Page 6 - WJOLS - Journal of Laparoscopic Surgery

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WJOLS

10.5005/jp-journals-10033-1312
Comparative Study of Tacker vs Glue Fixation of Mesh in Laparoscopic Intraperitoneal
ORIGINAL ARTICLE

Comparative Study of Tacker vs Glue Fixation of Mesh

in Laparoscopic Intraperitoneal Onlay Mesh Repair
of Ventral Hernias

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1 Vinaya K Ambore, Jalbaji P More, Ajay H Bhandarwar, Saurabh S Gandhi, Chintan B Patel, Ravi Taori
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ABSTRACT How to cite this article: Ambore VK, More JP, Bhandarwar AH,
Gandhi SS, Patel CB, Taori R. Comparative Study of Tacker
Aim: To compare results of tacker and glue fixation of mesh in vs Glue Fixation of Mesh in Laparoscopic Intraperitoneal
laparoscopic intraperitoneal onlay mesh repair of ventral hernias.
Onlay Mesh Repair of Ventral Hernias. World J Lap Surg
Materials and methods: Patients admitted to the General 2017;10(3):87-90.
Surgery Department of Sir Jamshedjee Jeejeebhoy Group Source of support: Nil
of Hospitals, Mumbai, India, from January 2015 to June 2016
for ventral hernia repair were included for the study. A total Conflict of interest: None
of 60 patients were enrolled, and each group consisted of
30 cases.
INTRODUCTION
Results: In our study, the mean age of ventral hernia patients
subjected for glue fixation was found to be 38 years and for An abdominal wall hernia, or a ventral hernia, often
tacker fixation it was found to be 38.77 years. There is no sta- occurs at the weakest point of the abdominal wall and it
tistically significant difference among the age of cases in the
two groups in terms of mean age (p = 0.75). Out of 60 cases, includes umbilical, incisional, epigastric, supraumbilical,
28 (46.66%) were females, whereas 32 (53.33%) cases were infraumbilical, etc. The intra-abdominal pressure forces
males. Maximum size of hernia defect was restricted to 6 cm. the contents to move out from the defect. The protruded
The mean size of hernia defect was 2.84 ± 1.02 cm in the glue contents dilate the opening further, leading to increased
fixation group, while that in the tacker fixation group was 3.15 ±
0.731 cm. Mean duration of surgery was 83.67 minutes in the diameter of the defect, and hence, more contents protrude.
glue fixation group and 64.50 minutes in the tacker fixation This positive feedback loop results in increase in size of
group. There was no intraoperative and postoperative complica- hernia, and continues till either the hernia is operated, or
tions with glue fixation. In tacker fixation, seroma was seen in
4 cases (13.33%), hematoma in 1 (3%), bowel ileus in 1 (3%), it develops complications like obstruction, strangulation,
whereas there were no intra-abdominal complications, bowel or incarceration. The mechanism behind the continued
obstruction, bleeding from trocar site, and enterocutaneous progression of hernia can be explained by Pascal’s law,
fistula. The mean pain [visual analog scale (VAS) score] of which states that “A change in pressure at any point in
glue fixation and tacker fixation at 24 hours was 1 and 2.23
respectively. Mean postoperative hospital stay for patients with an enclosed fluid at rest is transmitted undiminished to
tacker fixation is 3 days, and 2 days in glue fixation. Mean time all points in the fluid.” In this condition, the “fluid” can
to return to normal activities was 3 ± 0.6 days in tacker fixation be taken as the abdominal cavity contents. So, a rise in
group and 1 ± 0.58 days in glue fixation group. No recurrence pressure in the abdominal cavity is transmitted to all
was found in both groups of fixation methods.
points along the abdomen equally.
Conclusion: Mesh fixation with glue is better as compared with The open technique of ventral hernia repair involved
tacker in terms of cost, postoperative pain, and length of hospital
stay; however, the use of tacker or glue depends on surgeon extensive dissection of surrounding tissues, which led
preference, patient affordability, and availabilities of facilities. to complications, such as wound infections, seroma for-
mation, etc. To overcome these, laparoscopic techniques
Keywords: Glue fixation, Intraperitoneal onlay mesh, Laparo-
scopic, Tacker fixation, Ventral hernia. were devised. In 1991, LeBlanc and Booth described
their experience with repair of incisional hernia using
expanded polytetrafluoroethylene prosthetic graft using
1 Associate Professor and Head, 2,6 Chief Resident, Professor laparoscopic technique. Ever since its introduction, the
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and Head, Assistant Professor
trend is toward attempting a laparoscopic repair of
1-6 Department of General Surgery, Grant Medical College ventral hernias. In this technique, the contents of the
and Sir Jamshedjee Jeejeebhoy Group of Hospitals, Mumbai
Maharashtra, India hernia sac are reduced and a prosthetic mesh is placed
intraperitoneally/preperitoneally extending beyond the
Corresponding Author: Vinaya K Ambore, Associate Professor
and Head, Department of General Surgery, Grant Medical borders of the fascial defect and held in place by either
College and Sir Jamshedjee Jeejeebhoy Group of Hospitals staples sutures or glue.
Mumbai, Maharashtra, India, Phone: +919920707170, e-mail: The dilemma always persists regarding which
vinaya.ambore@gmail.com
technique is better, from a patient benefit point of view.
World Journal of Laparoscopic Surgery, September-December 2017;10(3):87-90 87