Page 51 - World's Most Popular Laparoscopic Journal

Abhijit Mahanta, RK Mishra

66 patients with fibrin glue mesh fixation in totally fibroblastic ingrowth that is enhanced by the chemotactic
extraperitoneal (TEP) laparoscopic procedure with an earlier action of its thrombin component.
series of 102 patients operated on according to the same Hung Lau et al studied in his randomized prospective
procedure in which mesh fixation used tack staples. For study a total of 93 patients with 186 inguinal hernias, who
the fibrin glue group, the operative time was 54 ± 23 minutes underwent bilateral TEP and were randomized to have mesh
and no difficulty was encountered during preparation or fixation by either FS (n = 46) or mechanical stapling (n =
application of the fibrin sealant. There were no reoperations 47). The FS group consumed significantly less analgesics
or postoperative deaths. The postoperative course was compared with that of staple group. There was no significant
uneventful for 53 patients (80.3%). Eight patients (12%) difference in postoperative pain score at rest and on coughing
had a seroma, which did not require any dedicated treatment from the day of operation to postoperative day 6 between
in the majority of cases. Three patients (4.5%) had a the groups.
hematoma: One patient had to remain on calciparin at the Stefano Olmi et al 1,10 in his randomized prospective study
time of the operation, and two patients (3%) had a small termed “Quantification of pain in laparoscopic trans-
bowel obstruction. No fever or inflammation was reported abdominal preperitoneal (TAPP)” involving 600 patients,
after surgery. Overall, patients were discharged 1.5 ± 1.7 came to the conclusion that postoperative pain ranged from
days after the operation. In the tack staple group mild pain between 12 and 72 hours with Tisseel and it was
complications occured in 26.4% of the patients. Ten patients higher in other methods of mesh fixation: Moderate pain
(9.8%) had a seroma and eight (7.8%) had a hematoma. with EMS (Ethicon Endo surgery, Inc.) to severe pain with
No major complications or deaths were reported. The length Protak at 48 hours follow-up. Significant differences in
of stay was a mean of 2.3 days (1.9 days, when the additional length of stay occurred, no recurrence or conversion rates
procedures were excluded). During the follow-up, three were observed among groups, and morbidity was generally
patients (2.9%) developed a recurrence at a mean of 16.3 lower with Tisseel. Patients using Tissseel also returned to
months after surgery. It was observed that 15 patients work sooner than as in other mesh fixing devices. Prostheses
(14.7%) complained of pain in the groin area more than were fixed with Protak (Tyco, Norwalk, Conn), Endoanchor
three months after surgery. There were slightly more (Ethicon Endosurgery, Inc., Cincinnati, Ohio), EMS
seromas but less hematomas in the fibrin glue group (Ethicon Endosurgery, Inc.) and Tisseel (Baxter Healthcare,
compared to the tack staples group, but this was not Milan, Italy).
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statistically significant. However, the postoperative chronic RH Fortelny and R Schwab et al assessed the quality
pain rate was significantly reduced in the fibrin glue group. of life in a trial with mesh fixation with fibrin glue in TAPP.
In an animal study in which TEP groin hernia repairs TAPP with fibrin mesh sealing was performed in 11 non-
2,4
were performed, Katkhouda et al demonstrated that graft selected consecutive patients. A direct control group (e.g.
motion and tensile strength were similar in the staples and TAPP with staples) was not considered as favorable change
fibrin glue groups. In addition, histological examinations in the quality of life in patients with fibrin glue mesh fixation
revealed that the fibrin glue triggered a stronger fibrous was the tested hypothesis and not the comparison of
reaction and inflammatory response with more fibroblastic techniques. Quality of life and pain were assessed
mesh ingrowth. The procedures were performed laparos- preoperatively and one year follow-up using the SF36 survey
copically in 49 sites. Eighteen grafts were fixed with fibrin and the visual analogue score (VAS). Post one-year analysis
glue and 16 with staples; 15 were not fixed. There was no of recurrences or complications was made. The analysis of
significant difference in graft motion between the fibrin glue the unmodifed SF-36 revealed a highly significant
and stapled groups; there was no significant difference in improvement. The scale ‘social functioning’ (SOCIAL),
median tensile strength between the fibrin glue and stapled which belongs to the mental-health-related scale, had also
groups. Fibrin glue triggered a significantly stronger fibrous significantly improved. The VAS significantly reduced after
reaction and inflammatory response than in the stapled and one year.
control groups. No infection related to method of fixation In an observational prospective multicenter study
was observed in any group. The experiment did not involve involving 1,201 patients performed in France B Descottes
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serial examinations at later dates because fibroblastic et al assessed Tisseel fibrin glue for atraumatic mesh
ingrowth has already fixed the mesh in position by fixation in inguinal hernia repair. Out of 1,201 patients, 526
postoperative day 12, after which further mesh migration procedures were performed using open techniques and 675
or folding is unlikely. It was found out that in addition to its using laparoscopic repairs. Local complications occurred
adhesive property, fibrin glue acts as scaffolding for in 4.7% of patients: 3.0% hematoma, 1.4% seroma, 0.3%

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