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Tissue Glue in Laparoscopic Inguinal Hernia Repair: A Retrospective Comparative Analysis

preperitoneal inguinal hernia repair. Half of the subjects were the staples group.The percentage of late postoperative
randomly assigned to fibrin glue and half to staples for mesh complications was 3 and 7% of patients in the fibrin glue
fixation. All patients completed the protocol and were and staples groups respectively. There were no cases of
available for evaluation for one year after the procedure. hernia recurrences.
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Pain was reduced with the fibrin glue by several measures. Over three years, Graziano Ceccarelli et al compared
On the first postoperative day, significantly fewer patients the characteristics of mesh fixation with titanium clips and
in the glue group reported mild pain (28% vs 46% of those fibrin glue (Tisseel) and evaluated if the use of fibrin sealant
receiving staples), and there was a nonsignificant trend was as safe and effective as conventional stapling and if
toward more glue patients reporting no pain (68% for glue, there were differences in postoperative pain, complications
42% for staples). One week after the procedure, pain and recurrences. Comparision was made between two
measures still showed a significant advantage for the glue. homogeneous groups of 68 patients (83 cases) treated with
Using a 10-point visual analogue scale, patients who received fibrin glue and 68 patients (87 cases), where the mesh was
glue reported pain in the 0 to 2 range, while those received fixed with staples. TAPP technique was used. Operative
staples reported pain in the range of 3 to 6. Patients in the times were longer in the group treated with fibrin glue with
glue group also consumed significantly less pain medication a mean of 35 minutes (range 22-65 mins) compared to the
(oral diclofenac and paracetamol): A mean of 4.5 tablets group treated with staples (25 minutes, range 14-50 mins).
per day vs 7.0 tablets per day for the staple group. The time of hospital stay was the same (24 hours).
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In a study by Stark et al the rate of nerve entrapment Postoperative complications that were more frequent in the
in laparoscopic patients was 4.2%. The genitofemoral nerve stapled group, included trocar site pain, hematomas,
was affected with a high frequency (2%), and the ilioinguinal intraoperative bleedings and incisional hernias. No significant
or lateral cutaneous nerve of the thigh was affected in 1.1% difference was observed concerning seromas, chronic pain
of the cases. and recurrence rate.
The morbidity in postoperative period in patients with A study by Arthur P Fine et al involved 38 adult patients
staples and fibrin glue mesh fixation is a topic of interest. with 51 inguinal hernias. 38 patients with 45 primary and
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Federico Lovisetto et al carried out a randomized study in six recurrent inguinal hernias were treated with laparoscopic
197 patients with inguinal or femoral hernia. The primary repair by the total extraperitoneal mesh placement (TEP)
outcomes were early postoperative and late neuralgia technique using mesh secured with fibrin sealant. All patients
recorded using a visual analog scale (VAS). The effects of could care for themselves within a day of surgery.
neuralgia on functional status were evaluated using the Immediately following surgery, patients on average took
modified SF-36 questionnaire. Secondary outcomes included 7 days off from work. Short-term pain associated with the
complications, such as nonspecific pain and recurrence. procedure generally subsided completely within three to
His study included 176 males (89.3%) and 21 females four days. Follow-up examination two weeks after the
(10.7%) patients with a mean age of 53 years (range 18- surgery revealed no swelling or localized abdominal pain,
79 years); 188 (95.4%) hernias were inguinal and nine and the patient was allowed full activity and returned to
(4.6%) were femoral. Patient characteristics were similar work. Postoperative complications were minor and generally
in the two groups. Follow-up visits were done in 1, 3, 6, expected as a consequence of surgery. Mild cord or canal
and 12 months. No intraoperative complications were swelling or both, following the procedure being the most
observed in either of the treatment groups. When compared, common complaint. The degree of swelling was not judged
there was no significant difference in quality of life in the as severe or necessitating intervention in any case. Mild to
two study groups. The mean duration of intervention was moderate orchitis was noted in three patients (7.9%)
54 minutes (range 30-95 minutes) in the Tisseel/fibrin glue following surgery, as were two cases of hematoma (5.3%)
group vs 40 minutes (range 25-105 minutes) in the staples and one suspected case of seroma (2.6%) that resolved
group. The mean postoperative hospitalization time in each without intervention. Two patients (5.3%) presented with
group was one day. The mean recovery time to normal mild fever and localized pain and swelling following surgery.
physical activity was 7.9 days (range 5-11 days) in the Ciprofloxacin was given for suspected infection, and both
fibrin glue group vs 9.1 days (range 7-11 days) in the staples patients eventually resolved without further intervention.
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group. Early postoperative complications which included P Topart et al in his retrospective analysis of Tisseel vs
hematoma/seroma, orchitis, nonspecific pain occurred in tack staples as mesh fixation in totally extraperitoneal
8% of patients in the fibrin group and in 12% of patients in laparoscopic repair of groin hernias compared the result of

World Journal of Laparoscopic Surgery, September-December 2010;3(3):165-174 171