1
Sutures. Suture is one of the least expensive ways to fixate
mesh, but keep in mind that suturing will likely extend the
amount of time you spend in the OR (see "Can Robotics Yield
Better Outcomes in Hernia Repair?"). Also, suturing raises the risk of
compressing or entrapping a nerve, which will likely result in post-oper-
ative pain or numbness and, quite possibly, the need for reoperation.
Besides traditional suture, we're starting to see some "hybrid" fixation
options that fall loosely into this category. One example is a newly
introduced system that offers suture-like fixation, in which each lock-
able suture is deployed with the speed and ease of use associated with
a handheld tacking device.
2
Tacks. Tacks come in an assortment of shapes and styles, so for
the sake of convenience, we'll distill them into 2 different types.
Permanent titanium tacks are durable and cost effective, though
the non-coated titanium tacks have been known to cause adhesions
and bowel lesions. Then there are absorbable tacks, which are pricier
alternatives that can be fully absorbed by the body within 12 to 18
months, depending on the manufacturer. Like suture, a misplaced tack
may result in an injury to the anatomy — a nerve or vessel, say — that
could necessitate reoperation. The good news is that tacking options
continue to improve and evolve. One example: A tacking device that
delivers a "liquid anchor" capable of setting in less than 10 seconds,
though it's currently available only in overseas markets.
3
Glues and sealants. Easy-to-use fibrin glues and other sealants
may help to reduce operative time, and they also tend to offer a
low incidence of chronic post-operative pain. At the same time,
glues tend to be more expensive when compared with tacks or
sutures. Some studies have examined the long-term results of glue-
based fixation, wondering if weakening adhesive strength over time
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