Long-term outcome and chronic pain in atraumatic fibrin glue versus staple fixation of extra light titanized meshes in laparoscopic inguinal hernia repair (TAPP): a single-center experience

Abstract

Background

Inguinal hernia repair belongs to the most frequently performed surgical procedures. Endoscopic techniques like TAPP and TEP have become standard of care together with the conventional open techniques. Especially in endoscopic techniques, there is a confusing amount of different meshes and fixation techniques with impact on perioperative and long-term outcome. We present the first single-center data on the use of titanized extra lightweight meshes and fibrin glue fixation compared to staple fixation regarding long-term outcome, especially chronic pain.

Materials and methods

A clinical trial with retrospective analysis of patient- and procedure-related data and questionnaire-based follow-up of TAPP procedures performed in 2012–2014 was conducted in a specialized hernia center. Standard TAPP technique was used with placement of TiMesh extra light (16 g/m2) and either fibrin glue or staple fixation. Procedure- and patient-related data are compared after propensity score matching regarding perioperative complications and long-term outcome.

Results

Of 612 TAPP procedures 372 procedures were included in analysis after propensity score matching. Fibrin glue was used in n = 279 and staple fixation in n = 93 cases. There were significant differences regarding duration of the surgical procedures (p = 0.001) and distribution of mesh size. No differences were noted regarding perioperative complications such as seroma or hematoma formation and need for re-laparoscopy. During a mean follow-up of 32.1 ± 20.6 month with a follow-up rate of 79%, there was no difference in long-term outcome, especially for rate of recurrence (p = 0.112) and development of chronic pain (p = 0.846). The overall rate of recurrence was 3.0% (n = 11), and in 2.4% (n = 9) patients complained of chronic pain.

Conclusion

Inguinal hernia repair using extra lightweight titanized meshes and fibrin glue fixation is safe and feasible compared to staple fixation even in large and combined hernia defects, if mesh size is adjusted to size of hernia defect. The rate of chronic pain was extremely low at 2.4%.

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Funding

Financial support for this study was given by pfm medical AG, Cologne, Germany.

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Correspondence to Ulrich Wirth.

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This study was supported by a grant to cover all administrative fees by pfm medical Ag, Cologne. Hans Martin Schardey received reimbursement for travel costs from pfm medical Ag, Cologne and worked as a consultant for pfm medical Ag, Cologne; Johnson & Johnson, Norderstedt; LifeCell Corporation, Branchburg, USA. Ferdinand Köckerling received grants to fund the Herniamed Registry from Johnson & Johnson, Norderstedt; pfm medical, Cologne; Dahlhausen, Cologne; B Braun, Tuttlingen; MenkeMed, Munich and Bard, Karlsruhe. The authors did not receive any payments. Ulrich Wirth, Thomas von Ahnen, Marie Luise Saller and Stefan Schopf have no conflicts of interest or financial ties to disclose.

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Wirth, U., Saller, M.L., von Ahnen, T. et al. Long-term outcome and chronic pain in atraumatic fibrin glue versus staple fixation of extra light titanized meshes in laparoscopic inguinal hernia repair (TAPP): a single-center experience. Surg Endosc 34, 1929–1938 (2020). https://doi.org/10.1007/s00464-019-06965-x

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Keywords

  • TAPP
  • Inguinal hernia
  • TiMesh® extra light
  • Fibrin sealant fixation
  • Laparoscopic hernia repair
  • Chronic pain