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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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