Mesh Fixation with Fibrin Sealant in Totally Extraperitoneal Hernia Repair

Abstract

Introduction: Repair of inguinal hernia is a common procedure, but there is a lack of consensus as to the optimal repair technique along with the use of mesh and methods of mesh fixation. The objective of this study was to evaluate the efficacy and safety of fibrin sealant for mesh fixation in laparoscopic totally extraperitoneal (TEP) inguinal hernia repair.Materials and Methods: A study was conducted of the first 200 patients undergoing TEP hernia repair with mesh fixation using fibrin sealant between March 2012 and January 2014. The primary outcome measures were (1) chronic pain (persisting for >3 months), (2) persistence of hernia (recurrence identified within first 2 weeks postoperatively), (3) hernia recurrence, and (4) any additional perioperative complications. The mean follow-up in the series was 34.4 ± 6.1 months (range 22.2–44.1).Results: Of the 278 hernias repaired in 204 patients (74 bilateral, 130 unilateral), 38 were recurrent and 240 were primary. Three patients (1.5%) had a persistent hernia, including one with a planned return to the operating room the next day due to poor visualization. Three patients (1.5%) had a hernia recurrence. Twelve patients (5.9%) reported experiencing chronic pain. The remaining complications were minor and resolved over time.Conclusions: TEP repair of inguinal hernia using mesh secured with fibrin sealant can be effectively used to treat primary, recurrent, unilateral, and bilateral inguinal hernias in adults with minimal recurrence rates and complications during almost 3 years of follow-up.

Tissue Adhesives for Hernia Mesh Fixation: A Literature Review

“…This result may be attributed to less irritating potential of adhesives, reduced nerve compression or injury, and lower tissue tension [1]. Tissue adhesives can be used in the triangle of pain regions, where tacks and sutures are prohibited [2]. Studies of postoperative pain using tissue adhesive mesh fixation demonstrate similar or improved pain outcomes compared to standard fixation techniques.…”

“…chronic postoperative pain rate after three months, mostly mild [2]. Lower incidence of groin numbness and discomfort compared to sutures [6].…”

“…Hernia Recurrence Minimal 1.5% hernia recurrence rate [2]. 0% hernia recurrence at six months compared to 5% recurrence with no fixation [11].…”

“…There was no statistical difference in the VAS score at three months between the groups with p=0.45. Another study collected data from TEP inguinal hernia repairs by a single surgeon using fibrin sealant method [2]. The study reported a 5.9% chronic postoperative pain rate after three months with this method.…”

“…Proper mesh fixation is another important consideration in preventing recurrence. The type of surgical method used may also play a role in recurrence [2]. Hernia recurrence outcomes are comparable between tissue adhesives and standard fixation techniques.…”