Mesh Fixation with Fibrin Sealant in Totally Extraperitoneal Hernia Repair.

Hank Hirsch,Kei Nagatomo,Jonathan Gefen

doi:10.1089/lap.2016.0555

Hank Hirsch, Kei Nagatomo + Show 1 more

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https://doi.org/10.1089/lap.2016.0555

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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.

Highlights

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
totally extraperitoneal (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
While laparoscopic hernia repair has become commonplace among surgeons with expertise in the technique,[6,7] controversy remains over the ideal method of mesh fixation

Summary

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. 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. Repair of inguinal hernia is a common procedure with over half a million performed per year in the United States.[1,2] The primary goals of hernia repair include prevention of a potential strangulation, minimizing chance of recurrence, early return to normal activity and avoidance of acute and chronic pain. A review of the literature found only one study conducted in the United States examining the use of fibrin sealant for mesh fixation,[8] a number of authors have described fibrin sealant use internationally.[9,10,11,12,13,14,15,16,17] Mesh fixation remains an off-label indication for fibrin sealant in the United States, which may contribute to the paucity of data on its use

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