World Journal of Laparoscopic Surgery

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VOLUME 2 , ISSUE 1 ( January-April, 2009 ) > List of Articles

RESEARCH ARTICLE

Fibrin Sealant versus Use of Tackers for Fixation of Mesh in Laparoscopic Inguinal Hernia Repair

Pramod T Shinde

Citation Information : Shinde PT. Fibrin Sealant versus Use of Tackers for Fixation of Mesh in Laparoscopic Inguinal Hernia Repair. World J Lap Surg 2009; 2 (1):42-48.

DOI: 10.5005/jp-journals-10007-1012

Published Online: 01-04-2009

Copyright Statement:  Copyright © 2009; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background

Laparoscopic fixation of meshes prior to their fibrous incorporation should be reliable to minimize recurrences following transabdominal preperitoneal hernia repair (TAPP) and totally extraperitoneal repair (TEP) repair of inguinal hernias. However, suture, tack and staple-based fixation systems are associated with postoperative chronic inguinal pain. Initial fixation with fibrin sealant offers an atraumatic alternative, but there is little data showing that fibrin-based mesh adhesion provides adequate biomechanical stability for repair of inguinal hernia by TAPP and TEP.

Methods

A literature search was performed using medline and the search Google, Springer link and Highwire press. The following search terms were used: Laparoscopic hernia mesh, Fibrin glue, and Tackers. 2293 citations were found in total. Selected papers were screened for further references. Criteria for selection of literature were the number of cases (excluded if less than 80), methods of analysis (statistical or nonstatistical), operative procedure (only universally accepted procedures were selected) and the institution where the study was done (specialized institution for laparoscopic surgery).

Results

Mesh fixation has always invited lots of interest amongst surgeons and instrument companies due to the wide range of postoperative complications each of them caused. TAPP and TEP usually involves fixation of mesh, however many studies challenging the mesh fixation in TEP are being published. There are two most common methods of fixing mesh using fibrin glue (Tissucol) and tackers. Fibrin sealant possesses both mechanical strength and elasticity. Overall, data from previous studies, shows that mesh stability with fibrin sealant fixation is at least equivalent to suture fixation, indicating that fibrin sealant could be considered the fixation method of choice in inguinal hernia repair. This new method of mesh fixation is obviously potentially less harmful than stapling the mesh and can help reduce the risk of chronic postoperative pain at a comparative or even lower cost than a stapling device.

Conclusions

Fibrin glue gives an adequate mesh fixation with a less chance of chronic postoperative pain. It appears to be an alternative to staples and may help reduce the postoperative pain problems after hernia repair. All methods give the same results in terms of recurrence rate, hospital stay, and costs; but with better results in terms of postoperative pain, seromas, and trocar-related trauma. However the use of fibrin glue needs extensive study, as the anatomical dissection and inguinal region preparation have to be carefully performed, and the mesh size has to be adequate; peritoneum closure with a running suture is more time consuming. Large randomized trials and longer follow-up are required to demonstrate the advantages of either technique.


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  1. New classification of physical status. Anesthesiology 1963;24:111.
  2. The visual analog scale for pain: clinical significance in postoperative patients. Anesthesiology 2001;95:1356-61.
  3. Surg Laparosc Endosc 1993;3:381-85.
  4. Laparoscopic repair of recurrent groin hernias. Surg Laparosc Endosc 1994;4:200-04.
  5. Surg Endosc 1998;12:226-31.
  6. Prospective randomized study of stapled versus unstapled mesh in a laparoscopic preperitoneal inguinal hernia repair. J Am Coll 1999;Surg188:461-65.
  7. Endoscopic extraperitoneal herniorrhaphy: a 5-year experience. Surg Endosc 1998;12:1311-13.
  8. Laparoscopic transabdominal preperitoneal (TAPP) hernia repair: A 7-year two-center experience in 3,017 patients. Surg Endosc 2001;15:972-75.
  9. Use of fibrin sealant for prosthetic mesh fixation in laparoscopic extraperitoneal inguinal hernia repair. Ann Surg 2001;233:18-25.
  10. Nerve injury during laparoscopic inguinal hernia repair. Surg Laparosc Endosc 1993;3:342-45.
  11. Fibrin sealant reduces the duration and amount of fluid drainage after axillary dissection: A randomized prospective clinical trial. J Am Coll Surg 2001;192:591-99.
  12. Laparoscopic transabdominal preperitoneal repair of inguinal hernia: Indications, technique, complications and results in 10 years experience(in Italian). Minerva Chir 2004;59:265-70.
  13. Incidence of complications following laparoscopic hernioplasty. Surg Endosc 1995;9:16-21.
  14. Laparoscopic herniorraphy: Review of complications and recurrence. J Laparoendosc Adv SurgTech A 1998;8:3-10.
  15. Stapled and nonstapled laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair: A prospective randomized trial. Surg Endosc 1999;13:804-06.
  16. Surg Endosc 1999;13(9):878-81.
  17. Etude de 401 cas chez 318 patients”. Chirurgie 1999;124:412-18.
  18. Is there a place for intraperitoneal onlay mesh repair (IPOM) of inguinal hernia among laparoscopic techniques? Hepatogastroent 2004;51:1387-92.
  19. Laparoscopic inguinal herniorraphy: results of a multicenter trial. Ann Surg 1995;221:313-18.
  20. Two-year results of celioscopic hernioplasties using an intraperitoneal ePTFE patch. A prospective multicenter study of 184 cases. Groupe CHIC (Cure des hernies inguinocrurales sous coelioscopie). Ann Chir 1996;50(9):799-802.
  21. Laparoscopic inguinal hernia repair by an intraperitoneal onlay mesh technique using expanded PTFE : A prospective study. Surg laparosc Endosc 1997;7:451-55.
  22. Laparoscopic transabdominal preperitoneal (TAPP) hernia repair. Surg Endosc 2001;15:972-75.
  23. Fecal fistula: a late complication of Marlex mesh repair. Dis Colon Rectum 1981;24:543-44.
  24. Laparoscopic intraperitoneal onlay inguinal herniorrhaphy. Am J Surg 1998;176:548-53.
  25. Laparoscopic repair of recurrent hernias. Surg Endosc 1999;13:807-10.
  26. Laparoscopic hernia repair: Lesson learned after 1224 consecutives cases. Surg Endosc 2001;15:50-54.
  27. Laparoscopic hernia repair. A prospective comparison of TAPP and IPOM techniques. Surg Lapar and Endoscopi 1997;6:472-76.
  28. Laparoscopic intraperitoneal onlay polytetrafluoroethylene mesh repair (IPOM) for inguinal hernia during spinal anestesia in patients with severe medical conditions. Surg Lap Endosc and Percut technique 2001;1:34-37.
  29. Laparoscopic hernia repair:the anatomic basis. J Laparosc Surg 1991;1:269-73.
  30. The use of Dacron in the repair of hernias of the groin. Surg Clin North Am 1984;64:269-85.
  31. Results of a prospective Multicenter trial evaluating the ePTFE peritoneal onlay laparoscopic inguinal hernioplasty. J Laparoendosc Surg 1996;6:375-86.
  32. Laparoscopic hernioplasty. Surg Laparosc Endosc 1991;1:151-55.
  33. Five year follow-up of patients undergoing laparoscopic or open hernia repair. A randomized controlled trial. Ann Surg 2002;3:333-37.
  34. Laparoscopic total extraperitoneal hernia repair: Mesh fixation is unnecessary. J Laparoendosc Adv Surg 2000;10:71-73.
  35. Am Surg 2003;69:839-41.
  36. Prospective study of chronic pain after hernia repair. Br J Surg 1999;86:1528-31.
  37. Inguinal hernia repair in patients with coagulation problems: Prevention of postoperative bleeding with human fibrin glue. Surgery 1999;125:315-17.
  38. Outcome of patients with severe chronic pain following repair of groin hernia. Br J Surg 2002;89:1310-14.
  39. Meta-analysis of randomized controlled trials. Ann Surg 2002;235:322-32.
  40. Prospective randomized study of stapled versus unstapled mesh in a laparoscopic preperitoneal inguinal hernia repair. J Am Coll Surg 1999;1881:461-65.
  41. Attendance at a pain clinic with severe chronic pain after open and laparoscopic inguinal hernia repairs. Br J Surg 2003;90:1152-54.
  42. Pain 3: S1–S226.
  43. Initial experience with the use of Nbutyl 2 cyanoacrylate glue for the fixation of polypropylene mesh in laparoscopic hernia repair. Surg Laparosc Endosc 1998;4:291-93.
  44. Use of fibrin sealant for prosthetic mesh fixation in laparoscopic extraperitoneal inguinal hernia repair. Ann Surg 2001;233: 18-25.
  45. Chrome pain after laparoscopic and open mesh repair of groin hernia. Br J Surg 2002;89:1476-79.
  46. Arch Surg 2003;138:1352-55.
  47. Prevalence and severity of chronic pain after endoscopic totally extraperitoneal inguinal hernioplasty. Surg Endosc 2003;17:1620-23.
  48. A review of chronic pain after inguinal herniorraphy. Clin J Pain 2003;19:48-54.
  49. Laparoscopic inguinal hernia repair: optimal technical variations and results in 1700 cases. Am Surg 2000;66:848-52.
  50. Redl H History of tissue adhesives. In: Tissues glues in cosmetic surgery Quality Medical, St. Louis,2004;3-28.
  51. Stapled and nonstapled laparoscopic transabdominal TAPP ingurnal hernia repair: A prospective randomized trial. Surg Endosc 1999;13:804-06.
  52. Totally extraperitoneal endoscopic inguinal hernia repair (TEP). Results of 5203 hernia repairs. Surg Endosc 2003;17: 190-95.
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