Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_888_Библиотеки_им_академика_М_И_Перельмана

in shear stresses of sutured and glued polypropylene mesh in a porcine model at 24h, 7days, and 14days (Fig.7.1). Histology with a scoring system was used to evaluate the mesh response at the three time points. Not surprisingly, sutured mesh had signicantly stronger shear forces at 24h (10N vs 5N), but equally interesting was that by 7days the interfaces between the mesh and the fascia exceeded sheer stress testing in both groups because either the fascia or the mesh failed before the interface between the two was disrupted. Essentially this meant that by 7days the form of xation was irrelevant. Histology also conrmed complete ingrowth of the mesh by the 7-day time point in both groups. Other differences were also found in the early time points. Glued mesh tended to have better load-sharing properties likely secondary to complete xation of the entire surface area of the mesh. Glued specimens also tended to fail in a reproducible manner due to more reproducible and even application, whereas sutured specimens tended to fail in a more unpredict­able secondary to point xation and inherent technical inconsistencies of placing sutures. An interesting observation during the study was that the glued specimens trended to have less mesh contraction at the three time points than the sutured speci­mens. All of these ndings are thought to be due to the immediate and complete surface area xation brin glue offers compared to point xation with sutures. Scientic models like this only begin to describe the differences between mechani­cal and adhesive xation, and new concepts like “load sharing” and the importance of “complete xation vs point xation” begin to take shape to permeate all catego­ries of hernia repair. Hopefully, future biomechanical studies will continue to tease out the advantages of each type of xation for a given hernia space so that hernia repair can be optimized. With this study alone, one can see how much there is to consider when it comes to prosthetic xation and how little we really know.