USE OF BIOLOGIC GLUE IN TAPP. TRICKS AND CHALLENGES

Abstract

Abstract Aim The fixation of the mesh in transabdominal preperitoneal inguinal hernia repair (TAPP) and the closing of the peritoneal flap are key parts of the operation. This is accomplished with sutures or tackers. The use of biologic glue is an acceptable alternative with the possible advantages of being safer and less painful than the other options. Its use however poses its own set of challenges. Materials and Methods 24 patients underwent TAPP repair for inguinal hernia, using biologic glue to fix the mesh and close the peritoneal flap. The practical challenges of its use were studied. Results No problems were encountered in the fixation of the mesh. In the closing of the peritoneal flap, tackers were used as an adjunct in the first 10 cases. After that, the operation was completed only using glue. Conclusions Various conclusions were drawn from the use of glue. First, it works best in a dry environment and with a lightweight microporous mesh, so that the glue can seep through the pores. Second it will not “fix” large creases of the mesh, although this also means a suboptimal positioning of the mesh. Third, it requires gentle moves during withdrawal, as the tip can stick to the tissues, and appliance of a wet gauze after every use, as the clotted glue can block the tip. All in all, after a learning curve period, it can be a safe and effective alternative to sutures and tackers in TAPP.