Retromuscular Mesh Repair Using Fibrin Glue: Early Outcomes and Cost-effectiveness of an Evolving Technique

Abstract

Background: Retromuscular hernia repairs (RHRs) decrease hernia recurrence and surgical site infections but can cause significant pain. We aimed to determine if pain and postoperative outcomes differed when comparing suture fixation (SF) of mesh to fibrin glue fixation (FGF). Methods: Patients undergoing RHR (n = 87) between December 1, 2015 and December 31, 2017 were retrospectively identified. Patients received SF of mesh (n = 59, 67.8%) before the senior author changing his technique to FGF (n = 28, 32.2%). These 2 cohorts were matched (age, body mass index, number of prior repairs, mesh type, defect size, and wound class). Outcomes were analyzed using a matched pairs design with multivariable linear regression. Results: Two matched groups (21 FGF and 21 SF) were analyzed (45.2% female, average age 56 years, average body mass index 34.7 kg/m 2 , and average defect size 330 cm 2 ). Statistical significance was observed for FGF compared with SF: length of stay (3.7 versus 7.1 days, P = 0.032), time with a drain (17.2 versus 27.5 days, P = 0.012), 30-day postoperative visits (2 versus 3, P = 0.003), pain scores (5.2 versus 3.1, P = 0.019) and activity within the first 24 hours (walking versus sitting, P = 0.002). Operative time decreased by 23.1 minutes ( P = 0.352) and postoperative narcotic represcription (3 versus. 8 patients, p=0.147) also decreased. Average cost for patients receiving SF was $36,152 compared to $21,782 for FGF ( P = 0.035). Conclusions: Sutureless RHR using FGF may result in decreased pain when compared with a matched cohort receiving SF, translating to enhanced recovery time, shortened hospital stay, and decreased costs.

Three-Year Clinical Outcomes and Quality of Life after Retromuscular Resorbable Mesh Repair Using Fibrin Glue

“…Therefore, we cannot comment on the effects that atraumatic fixation can have on movement, outside of the immediate 24 hours postoperatively. 13 Health care costs in ventral hernia repair have similarly garnered recent attention, as both incidence and burden of ventral hernia on health systems continue to grow. 27 Importantly, hernia recurrences are a major contributor to ventral hernia-related costs.…”

“…Therefore, we cannot comment on the effects that atraumatic fixation can have on movement, outside of the immediate 24 hours postoperatively. 13…”

“…1). Operative technique for the fibrin glue group is as described by Rhemtulla et al 13 This includes drying of the fascia with a sponge, followed by spraying of fibrin glue on the anterior surface of the posterior rectus sheath and the posterior surface of the anterior rectus complex, and then introducing the mesh into the retromuscular space.…”

“…We found that patients with fibrin glue had promising short-term results, including increased mobility, decreased pain, and a decreased length of hospital stay. 13 As an extension of our original work, we examined this patient population at 3-year follow-up to report on hernia recurrence, short- and long-term clinical outcomes, and patient-reported quality of life between cohorts.…”

Discussion: Three-Year Clinical Outcomes and Quality of Life after Retromuscular Resorbable Mesh Repair Using Fibrin Glue

“…2 The authors build on their prior study that examined the immediate postoperative outcomes between suture and fibrin glue mesh fixation methods, with an extended study inclusion period and an increased number of included subjects. 3 This follow-up study examines the long-term outcomes at the 3-year postoperative time point. This period is notable because it examines outcomes after the poly-4-hydroxybutyrate mesh used resorbs, which, as the authors note, occurs over 12 to 18 months postoperatively.…”