V-Loc, a new wound closure device for peritoneal closure--is it safe? A comparative study of different peritoneal closure systems.

BACKGROUND: Transabdominal laparoscopic hernia repair is a safe and commonly used procedure for groin hernias. Failure of peritoneal closure is rare but can lead to herniation and bowel obstruction. A new wound closure device named V-Loc was tested in this study. It consists of a barbed absorbable thread that is self-anchoring and eliminates the need to tie a knot. The efficacy of this device in achieving secure peritoneal closure was investigated. METHODS: In 10 recently deceased patients, peritoneal incisions were set and closed with 5 different devices including V-Loc. Peritoneal thickness was measured prior to testing. A tensiometer was used to apply tensile loads on the peritoneal closure. Tensile loads were measured in Newton at the time of peritoneal rupture or failure of the suture or knot. RESULTS: Peritoneal thickness had a significant impact on the results (P < .0001). A mean tensile load of 7.41 N was tolerated when the peritoneal thickness was ≤0.25 mm and 15.38 N when the peritoneal thickness was >0.25 mm. Peritoneal rupture was observed more often than failure of closure. The latter occurred more often at high tension and in experiments with tacking or stapling devices than with sutures. While testing V-Loc, peritoneal rupture occurred at 19.85 N, mean, showing significantly better results than AbsorbaTack, extracorporally knotted running suture, or Multifire Endo Hernia Stapler (P < .05). CONCLUSIONS: The new wound closure device V-Loc is a feasible and promising alternative to common peritoneal closure techniques but is yet to be evaluated in clinical studies.

Tensile strength and adhesion formation of mesh fixation systems used in laparoscopic incisional hernia repair.

BACKGROUND: Mesh tearoff from the tissue is the most common reason for hernia recurrence after hernia surgery involving the use of a synthetic mesh. Various fixation systems were critically compared in terms of their retention strength and the formation of adhesions. METHODS: In a prospective study with 25 Sprague-Dawley rats, two pieces of Parietex composite meshes measuring 2 x 3 cm were fixed intraperitoneally in a paramedian location. The randomized mesh fixation groups included transfascial fixed suture, ProTack, AbsorbaTack, and I-Clip. Of the 25 rats, 12 were killed and analyzed 1 week after implantation, with the remaining 13 rats killed and analyzed after 2 months. Adhesions observed at the time of mesh removal were measured according to an adhesion scoring system, and the fixation strengths of the individual fixation systems were tested. Additionally, the foreign body reaction to the mesh and fixation systems was measured as well as their potential degradation. RESULTS: After 1 week, the retention strength of transfascial fixed suture was significantly higher (8.7 N/cm(2)) than that of ProTack (5.6 N/cm(2)) or AbsorbaTack (5.7 N/cm(2)). After 2 months, the retention strength had increased to 13.2 N/cm(2) in the transfascial fixed suture group, which was significantly higher than in the ProTack (9.7 N/cm(2)) or AbsorbaTack (8.7 N/cm(2)) groups. In contrast, the mesh could be fixed with the I-Clip only in 56% of the cases, and then achieved rather poor retention strength. Adhesion was significantly greater in the ProTack group than in any of the other groups (p < 0.001). At 2 months, scanning electron microscopy showed only marginal degradation of the absorbable elements. CONCLUSIONS: Suture fixation led to satisfactory attachment of the prosthesis. Additional widespread anchorage of the mesh was achieved with ProTack or AbsorbaTack. The feasibility and retention strength of the I-Clip were poor.