A novel glue device for fixation of mesh and peritoneal closure during laparoscopic inguinal hernia repair: short- and medium-term results

Abstract

Mesh fixation during transabdominal preperitoneal (TAPP) hernia repair should be done using nonpenetrating fixation devices in order to reduce acute and chronic pain. Beside fibrin sealant, N‑butyl cyanoacrylate (NBCA) can be applied. However, there are limited data using NBCA exclusively for fixation of mesh and closure of peritoneum following TAPP repair. We therefore studied a novel laparoscopic fixation device (LiquiBand®Fix8™ by Advanced Medical Solutions, Plymouth, UK) addressing these issues. A prospective study was performed in two (different tertiary referral) centres in Austria, including patients undergoing TAPP repair between January and May 2015. The aforementioned device was used for fixation of mesh at predefined reference points (rectus muscle, pubic bone, triangle of doom, triangle of pain) and entire closure of peritoneum whenever possible. In a total of 34 (4 female) patients, 40 inguinal hernias were repaired using the TAPP approach. Fixation of mesh at four predefined reference points was successful using a single liquid anchor in 88.1 % (141/160). Thorough closure of peritoneum using NBCA was possible in 36 cases (90.0 %). Twice, additional suturing was done as the device clogged during this step of procedure. Finally, in another 2 patients, the attending surgeon declined using glue at all, as the sigmoid colon attached exerted too much traction. No device-related complication was recorded during 1‑year follow-up. Nonpenetrating fixation of mesh during TAPP repair using this novel device is highly effective. In addition, closure of peritoneum using exclusively NBCA is safe and feasible according to our experience