Mesh Fixation with Fibrin Sealant in Totally Extraperitoneal Hernia Repair

Tissue Adhesives for Hernia Mesh Fixation: A Literature Review

In an effort to optimize the results during inguinal hernia repair, surgeons need to consider the role of different mesh fixation techniques. The use of tissue adhesives is proposed for mesh fixation, which demonstrate similar or improved outcomes in the realm of postoperative pain, hernia recurrence, cost, and formation of a hematoma or seroma. In this review, mesh fixation using fibrin glue and cyanoacrylate glue is compared to standard suture or tack techniques. The results of this investigation warrant consideration by surgeons seeking to improve patient outcomes.

Comparison between single-incision and multiple-incision laparoscopic surgery for totally extraperitoneal inguinal hernia repair

Introduction: We compared the clinical outcomes of single-incision laparoscopic surgery (SILS) and multiple-incision laparoscopic surgery for totally extraperitoneal (TEP) inguinal hernia repair.Material and methods: This retrospective study included 134 consecutive patients undergoing single-incision or multiple-incision laparoscopic surgery for inguinal hernia between January 2012 and December 2016 at our hospital.Results: In total, 62 patients undergoing SILS-TEP and 72 receiving multiple-incision laparoscopic surgery were included in this study. No significant differences in patients' characteristics between the two groups were noted. No patient required conversion to open surgery in either group. No significant differences were noted between the two groups in operative time, bleeding volume, post-operative hospital stay, and analgesics used. Postoperative complications were observed in 5.7% (4 of 62) of patients in the SILS group and 3.2% (2 of 72) of patients in the control group. Among the few patients who experienced complications, most had hematomas. No major complications or hernia recurrences were observed during the follow-up period in either group.Conclusions: SILS-TEP produced good cosmetic outcomes for patients regardless of previous surgery, and it could be safely performed with acceptable morbidity. It also does not increase the possibility of conversion to open surgery.

Operative Outcomes after Open Abdominal Wall Reconstruction with Retromuscular Mesh Fixation Using Fibrin Glue versus Transfascial Sutures

Ideal fixation techniques have not been fully elucidated at the time of complex open abdominal wall reconstruction (AWR). We compared operative outcomes and quality of life with retromuscular mesh fixation using fibrin glue (FG) versus transfascial sutures (TS). Retrospective review identified complex hernia patients who underwent open AWR with mesh from November 2012 through April 2016. Multivariate analysis examined postoperative outcomes between groups. Quality of life was assessed using the Carolinas Comfort Scale. Seventy-five patients (18 FG vs 57 TS) with mean age (54.3 vs 53.9 years, P = 0.914), body mass index (35.8 vs 34.7 kg/m2, P = 0.623) and American Society of Anesthesiologist score (2.6 vs 2.5, P = 0.617) were reviewed. No differences in wound (P = 0.072) and nonwound (P = 0.639) related complications were noted between groups. Risk of reoperations (P = 0.275) and 30-day readmissions (P = 0.137) were also comparable. The TS group was twelve times more likely to report pain at six-month follow-up compared with FG (12.29 OR, 95 per cent confidence interval 1.26–120.35, P = 0.031). No hernia recurrences were noted in either group at a mean follow-up of 390 ± 330 days. The use of FG to secure mesh in the retromuscular space during complex open AWR may be a safe alternative to penetrating transfascial fixation with potential to reduce chronic pain.