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10.5005/jp-journals-10007-1105 WJOLS
REVIEW ARTICLE Tissue Glue in Laparoscopic Inguinal Hernia Repair: A Retrospective Comparative Analysis
Tissue Glue in Laparoscopic Inguinal Hernia

Repair: A Retrospective Comparative Analysis

2
1 Abhijit Mahanta, RK Mishra
1 General Physician and Surgeon, Resident Crimea State Medical University, Ukraine
2 Professor in Minimal Access Surgery, Chairman and Director, World Laparoscopic Hospital Pvt Ltd, DLF Cyber City, Phase 2
Gurgaon, Haryana, India

Abstract
During the last two decades, there have been two revolutions in inguinal hernia repair surgery. First, the introduction of tension-free
hernia repair by Liechtenstein in 1989 and then the application of laparoscopic surgery to the treatment of inguinal hernia in the early
1990s. In this context, the choice of mesh fixation methods being an integral part of this procedure remains a topic of arguments and
discussions in laparoscopic inguinal hernia repair. There exist many methods of mesh fixation like polyglactin suture, titanium spiral
tacks, nitinol anchors and fibrin glue.
Fixation usually uses staples that can lead to nerve injury and chronic postoperative pain. Laparoscopic repairs are associated with a
risk of chronic pain of upto 22.5%. The use of fibrin glue may represent an alternative method of mesh fixation preventing the risk of
nerve injury.
Keywords: Fibrin sealant, Tissue glue, Fibrin glue, Tisseel, Inguinal hernia, Laparoscopic herniorrhaphy, TAPP, TEP, Mesh fixation.

INTRODUCTION In 1997, Chevrel and Rath first proposed fibrin sealant
as an alternate means of mesh fixation in hernia repair with
Presently, the laparoscopic inguinal hernia repair is
accomplished by two approaches: Transabdominal the aim of reducing the rate of hernia recurrence. Canonico
preperitoneal (TAPP) and totally extraperitoneal (TEP) repair later reported the benefits of fibrin sealant in reducing
with mesh prosthesis. TAPP is preferred as it manages all bleeding complications following hernia repair in patients
types of hernia (direct, oblique, femoral, and obturatory), with impaired coagulation. Katkhouda employed a pig model
whether unilateral or bilateral, primary or recurrent. using a total extraperitoneal (TEP) technique to evaluate the
Furthermore, because of its size the preperitoneal mesh tensile strength of mesh fixation 12 days after the use of
®
prosthesis covers the entire musculopectineal foramen, Tisseel , demonstrating equal strength to staples. The results
where these hernias occur. Among various options available of these studies have encouraged surgeons to use fibrin
for mesh fixation, fibrin glue is being used increasingly as sealant in daily practice as an atraumatic alternative to
an alternative method for hernia surgery, significantly mechanical mesh fixation. As an atraumatic alternative, the
preventing the risk of nerve injury and helping to reduce the application of fibrin glue (Tissucol/Tisseel, Baxter
incidence of chronic pain. Reliable laparoscopic fixation of Healthcare, Deerfield, IL, USA) is a viable and reliable option,
meshes prior to their fibrous incorporation minimizes which keeps mesh in place without the complications
recurrences following transabdominal preperitoneal hernia associated with stapling. In terms of tensile strength and
repair (TAPP) and totally extraperitoneal repair (TEP) repair mesh dislocation, fibrin glue is equivalent to stapling.
of inguinal hernias. Various types of staples are available
for reliable mesh fixation. However, their use has been AIMS
associated with a certain amount of surgical trauma. Suture- The aim of this review article is to evaluate the feasibility
tack- and staple-based fixation systems are associated with and efficacy of use of fibrin glue/tissue glue (tisseel) in
postoperative chronic inguinal pain. Reported complications laparoscopic inguinal hernia repair, short- and long-term
include neuralgia or paresthesia because of nerve postoperative pain, surgical complications (bleeding, seroma,
entrapments. A chronic form of pubalgia is caused by hematoma, wound infection, incisional hernia, testicular
stapling of the prosthesis to Cooper’s ligament. Bleeding or complications) and recurrence rates. This article also
hematomas in Retzius’ space (muscular, corona mortis) emphasizes on evaluation of the advantages and
also may occur. disadvantages of fibrin glue as compared to other methods

World Journal of Laparoscopic Surgery, September-December 2010;3(3):165-174 165