Page 49 - World's Most Popular Laparoscopic Journal

Abhijit Mahanta, RK Mishra

the level of peritoneum. A vertical line is drawn down the postoperative complications observed were six seromas
long axis of the mesh by using a surgical marker to assist (1.8%) and one trocar-site hematoma (0.3%). The mean
mesh orientation during the procedure. The mesh (8 cm × operating time was 30 minutes for unilateral hernias and
13 cm or 10 cm × 15 cm) is placed through the 50 minutes for bilateral hernias, whether primary or
preperitoneum unfurled, and placed uncut over the recurrent. Patients usually were discharged the day after
myopectinate orifice after soaking the mesh in saline for 10 surgery and returned to work after five days. No patient
to 15 minutes. The two solutions of the fibrin sealant were experienced an inguinal hematoma, which sometimes occurs
drawn into separate syringes, which are then fitted into the after stapling. After a mean follow-up period of 26 months
laparoscopic applicator (Fig. 6). Once the mesh is deployed (range, 1-40 months), none of the patients reported
in the position desired, it is secured to the pubic bone immediate or late paresthesia or neuralgia. Evaluation of
(Cooper's ligament) in the midline, the lacunar ligament pain levels by the use of a visual analog score indicated that
laterally, and superiorly into the transversalis fascia with these patients were free of pain by day 7 after surgery. The
the fibrin sealant, which is allowed to set for several minutes. average operating time was 30 minutes for unilateral hernias
The posterior aspect of the matrix repair is then held in (range, 15-45 minutes) and 50 minutes (range, 30-75
place as the pneumopreperitoneum is released under direct minutes) for bilateral hernias, both primary and recurrent.
vision, observing the peritoneum to obtain its desired According to a randomized trial reported in 93rd Annual
position relative to the matrix repair (Fig. 7). Clinical Congress of the American College of Surgeons
In a study by S Olmi et al 1,10 on fibrin glue mesh fixation (ACS), fibrin glue was as effective as staples in preventing
in TAPP in 230 patients with 320 hernias (unilateral and hernia recurrence. At the same time, fibrin glue produces
bilateral) the results had been encouraging. No perioperative less of the postoperative pain experienced with staples,
complications were observed. After an average follow-up which may cause nerve entrapment. This study enrolled
period of 26 months (range, 1-40 months), the only 100 patients scheduled to undergo totally endoscopic

Fig. 6: Sealent syringe

A B
Figs 7A and B: Prosthesis fixation with glue

170
JAYPEE