Spray application of fibrin sealant with an angled spray tip device in laparoscopic inguinal hernia repair

Abstract

Zusammenfassung. Grundlagen: Die Art der Fibrinkleber (FS)-Applikation trägt wesentlich zu den Vorzü gen dieser Methode, um Herniennetze zu fixieren, bei. Obwohl in zahlreichen Studien belegt werden konnte, dass die punktförmige Applikation von FS ausreichende Festigkeiten und Elastizität gewährleistet, erschien die Sprayapplikation von FS als wesentliche Verbesserung. Diese Studie sollte die Sicherheit und den Anwendungskomfort eines neuartigen FS-Spraysystems mit abgewinkeltem Sprü hkopf in einer 1-jährigen klinischen Anwendungsbeobachtung testen.Methodik: Nachdem die schriftliche Zustimmung eingeholt wurde, wurden bei 27 Patienten 33 primäre Leistenhernien in TAPP-Technik versorgt. Das makroporöse TiMesh (GfE, Deutschland) wurde mit 2 ml FS (Tissucol + ) mittels eines neuartigen Spraysystems mit abgewinkeltem Sprü hkopf fixiert. Der Sprü hkatheter kann ü ber einen 5 mm-Trokar eingefü hrt werden und verfü gt ü ber eine separate CO 2 -Zufuhr. Der Beobachtungszeitraum war 1 Jahr.Ergebnisse: Die Bedienung des Spraysystems war einfach und ergonomisch zufriedenstellend, und es wurden keine Komplikationen im Zusammenhang mit dessen Anwendung beobachtet. Der Sprü hkegel des FS war gut sichtbar, und es wurden keine Serome gefunden. Die Patienten entwickelten keinen chronischen Schmerz, und es kam innerhalb des einen Jahres zu keinem Rezidiv. 2 ml fü r unilaterale bzw. 4 ml FS fü r bilaterale Hernien waren ausreichend.Schlussfolgerungen: Das neuartige Spraysystem mit abgewinkeltem Sprü hkopf stellt eine klare Verbesserung gegenü ber den bisher erhältlichen Fixationsmethoden dar. Die Anwendung ist einfach und ermöglicht eine erhebliche Reduktion der zur Netzfixation notwendigen FS-Menge. Eine Reduktion der Rate der Serome sowie eine Kostensenkung erscheinen so möglich.Summary. Background: The method of fibrin sealant (FS) application for hernia mesh fixation is essential to obtain its full benefits and advantages (i.e., the reduction of chronic pain). In several studies on hernioplasty, punctual mesh fixation with FS proved to be efficient in terms of fixation strength and elasticity and it was hypothesized that an angled tip laparoscopic spray system (LSS) would improve and facilitate the application of the sealant. The aim of the study was to examine the safety and handling of LSS as well as the one-year outcome.Methods: After informed written consent was obtained, transabdominal preperitoneal hernioplasty (TAPP) was performed in 33 primary inguinal hernias in 27 non-selected consecutive patients by a single surgeon. A macroporous mesh (TI-Mesh + , GfE, Germany) was fixed with 2 ml of FS composed of 1 ml of fibrinogen and 1 ml of thrombin (Tisseel + ¼ Tissucol + ). The FS was applied using a newly developed angled spray catheter insertable through a 5 mm trocar and attached to a CO 2 regulator device. Patients were followed up for one year.Results: The angled tip allowed targeted distribution of FS by minimal movements of the device and was safe. The spray cone was always clearly visible during application. At 3 and 12...

Use of fibrin sealant (Tisseel/Tissucol) in hernia repair: a systematic review

“…Some studies have reported that Tisseel/Tissucol fixation is associated with higher rates of seroma formation than staple fixation [31,36], although this finding has been inconsistent [38]. Moreover, a recent study that described the use of an angled-tip laparoscopic/ endoscopic spray system for application of Tisseel/Tissucol reported substantial advantages in fibrin sealant handling, with no seromas and no recurrences in 27 patients (33 hernias) after 1 year of follow-up [39]. It is likely that the avoidance of drop formation and local accumulation by spraying the sealant reduces the incidence of seroma formation.…”

“…It is likely that the avoidance of drop formation and local accumulation by spraying the sealant reduces the incidence of seroma formation. Other advantages of this spray application are costcutting effects in TAPP repair by reducing the required volume of Tisseel/Tissucol [39]. The use of Tisseel/ Tissucol as a fixative has no consistent effect on operating time; laparoscopic/endoscopic inguinal hernia studies have shown that this end point increases [33,37], decreases [34], or remains unchanged [31,38,40] when compared with suture or tack fixation.…”

“…Seroma may occur more frequently in Tisseel/Tissucol-treated patients than in controls (e.g., 17.4% vs. 5.3%; p = 0.009 [31]; 12.1% vs. 9.8% [36]), although clinical reports have demonstrated that the majority of these seromas resolve without intervention. Moreover, recent trial data suggest that use of the new angled-tip Tisseel/Tissucol spray applicator may substantially reduce the risk of seroma formation [39]; the risk may be further reduced depending on the experience of the surgeon.…”

The impact of atraumatic fibrin sealant vs. staple mesh fixation in TAPP hernia repair on chronic pain and quality of life: results of a randomized controlled study

“…fibrin sealant (FS), seems to be a good alternative. In several studies on hernioplasty via open and endoscopic repair, atraumatic mesh fixation with FS proved to be efficient in terms of fixation strength, elasticity, and quality of life (QoL) [4][5][6][7][8][9][10][11][12][13][14][15]. The learning curve seems to play an important role in TAPP repair [16] and demands clarification if mesh fixation via ST in experienced hands leads to equally good results in terms of patient safety and satisfaction.…”