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Figure-of-eights vs running suture for fascial closure of large ventral hernias: do figure-of-eights induce ischemia?

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Related Experiment Video

Updated: May 15, 2026

Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device
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Laparoscopic mechanical fixation devices: does firing angle matter?

Emmanuel E Sadava1, David M Krpata, Yue Gao

  • 1Case Comprehensive Hernia Center, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106-5047, USA.

Surgical Endoscopy
|January 10, 2013
PubMed
Summary
This summary is machine-generated.

Titanium spiral tacks offer superior mesh fixation in laparoscopic hernia repair, even when deployed at an acute angle. This permanent tacking method provides reliable strength comparable to or exceeding absorbable options.

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Area of Science:

  • Surgical innovation
  • Biomaterials science
  • Minimally invasive surgery

Background:

  • Laparoscopic hernia repair commonly uses permanent and absorbable tacks for mesh fixation.
  • Optimal tack deployment is typically perpendicular to tissue, but challenging in practice.
  • This study evaluates the impact of angled tack deployment on fixation strength.

Purpose of the Study:

  • To compare the fixation strength of commonly used tacks when deployed at perpendicular (90°) versus acute (30°) angles.
  • To assess the performance of both permanent and absorbable tacking devices under angled deployment conditions.

Main Methods:

  • A lap-shear test was used to measure the acute tensile strength of mesh fixation on porcine peritoneum.
  • Five tack devices were tested: two permanent (Protack, PermaFix) and three absorbable (Absorbatack, SorbaFix, SecurStrap).
  • Tacks were deployed at 90° and 30°, with transfascial sutures serving as a control.

Main Results:

  • Transabdominal sutures exhibited the highest acute tensile strength.
  • Protack (titanium spiral tack) demonstrated superior performance over all absorbable tacks at both deployment angles.
  • While angled deployment reduced fixation strength for Protack and Absorbatack, Protack at 30° still matched perpendicular absorbable tack performance.

Conclusions:

  • Transabdominal sutures provide the strongest acute fixation.
  • No single absorbable tack type showed superiority within its class.
  • Spiral titanium tacks offer robust fixation, even when deployed at an acute angle, making them a strong consideration when perpendicular deployment is not feasible.