Quantification of pain in laparoscopic transabdominal preperitoneal (TAPP) inguinal hernioplasty identifies marked differences between prosthesis fixation systems

Update with level 1 studies of the European Hernia Society guidelines on the treatment of inguinal hernia in adult patients

“…Although the VAS scores were lower in the fibrin sealant group after 1, 3 and 6 months, this was not the case after 1 year. In another TAPP study, Olmi et al [43] also showed a short-term benefit (up to 1 month, but especially the first week) for fibrin glue fixation vs. tack fixation (two tacks medially, three laterally to the epigastric vessels and two on the Cooper ligament). Boldo et al [44] compared autologous fibrin sealant and Protack in single patients with bilateral hernias undergoing TAPP; in this study with a follow-up of only 6 months, there was only a benefit of less pain in the glue group at 1 week.…”

Mesh fixation with fibrin glue (Tissucol/Tisseel®) in hernia repair dependent on the mesh structure—is there an optimum fibrin–mesh combination?—Investigations on a biomechanical model

“…Because of the possibility of acute bleeding problems in fixation near blood vessels ("triangle of doom") and chronic pain symptoms in stapler fixation in the proximity of nerves ("triangle of pain"), the use of staplers is regarded more and more critically in many cases [7][8][9][10]. If fixation is nevertheless necessary, the effectiveness and advantages of using fibrin glue have been proven experimentally by Kathkouda [3,4].…”

“…The approach does not play any decisive role here (TEP, TAPP). The potential pain symptoms are also a reason for the increasing omission of basic fixation [7][8][9][10] …”

“…A lower rate of early postoperative pain with earlier reconvalescence is reported, but also, and primarily, a reduction in chronic pain in comparison with mesh fixation using staples. In various studies, chronic pain occurs in up to more than 20% of hernia treatment cases and can be brought down to 4-6% by this alternative fixation method [7][8][9][10]. A significant decrease in seroma formation is described in most studies, but is also the subject of controversial discussion [11].…”

Fixation of mesh to the peritoneum using a fibrin glue: investigations with a biomechanical model and an experimental laparoscopic porcine model

“…In the everyday clinical setting and in clinical trials, some of which were prospective randomized studies, it was possible to demonstrate a reduced postoperative complication rate, particularly in the case of endoscopic techniques used for hernia repair, namely, total extraperitoneal (TEP) and transabdominal preperitoneal polypropylene (TAPP) repair. Chronic pain was reduced from more than 20% to between 4% and 5% compared with the use of staples for fixation [7][8][9][10][11].…”