New Fixation Technique Reduces Tack Use During Hernia Repair

A new method of mesh fixation that uses a combination of tacks and fibrin glue significantly reduces the number of tacks required in laparoscopic ventral hernia repair, according to a new study.

Developed by researchers at the University Hospital Virgen del Rocío (Seville, Spain) the new technique first requires placing the mesh in place and depositing four tacks at the cardinal points around the mesh perimeter. The surgeons then mark all the spots where they would usually put tacks, leaving less than one centimeter between each mark. After marking the exterior and inner ring of the double crown, the surgeons place a tack at every third or every fourth mark and fill in the gaps with fibrin glue, which possesses a chemotactic effect that increases collagen production and spurs angiogenesis, consequently causing a biological rather than mechanical fixation.

In a series of 38 patients, the researchers showed they could reduce the number of tacks by 66% by using this technique. All patients included in the study had primary or secondary ventral hernias, located at the midline, far from bones, and with sizes ranging between 3×3 and 17×12 centimeters. The researchers reported no intraoperative complications; postoperative days in the hospital averaged 1.62 days, and two patients were readmitted due to paralytic ileus. None of the patients reported chronic pain at a median follow-up of 24 months. The study was presented at the Fifth International Hernia Congress, held in March 2012 in New York (NY, USA).

“I think with this study, we have shown the feasibility of this technique, which decreases mechanical fixation and should reduce acute and postoperative chronic pain without increasing the recurrence rate,” said lead author and study presenter Salvador Morales-Conde, MD, chief of the advanced laparoscopic unit.

Several groups in Spain and Italy have adopted the new technique.

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University Hospital Virgen del Rocío