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Pain after laparascopic bilateral hernioplasty

Early results of a prospective randomized double-blind study comparing fibrin versus staples

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An Erratum to this article was published on 13 February 2008

Abstract

Background

The use of fibrin for mesh fixation in laparascopic hernioplasty has theoretical advantages in that it could result in reducing postoperative pain. The objective of this study is to demonstrate this improvement in postoperative pain with the highest level of evidence possible.

Methods

Unicenter single surgeon prospective randomized double-blind study of transabdominal preperitoneal (TAPP) bilateral hernioplasties comparing autologous fibrin sealant (FG) used for mesh fixation on one side and staples (SG) on the other. Data were collected regarding anthropometric measures, costs, complications and pain evaluation at postoperative days 7, 30 and 180 using a visual analogue scale. The patients were also asked to answer the following simple question: “On which side do you have more pain?”

Results

Twenty-two eligible patients were included in the study. Both groups were comparable. The operating time was significantly longer (30 min more) in the FG. The incidence of seroma was similar in both groups, and that of hematoma was higher in the SG (0 vs. 9.1%). At 1 week, the visual analogue scale scores were significantly lower in the FG (median: 1.7 vs. 4.5; MWU:103.5, p < 0.05). At 1 month, this difference became clinical and statistically insignificant. 72.7% of the patients referred more pain on the side with staples at 1 week, 38% at 1 month, and 0% at 6 months (after patients with hernia recurrence were excluded). The recurrence rate was higher in the FG (9.9 vs. 13.6%). A hernia in the FG cost 200 Euros more than that in the SG, or even more if a complete economic study is considered.

Conclusions

The use of fibrin produces less postoperative pain in the first week, but prolongs operating time and increases costs. Moreover, there appears to be a higher recurrence rate and a lower incidence of hematoma, while the incidence of seroma remains unchanged.

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Acknowledgments

The authors are grateful to the Fundacion de la Comunidad Valenciana Hospital Provincial de Castellon (the public foundation for promoting investigation in health sciences of the Consorcio Hospitalario Provincial de Castellon) for technical and financial support. Dr. Perez de Lucia, the surgeon in charge of collecting the postoperative evaluation has no personal or financial relationship with the MBA company, distributor of Vivostat in Spain. Dr. Boldo was invited to present this early result as a nonprofit CME activity (conference) organized by the MBA company for Spanish surgeons.

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Correspondence to E. Boldo.

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Boldo, E. Pain after laparascopic bilateral hernioplasty. Surg Endosc 22, 1206–1209 (2008). https://doi.org/10.1007/s00464-007-9587-z

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  • DOI: https://doi.org/10.1007/s00464-007-9587-z

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