Sutureless Tension-Free Hernia Repair with Human Fibrin Glue (Tissucol) in Soccer Players with Chronic Inguinal Pain: Initial Experience

Abstract

Chronic groin pain is a common symptom experienced by soccer players, resulting in many athletes undergoing prolonged periods of conservative treatment. In a high proportion of these cases, however, the cause of groin pain is due to impalpable hernias, thus nullifying the usefulness of a conservative approach. Of the current surgical procedures for inguinal hernia repair, the Lichtenstein technique is widely used. The present study aims to evaluate the efficacy of mesh fixation with human fibrin glue (Tissucol) in open, tension-free inguinal repair, in the treatment of soccer players with groin hernia. A sutureless Lichtenstein technique was employed in 16 consecutive soccer players with primary groin hernia. Inguinal nerves were prepared and preserved. Human fibrin glue was used for mesh fixation, in place of conventional sutures. Results were rated as excellent in all cases, with no reported intra- or postoperative complications. All patients were discharged 4 - 5 h after the operation, and all returned to full pre-injury level sporting-activity, on average, 31 days (range 24 - 42 days) post surgery. This study confirms the efficacy of sutureless tension-free hernia repair with human fibrin glue for the treatment of soccer players suffering from chronic groin pain due to impalpable groin hernia.

Self-fixating mesh for the Lichtenstein procedure—a prestudy

“…In some cases, only juvenile athletes were included [11]. We planned our investigation of this new mesh intentionally as a prestudy without excluding cohorts of a specific age.…”

“…This includes perhaps the fixation sutures of the mesh [18]. In general, not only during groin hernia repair, fixation of the mesh remains subject to discussion [11,19]. There have been investigations of postoperative pain focusing on the application of absorbable vs. nonabsorbable suture material [10] as well as skin stapler systems vs. suture to fix the mesh [9].…”

“…Whereas during endoscopic groin hernia repair fixation of the mesh may be omitted, this is not accepted in the open hernia repair technique [8]. Different fixation procedures were investigated to determine if and to which extended fixation of the mesh is a source of acute and chronic pain: fibrin glue, absorbable sutures, and skin staples [9][10][11]. As a solution for this problem, we tested a new self-fixating mesh (Parietene progrip © ) regarding postoperative and chronic pain compared with a traditional suture mesh fixation in a prestudy setting.…”

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

“…However, such studies have allowed surgeons to conclude that Tisseel/ Tissucol, in both the short and long term, is effective as a means of fixating mesh during open repair of inguinal hernias [27][28][29][30]. For example, when Tisseel/Tissucol was used instead of sutures in a modification of the Lichtenstein technique, it was not associated with any complications during 12 months of follow-up in a series of 80 patients [27].…”

The inguinal release procedure for groin pain: initial experience in 73 sportsmen/women

“…We believe that a true sportsman’s hernia does not exist and that the pathology relates to an enthesopathy of one of the attachments around the pubic tubercle, which may be analogous to tennis elbow. The majority of operative interventions thus far for this condition have attempted to support the posterior wall of the inguinal canal, using a standard mesh hernia repair,910111213 a modified hernia repair,14 Bassini repair31516 or more recently laparoscopic totally extraperitoneal (TEP)17181920 and transabdominal preperitoneal (TAPP)8202122 mesh hernia repair.…”