Laparoscopic resorbable mesh fixation. Assessment
Primary musculo fascial repair leads to a high rate of recur- rences, particularly in obese patients [1–3]. These arguments encourage surgeons to use synthetic textile devices for wall defect repair. In ventral hernia repair, the techniques using a retromuscular mesh are correlated with complications due to the wideness of the required dissection .
The appearance of new materials, intraperitoneally implanted and, therefore, feasible via a laparoscopic approach, has been widely accepted by the surgical community [5–7].
One of the success factors of this procedure is the quality of the mesh fixation that enables the surgeon to obtain accurate positioning of the mesh, while preventing early migra- tion with its associated complications.
Concerning inguinal hernias, mesh fixation during a laparoscopic procedure is a frequently chosen option allowing a precise positioning of the mesh and, thus, avoiding also an early migration and its correlated drawbacks . This technical point is often preferred to the absence of mesh Wxation, even if the results obtained after laparoscopic pro- cedure with fixed and non-fixed mesh does not demonstrate statistical diVerence between the two groups [9, 10]. Recently, the gluing of mesh has been successfully experienced by some authors [11, 12].
In those laparoscopic parietal repairs, conventional metallic stapling may, however, be itself the source of other complications, such as chronic pain due to local nerve injury, haemorrhage, osteitis and intraperitoneal adhesions [13, 14]. These neuropathic pains are more frequent and persistent than generally estimated and they usually inter-fere with patients' daily lives [15, 16]. Their treatment may require surgery . The purpose of this study was to assess the eVectiveness and the tolerance of a new resorbable mesh fixation device, I-Clip™ by Sofradim, France. The concept of I-Clip™ is to have a disposable instrument delivering a slow resorption anchor via a hollow needle (Figs. 1, 2, 3). The composition of the anchor is polylactic acid. This concept has been validated for over 10 years in osteosynthesis and ligament anchoring [18, 19]. Its mechanical anchoring resistance data are comparable to current stapling devices using metal, with a high resistance to the peeling test. Polylactic acid is well known for its excellent tolerance and it degrades in 12 months by hydrolysis. In the case of improper positioning of the clip, it can be easily cut with laparoscopic scissors and removed.