Adhesions to sutures, tackers, and glue for intraperitoneal mesh fixation: an experimental study

Hernia. 2014;18(6):865-72. doi: 10.1007/s10029-013-1192-6. Epub 2013 Nov 24.


Purpose: Intraperitoneal mesh fixation for hernia repair is associated with adhesion formation. In this experimental study, adhesions against absorbable and non-absorbable fixation methods were compared.

Methods: Six commercially available fixation methods were placed intraperitoneally in rats with a small pore polypropylene mesh coated on one side with ePTFE (Intramesh T1(®)). Two non-absorbable fixation methods: Prolene(®) (polypropylene) sutures and Protack(®) (titanium) tackers. Four absorbable methods: Vicryl(®) sutures (polyglactin), Absorbatack(®) and Permasorb(®) tackers (both mixes of lactic and glycolic acids) and Tisseel Duo(®) (fibrin glue). Adhesions and histology were studied at 7 and 90 days follow-up. In addition, fixation methods were placed without mesh, in order to study the reaction to the fixation method per se.

Results: No adhesion formation, but also inadequate mesh fixation was found with Tisseel Duo(®), which had been completely resorbed at 7 days follow-up. Vicryl(®) sutures could no longer be detected at 90 days follow-up and were associated with a favorable adhesion profile. All other fixation methods were still intact 90 days after implantation. When placed without mesh, adhesion formation was significantly less than placed with a mesh (18 vs. 93 %, P < 0.001). Without mesh, adhesions were worst with Permasorb(®) tackers.

Conclusions: Absorbable fixation methods such as polyglactin sutures and fibrin glue show a favorable adhesion profile compared to longer-term absorbable or non-absorbable fixation methods. However, before using fibrin glue as a single fixation method more research is required.

Publication types

  • Comparative Study
  • Evaluation Study

MeSH terms

  • Animals
  • Disease Models, Animal
  • Fibrin Tissue Adhesive*
  • Herniorrhaphy / methods*
  • Male
  • Peritoneum / surgery*
  • Rats
  • Rats, Wistar
  • Surgical Mesh*
  • Sutures*
  • Tissue Adhesions*


  • Fibrin Tissue Adhesive