Article

Comparing fibrin sealant with staples for mesh fixation in laparoscopic transabdominal hernia repair: a case control-study

Department of General, Vascular and Mininvasive Surgery, Spoleto Hospital, Spoleto, PG, Italy.
Surgical Endoscopy (Impact Factor: 3.31). 04/2008; 22(3):668-73. DOI: 10.1007/s00464-007-9458-7
Source: PubMed

ABSTRACT Laparoscopic hernia repair is not as popular as cholecystectomy. We have performed more than 3,000 laparoscopic herniorrhaphies using the trans-abdominal (TAPP) technique. To prevent recurrences we fix the polypropylene mesh with staples. The use of fibrin glue for graft fixation is a possible alternative.
We have performed 3,130 laparoscopic hernia repairs over 14 years. For mesh fixation we used titanium clips and observed a small number of complications. In July 2003 we started using fibrin glue (Tissucol(R)). The purpose of this retrospective longitudinal study was to evaluate if the use of fibrin sealant was as safe and effective as conventional stapling and if there were differences in post-operative pain, complications and recurrences.
From July 2003 to June 2006 we performed 823 laparoscopic herniorrhaphies. Fibrin glue (Tissucol(R)) was used in 88 cases. Two homogeneous groups of 68 patients (83 cases) treated with fibrin glue and 68 patients (87 cases) where the mesh was fixed with staples, were compared. Patients with relevant associated diseases or large inguino-scrotal hernias were excluded. Operative times were longer in the group treated with fibrin glue with a mean of 35 minutes (range 22-65 mins) compared to the group treated with staples (25 minutes, range 14-50 mins). The time of hospital stay was the same (24 hours). Post-operative complications, that were more frequent in the stapled group, included trocar site pain, hematomas, intra-operative bleedings and incisional hernias. No significant difference was observed concerning seromas, chronic pain and recurrence rate.
Less post-operative pain, and a faster return to usual activities are the main advantages of laparoscopic repair compared to the traditional approach. The use of fibrin sealant reduces in our experience the risk of post- and intra-operative complications such as bleeding and incisional hernia; recurrence rates are similar, but the operative time is longer.

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    ABSTRACT: Die sehr guten Ergebnisse endoskopischer Leistenhernienchirurgie hierzulande, besonders vertreten von Bittner und Köckerling, wurden durch die Multicenterstudie von Neumayer Anfang 2004 in Frage gestellt. Daraus resultierte der Anspruch der vorliegenden Studie, durch möglichst lückenlose und konsequente Verlaufsbeobachtung, die zurzeit am häufigsten angewandten Verfahren zur Leistenhernienversorgung in einem Regelkrankenhaus, aus der Sicht der Patienten, ergänzend durch objektive Untersuchung der Problemfälle, zu vergleichen. Im Rahmen einer prospektiven Beobachtungsstudie wurden die Patienten zur Leistenbruchoperation eines Jahrganges mittels selbst entworfener Fragebögen prä-, 2 Tage postoperativ, nach 3 Monaten, 1 und 2 Jahren evaluiert. Präferiertes OP-Verfahren war die transabdominelle präperitoneale Netzplastik (TAPP) ohne Netzfixierung. Auf Patientenwunsch oder medizinisch erforderlich erfolgte die Lichtenstein-OP (LS) bzw. eine Shouldice-Reparation (Naht). 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Two days post-op the TAPP group experienced significantly less pain (median of 1 on the pain scale compared to 4 in LS-patients, p < 0.01) than the LS group, requested significantly shorter hospital stay (3 days compared to 5, p = 0.027), and required almost no analgetics (median 0 compared to 5, p < 0.01). 3 month, 1 year and 2 years follow-ups of 108 out 109 patients (99%) revealed no differences between TAPP and LS patients on all the scales but one – numbness was noticed in LS patients more often (p=0.022). Overall physical capacity and satisfaction by surgery was equally high in both groups in all post-op stages (10 on average). Among TAPP patients there were 3 recurrences of hernia (4%), and one among LS-patients (4%). TAPP technique is an excellent procedure, favoured by patients in the immediate post-operative period. The hernia recurrence rates are low in both cases, especially compared to the 2004 Neumayer study. 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