Suture versus staple for fixation of mesh in incisional hernia repair

The incidence of incisional hernia has been reported to be between 11 and 20% in patients post laparotomy and carries the risk of pain, incarceration and strangulation. Prosthetic mesh for incisional hernia repair has been shown to be superior to suture repair. The recurrence rate of primary mesh repair of incisional hernias has been reported to be as high as 38%. This experimental study in euthanised rats aims to compare the fixation strength of mesh using sutures and surgical staples. Forty euthanised adult male Sprague-Dawley rats were used for midline laparotomy incisions and repair of the abdominal wall carried out using polypropylene mesh anchored using either skin staples or Prolene sutures. An intra-abdominal expander device was inserted into the abdomen and inflated to measure 'burst pressure'. Pressure changes and surgical time were recorded. There was no statistically significant difference (P = 0.83) in the pressure required to disrupt the mesh fixation between the two groups, 101 +/- 12 mmHg in the suture group versus 102 +/- 14 mmHg in the staple group. Staple fixation was 9.7 times faster compared with suture fixation, 291 +/- 42 s for suture versus 30 +/- 8 s for staples (P < 0.001) (power = 94%). The immediate strength of fixation is equal using both sutures and staples, however staple fixation is faster. Mesh migration due to inadequate fixation using either method is unlikely to cause early failure, however suture and staple 'cut out' during early movement may explain this.