2019 Basic Science Presentations

Christopher J Scheiber, MD, Dearth Christopher, PhD, Alfred Pisano, Liacouras Peter, PhD, Jason Souza, MD; WRNMMC

INTRODUCTION: Despite recent studies1,2 investigating different closure techniques following laparotomy, the incidence of incisional hernia remains high. A common cause of failure is suture pull-through, leading to early dehiscence. In order to decrease this risk, the authors have previously proposed a novel mesh suture design. This design has an enlarged surface area with the goal to increase tensile strength of the repair.

OBJECTIVES: To provide an objective measurement of tissue pull-through that results in failed wound approximation using a porcine model.

METHODS: The rectus muscle complex was dissected from the porcine abdominal wall in 28 specimens. An incision was made in order to simulate laparotomy. Samples were randomized into four groups and a 7cm long segment was repaired using four different methods. Three methods were derived from prior studies1,2 using conventional polypropylene sutures with varied suture bites and distances (1 PDS double loop at 1 cm bites/travel1,2; 1 PDS double loop with 0.5 cm bites/travel1; 2-0 PDS with 0.5 cm bites/travel2). The fourth method was a novel mesh suture (3.4mm TetraMesh with 1cm bites/travel). Using a MTS Bionix Load Frame, linear force was applied until suture pull-through occurred.

RESULTS: The mean force for the 3.4 mm TetraMesh was found to be significantly higher than that of the other three groups (TetraMesh= 473.3N, 1PDS 1cm bites: 324.3N, 1PDS 0.5cm bites = 386.6N, 2-0 PDS 0.5cm bites = 355.4N). A one-way ANOVA was performed showing a significant difference between groups (p=0.009).  Post-hoc analysis demonstrated that there was a significant difference between the TetraMesh and the other groups (all p-values <0.05).

CONCLUSION: This study demonstrates that the novel mesh suture provides a significant improvement in tensile force when compared to the conventional polypropylene design. Therefore, this novel suture may be useful in laparotomy closure in order to decrease the risk of complications such as incisional hernia.

REFERENCES: [1] Harlaar et. al. 2009 AJS 198:392-395 [2] Deerenberg et. al. 2015 Lancet 386:1254-60.