Thus, when selecting a fixation device the mesh pore size has to be considered. If the pores are too large compared to the fixation device the interface between mesh and device will be too small and fixation can be compromised. Given that, fixation can be accomplished in many different ways. Currently, there are 16 different types of fixation devices that can be categorized into four groups: Non-absorbable tacks, absorbable tacks, sutures and tissue glue (Table 1). In addition, two self-adhering meshes are available. There are many factors to consider when selecting a fixation device: Post-operative pain, infection, formation of seromas, adhesions, fixation strength, strength of ingrowth, shrinkage, fistulas, tack migration and most importantly recurrence. This paper reviews the current fixation devices and their role in the above-mentioned problems.

Authors:

Sanne Shiroma Harsløf, MD, PhD-student, Resident, Surgical Department , Regional Hospital Horsens , Denmark, Pål Wara, MD, DMSc, Chief Surgeon, Surgical Department, Aarhus University Hospital, THG, Denmark, Hans Friis-Andersen MD, Chief Surgeon, Surgical Department, Regional Hospital Horsens, Denmark

PMID:  24700224

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