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Use of fibrin glue in preventing pseudorecurrence after laparoscopic total extraperitoneal repair of large indirect inguinal hernia

View Article: PubMed Central - PubMed

ABSTRACT

Purpose: Seroma is among the most common complications of laparoscopic total extraperitoneal (TEP) for especially large indirect inguinal hernia, and may be regarded as a recurrence by some patients. A potential area localized behind the mesh and extending from the inguinal cord into the scrotum may be one of the major etiological factors of this complication. Our aim is to describe a novel technique in preventing pseudorecurrence by using fibrin sealant to close that potential dead space.

Methods: Forty male patients who underwent laparoscopic TEP for indirect inguinal hernia with at least 100-mL volume were included in this prospective clinical study. While fibrin sealant was used to close the potential dead space in the study group, nothing was used in the control group. The volume of postoperative fluid collection on ultrasound was compared between the groups.

Results: Patient characteristics and the volumes of hernia sac were similar between the 2 groups. The mean volume of postoperative fluid collection was found as 120.2 mL in the control group and 53.7 mL in the study group, indicating a statistical significance (P < 0.001).

Conclusion: Minimizing the potential dead space with a fibrin sealant can reduce the amount of postoperative fluid collection, namely the incidence of pseudorecurrence.

No MeSH data available.


Related in: MedlinePlus

The image of a pseudorecurrence following laparoscopic total extraperitoneal for left scrotal hernia in a patient of control group.
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Figure 2: The image of a pseudorecurrence following laparoscopic total extraperitoneal for left scrotal hernia in a patient of control group.

Mentions: Although the first report on using fibrin sealants for mesh fixation had a primary aim of reducing the recurrence rate [18], minimizing bleeding complications and postoperative chronic groin pain were other primary endpoints in subsequent studies [1119202122]. However, postoperative seroma, in other words pseudorecurrence, is also an important and common complication of laparoscopic large hernia repair (Fig. 2). It is well known that fluid collection at the surgical site is a normal process of wound healing depending on inflammatory response directly related to various surgical applications such as cutting, catheterization, suturation, etc. The extent of dissecting area, being old or recurrent hernia, and use of prosthetic patch also contribute to the development of fluid collection. The effectiveness of an adhesive material for mesh fixation in inguinal hernia repair upon seroma formation has not been clearly demonstrated. Although some authors suggested otherwise, many clinical studies on this issue showed that seroma formation is less frequently seen with use of an adhesive material for mesh fixation [122023]. However, in those studies, the effectiveness of the adhesive materials was only evaluated in fixation of the prosthetic patch to the underlying tissues, instead of staples, tacks, or sutures. It is fact that a potential dead space located behind the mesh and extending along the inguinal canal into the scrotum occurs after retraction of indirect hernia sac towards the abdomen and placement of mesh during laparoscopic hernia repair. In addition, depending on our experience in laparoscopic surgery, we suggest that the size of this potential dead space takes an important place in the occurrence of pseudorecurrence, and therefore minimizing its size can reduce the amount of fluid collection. As far as we know, there is no clinical study regarding any intervention of the dead space. Hence, our work is the first report on this topic in the literature. It should be noted here that fibrin sealant was only used to close the dead space, and the fixation of the mesh to the standard points was performed by tacks. The study was designed in this form in order to determine the effect of fibrin sealant alone on the development of pseudorecurrence.


Use of fibrin glue in preventing pseudorecurrence after laparoscopic total extraperitoneal repair of large indirect inguinal hernia
The image of a pseudorecurrence following laparoscopic total extraperitoneal for left scrotal hernia in a patient of control group.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5016602&req=5

Figure 2: The image of a pseudorecurrence following laparoscopic total extraperitoneal for left scrotal hernia in a patient of control group.
Mentions: Although the first report on using fibrin sealants for mesh fixation had a primary aim of reducing the recurrence rate [18], minimizing bleeding complications and postoperative chronic groin pain were other primary endpoints in subsequent studies [1119202122]. However, postoperative seroma, in other words pseudorecurrence, is also an important and common complication of laparoscopic large hernia repair (Fig. 2). It is well known that fluid collection at the surgical site is a normal process of wound healing depending on inflammatory response directly related to various surgical applications such as cutting, catheterization, suturation, etc. The extent of dissecting area, being old or recurrent hernia, and use of prosthetic patch also contribute to the development of fluid collection. The effectiveness of an adhesive material for mesh fixation in inguinal hernia repair upon seroma formation has not been clearly demonstrated. Although some authors suggested otherwise, many clinical studies on this issue showed that seroma formation is less frequently seen with use of an adhesive material for mesh fixation [122023]. However, in those studies, the effectiveness of the adhesive materials was only evaluated in fixation of the prosthetic patch to the underlying tissues, instead of staples, tacks, or sutures. It is fact that a potential dead space located behind the mesh and extending along the inguinal canal into the scrotum occurs after retraction of indirect hernia sac towards the abdomen and placement of mesh during laparoscopic hernia repair. In addition, depending on our experience in laparoscopic surgery, we suggest that the size of this potential dead space takes an important place in the occurrence of pseudorecurrence, and therefore minimizing its size can reduce the amount of fluid collection. As far as we know, there is no clinical study regarding any intervention of the dead space. Hence, our work is the first report on this topic in the literature. It should be noted here that fibrin sealant was only used to close the dead space, and the fixation of the mesh to the standard points was performed by tacks. The study was designed in this form in order to determine the effect of fibrin sealant alone on the development of pseudorecurrence.

View Article: PubMed Central - PubMed

ABSTRACT

Purpose: Seroma is among the most common complications of laparoscopic total extraperitoneal (TEP) for especially large indirect inguinal hernia, and may be regarded as a recurrence by some patients. A potential area localized behind the mesh and extending from the inguinal cord into the scrotum may be one of the major etiological factors of this complication. Our aim is to describe a novel technique in preventing pseudorecurrence by using fibrin sealant to close that potential dead space.

Methods: Forty male patients who underwent laparoscopic TEP for indirect inguinal hernia with at least 100-mL volume were included in this prospective clinical study. While fibrin sealant was used to close the potential dead space in the study group, nothing was used in the control group. The volume of postoperative fluid collection on ultrasound was compared between the groups.

Results: Patient characteristics and the volumes of hernia sac were similar between the 2 groups. The mean volume of postoperative fluid collection was found as 120.2 mL in the control group and 53.7 mL in the study group, indicating a statistical significance (P < 0.001).

Conclusion: Minimizing the potential dead space with a fibrin sealant can reduce the amount of postoperative fluid collection, namely the incidence of pseudorecurrence.

No MeSH data available.


Related in: MedlinePlus