Amit Kaul, MD, Susan Hutfless, PhD, Senan A Hamed, MD, Kevin Tymitz, MD, Hamilton Le, MD, Hien Nguyen, MD, Michael Marohn, MD. Johns Hopkins University School of Medicine
INTRODUCTION – Fixation of mesh is typically performed to minimize risk of recurrence in laparoscopic inguinal hernia repair. Mesh fixation with staples has been implicated as a cause of chronic inguinal pain. Our study aim was to compare mesh fixation using a fibrin sealant versus staple fixation in laparoscopic inguinal hernia and compare outcomes for hernia recurrence and chronic inguinal pain. METHODS AND PROCEDURES – PUBMED was searched through September 2010 by use of specific search terms. Inclusion criteria were laparoscopic Total Extra Peritoneal (TEP) inguinal hernia repair, and comparison of both mesh fibrin glue fixation and mesh staple fixation. Primary outcomes were inguinal hernia recurrence and chronic inguinal pain. Secondary outcomes were operative time, seroma formation, hospital stay and time to return to normal activity. Pooled odds ratio (OR) were calculated assuming fixed-effects models.RESULTS – Four reports were included in the review. A total of 662 repairs were included, of which mesh was fixed by staples or tacks in 394, and mesh fixed by fibrin glue in 268. There was no difference in inguinal hernia recurrence with fixation of mesh by staples/ tacks versus fibrin glue (OR 2.13; 95% Confidence Interval [CI] 0.60-7.63). Chronic inguinal pain (at 3 months) incidences were significantly higher with staple/ tack fixation (OR 3.25; 95% CI 1.62 – 6.49). There was no significant difference in operative time, seroma formation, hospital stay, or time to return to normal activities.CONCLUSION(S) – Meta-analysis of laparoscopic inguinal hernia mesh fixation technique comparing fibrin sealant versus staple or tack fixation finds both effective with no difference when measuring inguinal hernia recurrence rates. When postoperative groin pain is compared, however, meta-analysis favors mesh fixation with fibrin glue, with a lower incidence of chronic groin pain. Because fibrin glue mesh fixation in laparoscopic inguinal hernia repair achieves similar hernia recurrence rates compared with staple/ tack fixation, but decreased incidence of chronic inguinal pain, it may be the preferred technique.
Program Number: S079