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

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

Research output: Contribution to journalArticle

1 Citation (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)3120-3126
Number of pages7
JournalSurgical Endoscopy
Volume26
Issue number11
DOIs
StatePublished - Jan 1 2012
Externally publishedYes

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Fibrin Tissue Adhesive
Swine
Hiatal Hernia
Sutures
Herniorrhaphy
Operative Time
Acellular Dermis
Diaphragm
Adhesives

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Krpata, D. M., Blatnik, J. A., Harth, K. C., Lapinska, M., Novitsky, Y. W., & Rosen, M. J. (2012). Evaluation of fibrin sealant for biologic mesh fixation at the hiatus in a porcine model. Surgical Endoscopy, 26(11), 3120-3126. https://doi.org/10.1007/s00464-012-2302-8

Evaluation of fibrin sealant for biologic mesh fixation at the hiatus in a porcine model. / Krpata, David M.; Blatnik, Jeffrey A.; Harth, Karem C.; Lapinska, Melissa; Novitsky, Yuri W.; Rosen, Michael J.

In: Surgical Endoscopy, Vol. 26, No. 11, 01.01.2012, p. 3120-3126.

Research output: Contribution to journalArticle

Krpata, David M. ; Blatnik, Jeffrey A. ; Harth, Karem C. ; Lapinska, Melissa ; Novitsky, Yuri W. ; Rosen, Michael J. / Evaluation of fibrin sealant for biologic mesh fixation at the hiatus in a porcine model. In: Surgical Endoscopy. 2012 ; Vol. 26, No. 11. pp. 3120-3126.
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