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Randomized Double-Blinded Prospective Trial of Fibrin Sealant Spray Versus Mechanical Stapling in Laparoscopic Total Extraperitoneal Hernioplasty

Melissa, Chan Shannon MBChB, MRCSEd*; Bun, Teoh Anthony Yuen MBChB, FRCSEd (Gen), FHKAM (Surgery)*; Wing, Chan Kin MBBS, FRCS (Edin), FHKAM (Surgery); Chung, Tang Yiu MBChB, FRCS (Edin), FHKAM (Surgery); Wai, Ng Enders Kwok MD, MBChB, FRCS (Edin), FHKAM (Surgery)*; Tat, Leong Heng MBBS, FRCS (Edin), FHKAM (Surgery)

doi: 10.1097/SLA.0b013e3182a6c513
Randomized Controlled Trials

Objective: The aim of the current study was to compare the clinical outcomes of mesh fixation with fibrin sealant (FS) spray or mechanical stapling (MS) in laparoscopic total extraperitoneal hernioplasty (TEP).

Background: The most appropriate method of mesh fixation is uncertain.

Methods: Between June 2007 and June 2011, consecutive patients with primary reducible unilateral inguinal hernia who underwent day-case laparoscopic TEP were recruited. Outcome parameters included the incidence of acute and chronic pain, recurrence rates, morbidity rates, analgesic requirements, quality-of-life (QOL) scores, and direct cost.

Results: During the study period, 130 patients were included in the study. Patients in the MS group had significantly worse pain scores on the day after operation (P = 0.006). Analgesic requirements were similar between the 2 groups (P = 0.558). At 6 months, no significant differences in the incidence of chronic pain were observed (at rest, after coughing or cycling). The incidence of seroma formation was similar between the 2 groups (P = 0.64), and no recurrences were observed at 1 year. No differences in the QOL scores were detected. The direct cost of the entire hospitalization in the FS group was less expensive (P < 0.001).

Conclusions: FS and MS are both effective methods of providing mesh fixation. FS was associated with reduced acute pain but not chronic pain. The rates of seroma formation were similar. However, the use of FS for mesh fixation was less.

The current study compared the outcomes of fibrin sealant (FS) spray versus mechanical stapling for mesh fixation during laparoscopic total extraperitoneal hernioplasty. Both modalities were effective methods of providing mesh fixation. No differences in seroma rates were observed but FS was associated with reduced acute pain and was less expensive.

*Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong; and

Ambulatory Surgery Unit, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong SAR, China.

Reprints: Teoh Anthony Yuen Bun, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong. E-mail: anthonyteoh@surgery.cuhk.edu.hk.

Disclosure: This study was not supported by any research grant, and the authors do not have any disclosures (Clinicaltrials.gov identifier: NCT01727050).

© 2014 by Lippincott Williams & Wilkins.