Download PDF
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
1   Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington, USA
,
B. A. Fransson
1   Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington, USA
,
H. M. Davis
2   The Gene and Linda Voiland School of Chemical Engineering and Bioengineering, Washington State University, Pullman, Washington, USA
,
J. P. Gay
1   Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington, USA
› Author Affiliations
Further Information

Publication History

Received 19 June 2012

Accepted 25 April 2012

Publication Date:
19 December 2017 (online)

Also available at
    Permissions and Reprints

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
 

  • 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.
    PubMedGoogle Scholar
  • 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.
    CrossrefPubMedGoogle Scholar
  • 3 Boudrieau SJ, Muir WW. Pathophysiology of traumatic diaphragmatic hernia in dogs. Compend Contin Educ Pract Vet 1987; 9: 379-385.
    PubMedGoogle Scholar
  • 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.
    Google Scholar
  • 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.
    CrossrefPubMedGoogle Scholar
  • 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.
    CrossrefPubMedGoogle Scholar
  • 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.
    CrossrefPubMedGoogle Scholar
  • 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.
    PubMedGoogle Scholar
  • 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.
    PubMedGoogle Scholar
  • 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.
    CrossrefPubMedGoogle Scholar
  • 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.
    CrossrefPubMedGoogle Scholar
  • 12 Matthews BD, Bui H, Harold KW. et al. Laparoscopic repair of traumatic diaphragmatic injuries. 2003 2. 254-258.
    PubMedGoogle Scholar
  • 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.
    Google Scholar
  • 14 Mishra RK. Laparoscopic tissue approximation techniques. In: Mishra RK. editor. Textbook of Practical Laparoscopic Surgery. USA: McGraw Hill; 2010. p. 115-135.
    Google Scholar
  • 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.
    Google Scholar
  • 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.
    CrossrefPubMedGoogle Scholar
  • 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.
    CrossrefPubMedGoogle Scholar
  • 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.
    CrossrefPubMedGoogle Scholar
  • 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.
    Google Scholar
  • 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.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Kozar RA, Kaplan LJ, Cipolla J. et al. Laparoscopic repair of traumatic diaphragmatic injuries. J Surg Res 2001; 97: 164-171.
    CrossrefPubMedGoogle Scholar
  • 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.
    CrossrefPubMedGoogle Scholar
  • 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.
    CrossrefPubMedGoogle Scholar
  • 24 Whitson BA, Cheng BC, Kokini K. et al. Multilaminate resorbable biomedical device under biaxial loading. J Biomed Mater Res 1998; 43: 277-281.
    CrossrefPubMedGoogle Scholar
  • 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.
    CrossrefPubMedGoogle Scholar
  • 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.
    CrossrefPubMedGoogle Scholar
  • 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.
    PubMedGoogle Scholar
  • 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.
    CrossrefPubMedGoogle Scholar