Attendance at a pain clinic with severe chronic pain after open and laparoscopic inguinal hernia repairs

Hindmarsh, Andrew; Cheong, Edward; Lewis, Michael P.; Rhodes, Michael

doi:10.1002/bjs.4213

Cited by 76 publications

(56 citation statements)

References 15 publications

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“…34,45,48 Among other potential factors causing postoperative pain is the repair of recurrent hernias. There is a great variation in the rate of postoperative chronic pain, ranging from 0.1 to 0.4% and 22.5% 41,45,49 in laparoscopic repairs for which staples are used to attach the mesh. Among the explanations for such a wide discrepancy are the range of pain evaluation methods used, which include clinical examination of the patients, phone calls, and mailed questionnaires and tools to score the severity of the pain.…”

Section: Discussionmentioning

confidence: 99%

“…46 Reports of persistent neuralgia with inguinal pain attributable to stapling vary in the literature from 0.5 to 14%. 37,41,46 In a study by Stark et al, 49 the rate of nerve entrapment in laparoscopic patients was 4.2% (19/448). The genitofemoral nerve was affected with a high frequency (2%), and the ilioinguinal or lateral cutaneous nerve of the thigh was affected in 1.1% of the cases.…”

Section: Fibrin Glue Use Staples Usementioning

confidence: 96%

“…Other studies comparing stapling without fixation of the mesh found no difference. 41,47,48 However, these studies have been criticized as having too few patients, too short a follow-up period (range, 1-32 months), or too great a loss to follow-up evaluation(8-12% of patients). 5,6 The size of the prosthesis is an important factor.…”

Section: Fibrin Glue Use Staples Usementioning

confidence: 99%

“…The use of smaller stapled prostheses (11·6 cm) is associated with recurrence rates of up to 5%, whereas patients treated using TAPP with no mesh fixation have recurrence rates as low as 0.16%. 41,47 Inadequate lateral fixation is a main cause of recurrence after both TAPP (36%) and TEP (22%). 38 The reason for this is that most of the nerves run laterally where no staples can be applied.…”

Section: Fibrin Glue Use Staples Usementioning

confidence: 99%

“…44 In other study, the incidence of postoperative seromas was1.8% (6/320), whereas the incidence reported in the literature varies from 3.8 to 10.5%. 40,41,47 Tissucol also is cheaper than any other means of mesh fixation. For example, 1 ml of Tissucol costs e80, as compared with e300 for Endoanchor (Ethicon Endo-Surgery) and e250 for Protak (Tyco, Norwalk, CT, USA).…”

Section: Fibrin Glue Use Staples Usementioning

confidence: 99%

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

Shinde¹

2009

WJOLS

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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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