Comparison of mesh fixation devices for laparoscopic ventral hernia repair: an experimental study on human anatomic specimens

Background As there is a lack of clarity in terms of the tensile strength of mesh fixation for laparoscopic ventral hernia repair (LVHR), our aim was to investigate the immediate tensile strength of currently available mesh fixation devices on human anatomic specimens. Methods Sixteen recently deceased body donators (mean body mass index of 24.4 kg/m(2)) were used to test the immediate tensile strength (Newton) of 11 different LVHR mesh fixation devices. Results Each of the 11 different laparoscopic fixation devices was tested 44 times. Non-articulating tackers provided higher fixation resistance to tensile stress in comparison to articulating tackers (5.1-mm ReliaTack (TM): 16.9 +/- 8.7 N vs. 12.2 +/- 5.6 N, p = 0.013; 7-mm ReliaTack (TM): 19.8 +/- 9.4 N vs. 15.0 +/- 7.0 N, p = 0.007). Absorbable tacks with a greater length, i.e. >= 6 mm (7-mm ReliaTack (TM), 6-mm SorbaFix (TM) and 7.2-mm SecureStrap (TM)) had significantly higher fixation tensile strength than tacks with a shorter length, i.e. < 6 mm (5.1-mm ReliaTack (TM) and 5.1-mm AbsorbaTack (TM)) (p < 0.001). Furthermore, transfascial sutures (PDS 2-0 sutures 26.3 +/- 5.6 N) provided superior fixation tensile strength than 5.1-mm AbsorbaTack (TM) (13.6 +/- 7.3 N) and cyanoacrylate glues such as LiquiBand FIX8 (TM) (3.5 +/- 2.4 N) (p < 0.001, respectively). There was a significant deterioration in fixation capacity in obese body donators with a body mass index > 30 kg/m(2) (13.8 +/- 8.0 vs. 17.9 +/- 9.7 N, p = 0.044). Conclusions Although articulating laparoscopic tackers improve accessibility and facilitate the utilization of tacks within the fixation weak spot adjacent to the trocar placement, an articulating shaft that is not ergonomic to use may limit mechanisms of force transmission. For mesh fixation in LVHR, transfascial sutures and tacks with a longer length provide better immediate fixation tensile strength results.