Page 45 - World's Most Popular Laparoscopic Journal

Abhijit Mahanta, RK Mishra

of mesh fixation to demonstrate whether fibrin-based mesh highly concentrated fibrinogen, factor XIII, fibronectin, and
adhesion provides adequate biomechanical stability for repair traces of other plasma proteins. The second component
of inguinal hernia by TAPP and TEP and to elucidate the contains thrombin, calcium chloride, and antifibrinolytic
extent to which tacks, anchor-based fixations can be agent such as aprotinin (Table 1). Mixing of two components
replaced with fixation with fibrin glue/bioadhesives for leads to activation of fibrinogen and thrombin by calcium
laparoscopic inguinal hernia repair. The following parameters chloride, formation and cross-linking of fibrin leading to
were also evaluated: the formation of polymerized fibrin chains, duplicating the
1. Patient selection last step of the coagulation cascade. The fibrinogen
2. Operative technique component gives tensile strength, thrombin stimulates
3. Operating time fibroblast proliferation and aprotinin, an antifibrinolytic agent
4. Intra and postoperative complications enhances the life span of the sealant.
5. Postoperative pain The required dose of fibrin sealant depends on the size
6. Hospital stay of the surface to be covered, as shown in Table 2.
7. Cost effectiveness. Fibrin sealant contains the following substances in four
separate vials:
MATERIALS AND METHODS 1. Sealer protein concentrate (Human), vapor-heated,
freeze-dried
The literature utilized in this article were taken from search
engine Google, SpringerLink library, HighWire press, 2. Fibrinolysis inhibitor solution (Bovine)
3. Thrombin (Human), vapor-heated, freeze-dried
Surgical endoscopy journal, World journal of surgery,
Medscape. The following terms were used: Fibrin glue in 4. Calcium chloride solution.
Freeze-dried sealer protein concentrate and thrombin
laparoscopic hernia repair, TAPP, Fibrin sealant in hernia
repair, role of fibrin glue in TAPP, TEP. The selected articles are reconstituted in fibrinolysis inhibitor solution and calcium
chloride solution respectively (Flow Chart 1). The resulting
were screened for further references.
sealer protein solution and thrombin solution are then
combined (by using the duploject system, or equivalent
FIBRIN GLUE
delivery device) to form the fibrin sealant:
Fibrin glue/sealant is a commercial tissue adhesive containing Various methods can be used to apply the two
fibrinogen and thrombin. The commercial product is a two components of the sealant, the duploject and application
component system from human plasma that contains more needle being the most convenient and popular in
than fibrinogen and thrombin. The first component contains laparoscopic surgery.

Table 1: Composition of tissue glue
Package sizes
0.5 ml 1.0 ml 2.0 ml 5.0 ml

Sealer protein Fibrinogen (mg) 37.5-57.5 75-115 150-230 375-575
concentrate Total protein (mg) 50-65 100-130 200-260 500-650
Polysorbate 80 (mg) 0.1-0.2 0.2-0.4 0.4-0.8 1-2
Sodium chloride (mg) 1-2 2-4 4-8 10-20
Trisodium citrate (mg) 2-4 4-8 8-16 20-40
Glycine (mg) 7.5-17.5 15-35 30-70 75-175
Fibrinolysis Aprotinin (KIU) 1500 3000 6000 15000
Inhibitor solution Volume (ml) 0.5 1.0 2.0 5.0
Thrombin Thrombin (IU) 250 500 1000 2500
Total protein (mg) 22.5-27.5 45-55 90-110 225-275
Sodium chloride (mg) 4-6 8-12 16-24 40-60
Glycine (mg) 1.2-1.8 2.4-3.6 4.8-7.2 12-18
Calcium chloride CaCl 2 (µmol) 20 40 80 200
Solution Volume (ml) 0.5 1.0 2.0 5.0
Total combined
Volume (ml) 1.0 2.0 4.0 10.0

166
JAYPEE