Enrico Lauro1, Ilaria Corridori2,3, Lorenzo Luciani4, Alberto Di Leo5, Alberto Sartori6, Jacopo Andreuccetti7, Diletta Trojan8, Giovanni Scudo9, Antonella Motta3, Nicola M Pugno10,11. 1. Department of General Surgery, St. Maria Del Carmine Hospital, Rovereto, Italy. enrico.lauro@apss.tn.it. 2. Laboratory for Bioinspired, Bionic, Nano, Meta Materials and Mechanics, Department of Civil, Environmental and Mechanical Engineering, University of Trento, Trento, Italy. 3. BIOtech Center for Biomedical Technologies, Department of Industrial Engineering, University of Trento, Trento, Italy. 4. Robotic Unit and Department of Urology, Santa Chiara Hospital, Trento, Italy. 5. Department of General Surgery, San Camillo Hospital, Trento, Italy. 6. Department of General Surgery, Montebelluna-Castelfranco Veneto Hospital, Treviso, Italy. 7. Department of General Surgery 2^, ASST Spedali Civili di Brescia, Brescia, Italy. 8. Fondazione Banca dei Tessuti Treviso FBTV, Treviso, Italy. 9. Department of General Surgery, St. Maria Del Carmine Hospital, Rovereto, Italy. 10. Laboratory for Bioinspired, Bionic, Nano, Meta Materials and Mechanics, Department of Civil, Environmental and Mechanical Engineering, University of Trento, Trento, Italy. nicola.pugno@unitn.it. 11. School of Engineering and Material Science, Queen Mary University of London, London, UK. nicola.pugno@unitn.it.
Abstract
BACKGROUND: Recently, in the field of abdominal wall repair surgery, some minimally invasive procedures introduced the use of staplers to provide a retromuscular prosthetic repair. However, to the knowledge of the authors, there are little data in the literature about the outcomes of stapled sutures adoption for midline reconstruction. This study aims to investigate the biomechanics of stapled sutures, simple (stapled), or oversewn (hybrid), in comparison with handsewn suture. From the results obtained, we tried to draw indications for their use in a clinical context. METHODS: Human cadaver fascia lata specimens, sutured (handsewn, stapled, or hybrid) or not, underwent tensile tests. The data on strength (maximal stress), ultimate strain (deformability), Young's modulus (rigidity), and dissipated specific energy (ability to absorb mechanical energy up to the breaking point) were recorded for each type of specimens and analyzed. RESULTS: Stapled and hybrid suture showed a significantly higher strength (handsewn 0.83 MPa, stapled 2.10 MPa, hybrid 2.68 MPa) and a trend toward a lower ultimate strain as compared to manual sutures (handsewn 344%, stapled 249%, hybrid 280%). Stapled and hybrid sutures had fourfold higher Young's modulus as compared to handsewn sutures (handsewn 1.779 MPa, stapled 7.374 MPa, hybrid 6.964 MPa). Handsewn and hybrid sutures showed significantly higher dissipated specific energy (handsewn 0.99 mJ-mm3, stapled 0.73 mJ-mm3, hybrid 1.35 mJ-mm3). CONCLUSION: Stapled sutures can resist high loads, but are less deformable and rigid than handsewn suture. This suggests a safer employment in case of small defects or diastasis (< W1 in accord to EHS classification), where the presumed tissutal displacement is minimal. Oversewing a stapled suture improves its efficiency, becoming crucial in case of larger defects (> W1 in accord to EHS classification) where the expected tissutal displacement is maximal. Hybrid sutures seem to be a good compromise.
BACKGROUND: Recently, in the field of abdominal wall repair surgery, some minimally invasive procedures introduced the use of staplers to provide a retromuscular prosthetic repair. However, to the knowledge of the authors, there are little data in the literature about the outcomes of stapled sutures adoption for midline reconstruction. This study aims to investigate the biomechanics of stapled sutures, simple (stapled), or oversewn (hybrid), in comparison with handsewn suture. From the results obtained, we tried to draw indications for their use in a clinical context. METHODS: Human cadaver fascia lata specimens, sutured (handsewn, stapled, or hybrid) or not, underwent tensile tests. The data on strength (maximal stress), ultimate strain (deformability), Young's modulus (rigidity), and dissipated specific energy (ability to absorb mechanical energy up to the breaking point) were recorded for each type of specimens and analyzed. RESULTS: Stapled and hybrid suture showed a significantly higher strength (handsewn 0.83 MPa, stapled 2.10 MPa, hybrid 2.68 MPa) and a trend toward a lower ultimate strain as compared to manual sutures (handsewn 344%, stapled 249%, hybrid 280%). Stapled and hybrid sutures had fourfold higher Young's modulus as compared to handsewn sutures (handsewn 1.779 MPa, stapled 7.374 MPa, hybrid 6.964 MPa). Handsewn and hybrid sutures showed significantly higher dissipated specific energy (handsewn 0.99 mJ-mm3, stapled 0.73 mJ-mm3, hybrid 1.35 mJ-mm3). CONCLUSION: Stapled sutures can resist high loads, but are less deformable and rigid than handsewn suture. This suggests a safer employment in case of small defects or diastasis (< W1 in accord to EHS classification), where the presumed tissutal displacement is minimal. Oversewing a stapled suture improves its efficiency, becoming crucial in case of larger defects (> W1 in accord to EHS classification) where the expected tissutal displacement is maximal. Hybrid sutures seem to be a good compromise.
Authors: R Bittner; K Bain; V K Bansal; F Berrevoet; J Bingener-Casey; D Chen; J Chen; P Chowbey; U A Dietz; A de Beaux; G Ferzli; R Fortelny; H Hoffmann; M Iskander; Z Ji; L N Jorgensen; R Khullar; P Kirchhoff; F Köckerling; J Kukleta; K LeBlanc; J Li; D Lomanto; F Mayer; V Meytes; M Misra; S Morales-Conde; H Niebuhr; D Radvinsky; B Ramshaw; D Ranev; W Reinpold; A Sharma; R Schrittwieser; B Stechemesser; B Sutedja; J Tang; J Warren; D Weyhe; A Wiegering; G Woeste; Q Yao Journal: Surg Endosc Date: 2019-06-27 Impact factor: 4.584
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