Abstract
Endoscopic hernia repair methods have become increasingly popular over the past 15 years. The postulated main advantages of the endoscopic technique are less postoperative pain, early recovery and lower recurrence rates. Fixation of the endoscopic mesh seems to be necessary to minimize the risk of recurrence. Stapling has been implicated to cause chronic inguinal pain syndromes. We performed a retrospective study on male patients who were endoscopically operated on primary inguinal hernias. Our aim was to clarify whether mesh fixation using a fibrin sealant is as safe and reliable as conventional stapling. Additionally, we compared the prevalence of chronic inguinal pain. A standardized population of 133 male patients (mean age 55.9 years) with 186 (80 unilateral; 53 bilateral) consecutive primary laparoscopic total extraperitoneal inguinal hernia repairs was assigned to two groups, depending on whether stapling or a fibrin sealant had been used for mesh fixation. A retrospective case control study was performed to conduct statistical analysis based on the following parameters: recurrence, complications, chronic inguinal pain, foreign body sensation and numbness. Hernia repairs numbering 173 (staples n=87; fibrin n=86) were followed up for a mean duration of 23.7 (11–47) months. The prevalence of chronic inguinal pain was significantly (P=0.002; Fisher exact test) higher in the stapled group—20.7% than in the fibrin sealant group with a prevalence of 4.7%. In terms of recurrence rate, complications and foreign body sensation, fewer patients were affected in the fibrin group than in the reference population, although the differences were not statistically significant. There were no major complications in either of the groups. The mean postoperative stay in hospital was 1.4 days. Fibrin sealing is as effective as stapling in providing secure mesh fixation. The fibrin group displayed a statistically significant lower prevalence of chronic pain syndromes. Mesh sealing provides adequate fixation and reduces the risk of chronic inguinal pain as a complication of the intervention.
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References
Atkinson H, Nicol S, Purkayastha S, Paterson-Brown S (2004) Surgical management of inguinal hernia: retrospective cohort study in southeastern Scotland, 1985–2001. BMJ 329(7478):1315–1316
EU Hernia Trialists Collaboration. Laparoscopic versus open groin hernia repair: meta-analysis of randomised trials based on individual patient data. Hernia 6(1):2–10
McCormack K, Scott NW, Go PM, Ross S, Grant AM, EU Hernia Trialists Collaboration (2003) Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev (1):CD001785
Beattie GC, Rumar S, Nixon SJ (2000) Laparoscopic total extraperitoneal hernia repair: mesh fixation is unnecessary. J Laparoendosc Adv Surg 10:71–73
Poobalan AS, Bruce J, Cairns W, Smith S, King PM, Krukowski ZH, Chambers W (2003) A review of chronic pain after inguinal herniorrhaphy. Clin J Pain 19:48–54
Stark E, Oestreich K, Wendl K, Rumstadt B, Hagmüller E (1999) Nerve irritation after laparoscopic hernia repair. Surg Endosc 13(9):878–881
Bay-Nielsen M, Perkins FM, Kehlet H, The Danish Hernia Database (2001) Pain and functional impairment one year after inguinal herniorrhapy: a nationwide questionnaire study. Ann Surg 223:1–7
Köninger J, Redecke J, Butters M (2004) Chronic pain after hernia repair: a randomized trial comparing Shouldice, Lichtenstein and TAPP. Langenbecks Arch Surg 389:361–365
Neumayer L, Giobbie-Hurder A, Jonasson O, Fitzgibbons R Jr, Dunlop D, Gibbs J, Reda D, Henderson W (2004) Veterans Affairs Cooperative Studies Program 456 Investigators. Open mesh versus laparoscopic mesh repair of inguinal hernia. N Engl J Med 350(18):1819–1827
Hindmarsh AC, Cheong E, Lewis MPN, Rhodes M (2003) Attendance at a pain clinic with severe chronic pain after open and laparoscopic inguinal hernia repairs. Br J Surg 90:1152–1154
Kumar S, Wilson RG, Nixon SJ, Macintyre IMC (2002) Chronice pain after laparoscopic and open mesh repair of groin hernia. Br J Surg 89:1476–79
Callesen T, Bech K, Kehlet H (1999) Prospective study of chronic pain after hernia repair. Br J Surg 86:1528–1531
Ferzli GS, Frezza E, Pecoraro AM, Dee Ahern K (1999) Prospective randomized study of stapled versus unstapled mesh in a laparoscopic preperitoneal inguinal hernia repair. J Am Coll Surg 1881:461–465
Lau H, Nivritti GP (2003) Selective non-stapling of mesh during unilateral endoscopic extraperitoneal inguinal hernioplasty. Arch Surg 138:1352–1355
Smith AI, Royston CM, Sedman PC (1999) Stapled and non-stapled laparoscopic transabdominal TAPP inguinal hernia repair: a prospective randomized trial. Surg Endosc 13:804–806
Zieren J, Castenholz E, Jacobi CA, Zieren HU, Müller J (1999) Is mesh fixation in abdominal hernia necessary? Langenbecks Arch Surg 384:71–75
Chevrel JP, Rath AM (1997) The use of fibrin glues in the surgical treatment of incisional hernias. Hernia 1:9–14
Katkhouda N, Mavor E, Friedlander MH, Mason RJ, Kiyabu M, Grant SW, Achanta K, Kirkman EL, Narayanan K, Essani R (2001) Use of fibrin sealant for prosthetic mesh fixation in laparoscopic extraperitoneal inguinal hernia repair. Ann Surg 233:18–25
Lau H (2005) Fibrin sealant versus mechanical stapling for mesh fixation during endoscopic extraperitoneal inguinal hernioplasty: a randomized prospective trial. Ann Surg 242(5):670–675
Topart P, Vandenbroucke F, Lozac’h P (2005) Tisseel vs tack staples as mesh fixation in totally extraperitoneal laparoscopic repair of groin hernias. Surg Endosc 19:724–727
Courtney CA, Duffy K, Serpell MG, O’Dwyer PJ (2002) Outcome of patients with severe chronic pain following repair of groin hernia. Br J Surg 89:1310–1314
Tamme C, Scheidbach H, Hampe C, Schneider C, Köckerling F (2003) Totally extraperitoneal endoscopic inguinal hernia repair (TEP). Results of 5203 hernia repairs. Surg Endosc 17:190–195
Lau H, Patil NG, Yuen WK, Lee F (2003) Prevalence and severity of chronic groin pain after endoscopic totally extraperitoneal inguinal hernioplasty. Surg Endosc 17(10):1620–1623
Khajanchee Y, Urbach R, Swanstrom L, Hansen P (2001) Outcomes of laparoscopic herniorrhaphy without fixation of mesh to the abdominal wall. Surg Endosc 15: 1102–1107
Jourdan IC, Bailey ME (1998) Initial experience with the use of N-butyl 2-cyanoacrylate glue for the fixation of polypropylene mesh in laparoscopic hernia repair. Surg Laparosc Endosc 4:291–293
Helbling C, Schlumpf R (2003) Sutureless Lichtenstein: first results of a prospective randomised clinical trial. Hernia 7:80–84
Montanaro L, Arciola CR, Cenni E, Ciapetti G, Savioli F, Filippini F, Barsanti LA (2001) Cytotoxicity, blood compatibility and antimicrobial activity of two cyanoacrylate glues for surgical use. Biomaterials 22:59–66
Arvidsson D, Berndsen FH, Larsson LG, Leijonmarck CE, Rimbäck G, Rudberg C, Smedberg S, Spangen L, Montgomery A (2005) Randomized clinical trial comparing 5-year recurrence rate after laparoscopic versus Shouldice repair of primary inguinal hernia. Br J Surg 92:1085–1091
Canonico S, Santoriello A, Campitiello F, Fattopace A, Della Corte A, Sordelli I, Benevento R (2005) Mesh fixation with human fibrin glue (Tissucol) in open tension-free inguinal hernia repair: a preliminary report. Hernia 17:1–4
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Schwab, R., Willms, A., Kröger, A. et al. Less chronic pain following mesh fixation using a fibrin sealant in TEP inguinal hernia repair. Hernia 10, 272–277 (2006). https://doi.org/10.1007/s10029-006-0080-8
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DOI: https://doi.org/10.1007/s10029-006-0080-8