Biomechanical strength of two laparoscopic herniorrhaphy techniques in a cadaveric diaphragm and in a neoprene model

R. W. Fugazzi; B. A. Fransson; H. M. Davis; J. P. Gay

doi:10.3415/VCOT-12-06-0083

Veterinary and Comparative Orthopaedics and Traumatology, Table of Contents

Vet Comp Orthop Traumatol 2013; 26(03): 198-203
DOI: 10.3415/VCOT-12-06-0083

Original Research

Schattauer GmbH

Biomechanical strength of two laparoscopic herniorrhaphy techniques in a cadaveric diaphragm and in a neoprene model

R. W. Fugazzi

¹Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington, USA

,

B. A. Fransson

¹Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington, USA

,

H. M. Davis

²The Gene and Linda Voiland School of Chemical Engineering and Bioengineering, Washington State University, Pullman, Washington, USA

,

J. P. Gay

¹Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington, USA

› Author Affiliations

Abstract

Summary

Objectives: Our objectives were to 1) Biomechanically compare two laparoscopic repair techniques; an automated suturing device and a stapling device to conventional open suturing, and 2) Evaluate a model for canine diaphragmatic tissue by comparisons to similar constructs in fresh diaphragms. We hypothesized that automated suturing is biomechanically superior to laparoscopic stapling in dogs, and that neoprene defect repair is an acceptable model for experimental cadaveric diaphragm herniorrhaphy.

Materials and methods: Samples of diaphragm pars costalis were prepared with defects mimicking radial muscular tears. Defects were repaired using conventional open suturing, laparoscopic automated suturing, and laparoscopic stapling techniques. Similar defects were created in 6.35 mm thick single-sided neoprene. Samples were biomechanically tested across a biaxial loading machine. Site and mode of failure were noted for all samples.

Results: In both the diaphragm muscle and neoprene, the laparoscopic stapling technique was significantly weaker. The neoprene model showed a similar failure load as the diaphragm in both laparoscopic techniques, and a similar stiffness in an open-sutured and stapled diaphragm compared to the neoprene samples. Site and mode of failure in neoprene were similar to cadaveric diaphragmatic tissue, but the overall median load-to-failure was higher for the neoprene.

Conclusion: The strength of laparoscopically repaired simulated diaphragmatic hernias was higher with an automated suture technique than with a stapling technique. Neoprene defect repair is an acceptable model of canine diaphragmatic herniorrhaphy for biomechanical testing.

Keywords

Laparoscopy - herniorrhaphy - Minimally invasive

Full Text

References

References
1 Wilson 3rd GP, Hayes Jr. HM. Diaphragmatic Hernia in the dog and cat: A 25-year overview. Semin Vet Med Surg (Small Anim) 1986; 1: 318-326.
2 Gibson TW, Brisson BA, Sears W. Perioperative survival rates after surgery for diaphragmatic hernia in dogs and cats: 92 cases (1990-2002). J Am Vet Med Assoc 2005; 227: 105-109.
3 Boudrieau SJ, Muir WW. Pathophysiology of traumatic diaphragmatic hernia in dogs. Compend Contin Educ Pract Vet 1987; 9: 379-385.
4 Hunt G, Johnson KA. Diaphragmatic, Pericardial, and Hiatal Hernia. In: Slatter D. editor. Textbook of Small Animal Surgery. Philadelphia: WB Saunders Co; 2003. p. 471-486.
5 Garson HL, Dodman NH, Baker GJ. Diaphragmatic hernia. Analysis of fifty-six cases in dogs and cats. J Small Anim Pract 1980; 21: 469-481.
6 Devitt CM, Cox RE, Hailey JJ. Duration, complications, stress, and pain of open ovariohysterectomy versus a simple method of laparoscopic-assisted ovariohysterectomy in dogs. J Am Vet Med Assoc 2005; 227: 921-927.
7 Ramachandran CS, Arora V. Two-port laparoscopic cholecystectomy: an innovative new method for gallbladder removal. J Laparoendosc Adv Surg Tech A 1998; 8: 303-308.
8 Ouazzani A, Guerin E, Dryjski J. et al. [Acute and latent right side diaphragmatic rupture after blunt trauma: cases studies and review of the literature][Article in French]. Rev Med Brux 2008; 29: 107-112.
9 Nicolau AE, Gheju I, Micu B. et al. Laparoscopic repair of post-traumatic diaphragmatic hernia: a case report. Chirurgia (Bucur) 2009; 104: 341-345.
10 Palanivelu C, Rangarajan M, Rajapandian S. et al. Laparoscopic repair of adult diaphragmatic hernias and eventration with primary sutured closure and prosthetic reinforcement: a retrospective study. Surg Endosc 2009; 23: 978-985.
11 Muysoms FE, Cathenis KK, Hamerlijnck RP. et al. Laparoscopic repair of iatrogenic diaphragmatic hernias after sternectomy and pedicled omentoplasty. Hernia 2009; 13: 617-623.
12 Matthews BD, Bui H, Harold KW. et al. Laparoscopic repair of traumatic diaphragmatic injuries. 2003 2. 254-258.
13 Pievaroli A BM. Laparoscopic approach for the correction of diaphragmatic defects. Proceedings of the 8th Annual Symposium of Veterinary Endoscopy Society. 2011. May 2-3 Kaye Ambergris, Belize: p. 14-15.
14 Mishra RK. Laparoscopic tissue approximation techniques. In: Mishra RK. editor. Textbook of Practical Laparoscopic Surgery. USA: McGraw Hill; 2010. p. 115-135.
15 Rosser J, Erdmann-Sager J, Lombardo V. et al. Intracorporeal suturing. In: Talamini M. editor. Advanced Therapy in Minimally Invasive Surgery. Hamilton, Ontario: pmph usa [BC Decker]; 2006. p. 31-39.
16 Dion YM, Charara J, Guidoin R. Bursting strength evaluation. Comparison of 0-Prolene sutures and endoscopic staples in an experimental prosthetic patch repair of abdominal wall defect. Surg Endosc 1994; 8: 812-816.
17 Powell JJ, Murray GD, O'Dwyer PJ. Evaluation of staples and prostheses for use in laparoscopic inguinal hernia repair. J Laparoendosc Surg 1994; 4: 109-112.
18 Dunlap JT, Chong AC, Lucas GL. et al. Structural properties of a novel design of composite analogue humeri models. Ann Biomed Eng 2008; 36: 1922-1926.
19 Institute for Laboratory Animal Research. Natioanl Research Council of the National Academies. Scientific and Humane Issues in the Use of Random Source Dogs and Cats in Research. Washington (DC): National Academies Press; 2009. p. 37.
20 Voermans RP, Worm AM, van Berge Henegouwen MI. et al. In vitro comparison and evaluation of seven gastric closure modalities for natural orifice transluminal endoscopic surgery (NOTES). Endoscopy 2008; 40: 595-601.
21 Kozar RA, Kaplan LJ, Cipolla J. et al. Laparoscopic repair of traumatic diaphragmatic injuries. J Surg Res 2001; 97: 164-171.
22 Murray JA, Cornwell 3rd EE, Velmahos GC. et al. Healing of traumatic diaphragm injuries: comparison of laparoscopic versus open techniques in an animal model. J Surg Res 2001; 100: 189-191.
23 Schmit BD, Stellato TA, Mortimer JT. Staple penetration and staple histological response for attaching an epimysial electrode onto the abdominal surface of the diaphragm using a laparoscopic approach. Surg Endosc 1997; 11: 45-53.
24 Whitson BA, Cheng BC, Kokini K. et al. Multilaminate resorbable biomedical device under biaxial loading. J Biomed Mater Res 1998; 43: 277-281.
25 Kobayashi M, Takemori S, Yamaguchi M. Differential rigor development in red and white muscle revealed by simultaneous measurement of tension and stiffness. Forensic Sci Int 2004; 140: 79-84.
26 Silbernagel JT, Johnson AL, Pijanowski GJ. et al. A mechanical comparison of 4.5 mm narrow and 3.5 mm broad plating systems for stabilization of gapped fracture models. Vet Surg 2004; 33: 173-179.
27 Zdero R, Rose S, Schemitsch EH. et al. Cortical screw pullout strength and effective shear stress in synthetic third generation composite femurs. J Biomech Eng 2007; 129: 289-293.
28 Schoenfeld AJ, Battula S, Sahai V. et al. Pullout strength and load to failure properties of self-tapping cortical screws in synthetic and cadaveric environments representative of healthy and osteoporotic bone. J Trauma 2008; 64: 1302-1307.