may increase the poten-
tial for migration. That
being said, we continue
to see new market
entrants promising
strong, rapid and long-
term adhesion without
causing any negative
reactions to surrounding
tissue.
4
Self-gripping mesh. Suture-less self-gripping meshes allow for a
quick fixation by way of Velcro-like micro-fasteners that grip the
tissue, which is especially useful in areas where tacking or
suturing may be contraindicated due to vessels and other structures.
The drawbacks? Self-gripping meshes are costly, and they're also
tough to use because they have a propensity to stick to just about
everything. Also, over-manipulating the mesh could diminish its ability
to adhere to tissue and, therefore, increase the risk of migration or
dislocation.
5
No fixation. Forgoing fixation is the least expensive option, and
it also has the potential to significantly reduce operative time and
post-op pain. But because there's essentially nothing to hold the
mesh in its intended position, non-fixation may present the greatest
risk of migration and reoperation. Even so, some clinical studies have
found that, when comparing fixation with non-fixation, there's virtually
no difference in terms of complications and early recurrence rates.
Mull your options
N O V E M B E R 2 0 1 7 • O U T PA T I E N T S U R G E R Y. N E T • 9 9
• STAY FLEXIBLE How you perform a hernia repair — open surgery, laparoscopy
or with robotic assistance — should influence your decisions on fixation.
