Laparoscopic Incisional/ventral hernia repair for suitable cases has become the procedure of choice. Mesh fixation is integral part of the procedure in addition to the size of the mesh. Stapples have been replaced by the metallic tacks, which in turn is being replaced by absorbable tacks. Of course trasnsfacial sutures, either 2 or 4 have become a common practice.
I believe that the difference among the fixation devicess lies in their active length, head size and their head profile. Protac penetrates best of all (e.g. periostium, Permacol), cylindric profile (already the first thread catches tissue), but is with 3.9 mm too short. (thickness of mesh + Peritoneum + preper. fat). Absorbatack has 4.1 mm active length (5.1 - 1mm head), the screw is like a wood-screw conic (the first thread doesn' have the same Holding strength.). Sorbafix is 6.4 mm (minus the head) and has cylindric Profile. That's why it needs pre-Perforation with the central pin). Securestrap is 7.1 mm long and catches mesh yarn ( filament) even with pores up to 3.1 mm.
Consequence is that the head of Sorbafix is smaller than the pores of Physiomesh , Fixation failure is possible and probable. If your patient is skinny, the securestrap will perforate the whole abdominal wall. Fixation issue is much more complex than bang bang and quite a cost besides the pain.
jan,Thankyou, very useful discription and discussion,recent paper described more recurrences with absorbable fixation devices.bjs.9750
I think that the crucial point is the incidence of recurrence, rather than the sensation of surgeons. I had used Protacks for long years until the advent of the absorbable one, but my data failed to demonstrate any reduction of recurrency. I wonder if a well-conducted RCT could be of some help for dining the best device (tacks and prosthesis as well).
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