Stapled and nonstapled laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair

Smith, A. I.; Royston, C. M. S.; Sedman, Peter

doi:10.1007/s004649901104

Cited by 116 publications

(65 citation statements)

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“…In contrast to these results, two recent prospective randomized studies comparing stapled versus unstapled laparoscopic inguinal hernia repair, one through a transabdominal preperitoneal approach 15 and the other through a totally extraperitoneal approach, 14 demonstrated no difference between the stapled and the unstapled mesh grafts in terms of hernia recurrence. The follow-up in one study, 15 however, was relatively short (median 16 month, range 1 to 32) and incomplete (12% lost to follow-up and 22% of postoperative follow-ups conducted by phone).…”

mentioning

confidence: 56%

“…7 Recent reports have suggested performing the preperitoneal hernia repair without the use of staples, 11,12 relying on the intraabdominal pressure transmitted through the peritoneal sac to secure the mesh over the defect. 13 Two recent studies comparing stapled with unstapled repair did not demonstrate an increased incidence of recurrence in the unstapled laparoscopic mesh repair group, 14,15 although the follow-up was incomplete and too short to allow meaningful conclusions. The lack of definitive data has resulted in a reluctance among surgeons to leave the prosthetic mesh in place without fixation because of the risk of migration.…”

Section: Resultsmentioning

confidence: 99%

“…The follow-up in one study, 15 however, was relatively short (median 16 month, range 1 to 32) and incomplete (12% lost to follow-up and 22% of postoperative follow-ups conducted by phone). The second series 14 was somewhat limited, consisting of 92 patients with a mean follow-up of only 8 months.…”

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confidence: 99%

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Use of Fibrin Sealant for Prosthetic Mesh Fixation in Laparoscopic Extraperitoneal Inguinal Hernia Repair

et al. 2001

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ObjectiveTo evaluate the efficacy of mesh fixation with fibrin sealant (FS) in laparoscopic preperitoneal inguinal hernia repair and to compare it with stapled fixation. Summary Background DataLaparoscopic hernia repair involves the fixation of the prosthetic mesh in the preperitoneal space with staples to avoid displacement leading to recurrence. The use of staples is associated with a small but significant number of complications, mainly nerve injury and hematomas. FS (Tisseel) is a biodegradable adhesive obtained by a combination of human-derived fibrinogen and thrombin, duplicating the last step of the coagulation cascade. It can be used as an alternative method of fixation. MethodsA prosthetic mesh was placed laparoscopically into the preperitoneal space in both groins in 25 female pigs and fixed with either FS or staples or left without fixation. The method of fixation was chosen by randomization. The pigs were killed after 12 days to assess early graft incorporation. The following outcome measures were evaluated: macroscopic findings, including graft alignment and motion, tensile strength between the grafts and surrounding tissues, and histologic findings (fibrous reaction and inflammatory response). ResultsThe procedures were completed laparoscopically in 49 sites. Eighteen grafts were fixed with FS and 16 with staples; 15 were not fixed. There was no significant difference in graft motion between the FS and stapled groups, but the nonfixed mesh had significantly more graft motion than in either of the fixed groups. There was no significant difference in median tensile strength between the FS and stapled groups. The tensile strength in the nonfixed group was significantly lower than the other two groups. FS triggered a significantly stronger fibrous reaction and inflammatory response than in the stapled and control groups. No infection related to method of fixation was observed in any group. ConclusionAn adequate mesh fixation in the extraperitoneal inguinal area can be accomplished using FS. This method is mechanically equivalent to the fixation achieved by staples and superior to nonfixed grafts. Biologic soft fixation with FS will prevent early graft migration and will avoid the complications associated with staple use.Laparoscopic hernia repair is an effective technique, offering more rapid recovery and less pain than with the traditional open approach; recurrence rates are equivalent to those of the traditional open approach.

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confidence: 56%

Section: Resultsmentioning

confidence: 99%

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Use of Fibrin Sealant for Prosthetic Mesh Fixation in Laparoscopic Extraperitoneal Inguinal Hernia Repair

et al. 2001

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“…However, the largest of these two series did not specify the length of follow-up and the other one was a rather small series (n = 89). Although two randomized studies with a short follow-up of nonfixed mesh in laparoscopic repairs (one in TEP and the other in TAPP) did show promising results in terms of recurrence, 40,51 justification for routine nonstapling of the mesh in TEP is not yet substantiated. 13 The low rate of chronic pain complications was similarly observed in many studies by avoiding stapling.This confirms that mesh stapling does play a key role in generating postoperative pain after laparoscopic hernia repair.…”

Section: Discussionmentioning

confidence: 99%

“…14 Stapling of the mesh, which may lead to nerve injury and osteitis pubis, has been identified as one of the possible causes of the persistence or development of pain after hernia surgery. 15,17 …”

Section: Introductionmentioning

confidence: 99%

Fibrin Sealant versus Use of Tackers for Fixation of Mesh in Laparoscopic Inguinal Hernia Repair

Shinde¹

2009

WJOLS

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Background: Laparoscopic fixation of meshes prior to their fibrous incorporation should be reliable to minimize recurrences following transabdominal preperitoneal hernia repair (TAPP) and totally extraperitoneal repair (TEP) repair of inguinal hernias. However, suture, tack and staple-based fixation systems are associated with postoperative chronic inguinal pain. Initial fixation with fibrin sealant offers an atraumatic alternative, but there is little data showing that fibrin-based mesh adhesion provides adequate biomechanical stability for repair of inguinal hernia by TAPP and TEP.Methods: A literature search was performed using medline and the search Google, Springer link and Highwire press. The following search terms were used: Laparoscopic hernia mesh, Fibrin glue, and Tackers. 2293 citations were found in total.Selected papers were screened for further references. Criteria for selection of literature were the number of cases (excluded if less than 80), methods of analysis (statistical or nonstatistical), operative procedure (only universally accepted procedures were selected) and the institution where the study was done (specialized institution for laparoscopic surgery).Results: Mesh fixation has always invited lots of interest amongst surgeons and instrument companies due to the wide range of postoperative complications each of them caused. TAPP and TEP usually involves fixation of mesh, however many studies challenging the mesh fixation in TEP are being published. There are two most common methods of fixing mesh using fibrin glue (Tissucol) and tackers. Fibrin sealant possesses both mechanical strength and elasticity. Overall, data from previous studies, shows that mesh stability with fibrin sealant fixation is at least equivalent to suture fixation, indicating that fibrin sealant could be considered the fixation method of choice in inguinal hernia repair. This new method of mesh fixation is obviously potentially less harmful than stapling the mesh and can help reduce the risk of chronic postoperative pain at a comparative or even lower cost than a stapling device. Conclusions:Fibrin glue gives an adequate mesh fixation with a less chance of chronic postoperative pain. It appears to be an alternative to staples and may help reduce the postoperative pain problems after hernia repair. All methods give the same results in terms of recurrence rate, hospital stay, and costs; but with better results in terms of postoperative pain, seromas, and trocar-related trauma. However the use of fibrin glue needs extensive study, as the anatomical dissection and inguinal region preparation have to be carefully performed, and the mesh size has to be adequate; peritoneum closure with a running suture is more time consuming. Large randomized trials and longer follow-up are required to demonstrate the advantages of either technique.

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Selective Non-Stapling of Mesh During Unilateral Endoscopic Total Extraperitoneal Inguinal Hernioplasty

Lau

Patil²

2003

Arch Surg

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Stapled and nonstapled laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair

Abstract: It is not necessary to secure the mesh during laparoscopic TAPP inguinal hernia repair, allowing a reduction in the size of the ports.

Cited by 116 publications

References 3 publications

Use of Fibrin Sealant for Prosthetic Mesh Fixation in Laparoscopic Extraperitoneal Inguinal Hernia Repair

Use of Fibrin Sealant for Prosthetic Mesh Fixation in Laparoscopic Extraperitoneal Inguinal Hernia Repair

Fibrin Sealant versus Use of Tackers for Fixation of Mesh in Laparoscopic Inguinal Hernia Repair

Selective Non-Stapling of Mesh During Unilateral Endoscopic Total Extraperitoneal Inguinal Hernioplasty

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