Page 42 - WJOLS - Surgery Journal

Fibrin Sealant versus Use of Tackers for Fixation of Mesh in Laparoscopic Inguinal Hernia Repair
to avoid displacement and reduce the risk of recurrence prevails breaking strength of 16-32 N is the minimum required . Also, the
among surgeons. The chronic pain that may persist in the groin fixation aid should tolerate elasticity in the range of 20-30% in
area postoperatively is one of the most serious problems that new meshes, without provoking rigid shear forces. Fibrin
may affect the results of hernia surgery. sealant possesses both of these mechanical properties. Overall,
Postoperative chronic pain is defined as pain persisting data from previous studies, shows that mesh stability with fibrin
more than 3 months after the operation. The prevalence of sealant fixation is at least equivalent to suture fixation, indicate
chronic postoperative pain after hernia surgery ranges from 3% that fibrin sealant could be considered the fixation method of
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to 54%. Although laparoscopic repair appears to be signi- choice in inguinal hernia repair. Tissucol_/Tisseel_ fibrin sealant
ficantly less likely to induce postoperative chronic pain this has been approved in Germany for the indication of mesh fixation
type of complication is still reported up to 22.5% of patients. 14 in hernia surgery.
Stapling of the mesh, which may lead to nerve injury and osteitis
pubis, has been identified as one of the possible causes of the Fixation of the Prosthesis
persistence or development of pain after hernia surgery. 15,17 Mesh is fixed with 1 ml of Tissucol for unilateral hernias and
2 ml for bilateral hernias. The prosthesis is fixed along its upper
AIMS AND OBJECTIVES margin, from Coopers ligament to the triangle of disaster and

The aim of this study was to compare the effectiveness and safety of to the triangle of pain, using a 3 mm catheter (Duplotip; Baxter
using fibrin sealant and tackers for mesh fixation in laparoscopic inguinal health care), which fits the Tissucol syringe. The mesh also
hernia repair based on: may be fixed wherever necessary to increase its stability.
• Operative time Tissucol may be applied in two different ways: by resting the
• Discharge period tip of the Duplotip catheter where the mesh is to be fixed and by
• Complications squeezing out a few drops of glue. With the latter method, the
– Groin chronic pain glue seeps across the mesh and fixes it. One also can separate
– Hematoma of scrotum the mesh slightly from the inguinal wall, spray the glue directly
– Seroma on it, and then place the mesh to the wall. The two methods
– Trocar hernia appear to be comparable.
– Trocar site bleeding
– 10 mm trocar site pain Postoperative Complications
• Recurrence rate
After a 23.7 months follow-up regarding postoperative pain,
MATERIAL AND METHODS hospital stay, complications and recurrence, together with short
term resumption of regular physical activity show the efficacy
A literature search was performed using medline and the search Google, and safety of this technique. The results are better considering
Springer link and Highwire press. The following search terms were there is no dissection of peritoneal structures that mesh fixation
used: Laparoscopic hernia mesh, Fibrin glue,and Tackers. 2293
citations were found in total. Selected papers were screened for further is completely nontraumatic and the procedure is easily
references. Criteria for selection of literature were the number of cases reproducible.
(excluded if less than 80), methods of analysis (statistical), operative With the use of Tissucol as the means of fixation (in both
procedure (only universally accepted procedures were selected) and TAPP and TEP techniques) there is decreased neuralgia, caused
the Institution where the study was done (specialized institution for mainly by staples placed in proximity to one of the several
laparoscopic surgery). nerves that course below the ileo-pubic tract with a percentage
varying from 0 to 19.6%. 18,20,21,24,27,31 Stapling Cooper’s
Content ligament may cause pain through osteitis, as stated by Toy. 31
Mesh fixation has always invited lots of interest amongst Regarding long-term results in terms of seroma and recurrence,
surgeons and instrument companies due to the wide range of the former are avoided by the porous structure of the mesh and
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postoperative complications each of them caused. TAPP and by the no structural dissection procedure. There is an argument
TEP usually involves fixation of mesh, however many studies going on as to how long follow-up has to last to assess
challenging the mesh fixation in TEP are being published. 22 recurrences correctly.
There are two most common methods of fixing mesh using fibrin Stoppa et al, showed that recurrences usually occur during
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glue (Tissucol) and tackers. the first postoperative year. It’s important for the mesh to
overlap the defect by 3 or 4 cm and to properly fix it with Tissucol.
Pascal’s hydrostatic law states that pressure applied within a
Ideal Mesh
limited space is transmitted equally in all direction. If the mesh
Ideally, modern hernia mesh fixation methods should be lies well over the defect, it will be kept in place by the abdominal
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compatible with the mechanical properties of the mesh. A pressure. There are two kind of meshes for these procedures,
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