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Fibrin glue for intraperitoneal laparoscopic mesh fixation: a comparative study in a swine model

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Abstract

Background

The classic method of mesh fixation in laparoscopic ventral hernia repair is transfascial sutures with tacks. This method has been associated with low recurrence rates, but yields significant morbidity from pain and bleeding. Fibrin glue has been used successfully in inguinal hernia repair with decreased incidence of chronic pain without an increase in recurrence rates, but its utility for laparoscopic ventral hernia repair is unknown. Our aim is to evaluate the efficacy of fibrin glue for laparoscopic mesh fixation to the anterior abdominal wall compared with other fixation methods.

Methods

Four different laparoscopic mesh fixation methods were randomly assigned to midline positions along the abdominal wall of 12 female pigs and compared: (1) fibrin glue only (GO), (2) transfascial sutures with tacks (ST), (3) fibrin glue with tacks (GT), and (4) tacks only (TO). At 4 weeks post implantation, tensile strength, adhesions, migration, contraction, and buckling/folding were assessed using Kruskal–Wallis one-way analysis by ranks test.

Results

There were no significant differences in tensile strength, adhesions or buckling/folding among the four fixation methods. A significant increase in mean migration (3.3 vs. 0.0 mm, p = 0.03) and percentage contraction (28% vs. 14%, p = 0.02) were identified in the GO group when compared with ST (see Table 3).

Conclusions

Mesh fixation using fibrin glue has comparable tensile strength and adhesion rate to sutures with tacks in the swine model. Increased contraction and migration rates associated with fibrin glue alone may be an issue and warrants further study. On the other hand, the GT group showed similar biomechanical characteristics to the other groups and may represent a reasonable alternative to the use of transfascial sutures.

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References

  1. Chelala E, Gaede F, Douillez V, Dessily M, Alle JL (2003) The suturing concept for laparoscopic mesh fixation in ventral and incisional hernias: preliminary results. Hernia 7(4):191–196

    PubMed  CAS  Google Scholar 

  2. Heniford BT, Park A, Ramshaw BJ, Voeller G (2003) Laparoscopic repair of ventral hernias: nine years’ experience with 850 consecutive hernias. Ann Surg 238(3):391–399

    PubMed  Google Scholar 

  3. Heniford BT, Park A, Ramshaw BJ, Voeller G (2000) Laparoscopic ventral and incisional hernia repair in 407 patients. J Am Coll Surg 190(6):645–650

    Article  PubMed  CAS  Google Scholar 

  4. LeBlanc KA (2007) Laparoscopic incisional hernia repair: are transfascial sutures necessary? A review of the literature. Surg Endosc 21(4):508–513

    Article  PubMed  CAS  Google Scholar 

  5. Olmi S, Scaini A, Erba L, Bertolini A, Croce E (2007) Laparoscopic repair of inguinal hernias using an intraperitoneal onlay mesh technique and a Parietex composite mesh fixed with fibrin glue (Tissucol). Personal technique and preliminary results. Surg Endosc 21(11):1961–1964

    Article  PubMed  Google Scholar 

  6. van der Linden FT, van Vroonhoven TJ (1988) Long-term results after surgical correction of incisional hernia. Neth J Surg 40(5):127–129

    PubMed  Google Scholar 

  7. Carbajo MA, Martin del Olmo JC, Blanco JI, de la Cuesta C, Toledano M, Martin F, Vaquero C, Inglada L (1999) Laparoscopic treatment vs open surgery in the solution of major incisional and abdominal wall hernias with mesh. Surg Endosc 13(3):250–252

    Article  PubMed  CAS  Google Scholar 

  8. DeMaria EJ, Moss JM, Sugerman HJ (2000) Laparoscopic intraperitoneal polytetrafluoroethylene (PTFE) prosthetic patch repair of ventral hernia. Prospective comparison to open prefascial polypropylene mesh repair. Surg Endosc 14(4):326–329

    Article  PubMed  CAS  Google Scholar 

  9. Itani KM, Neumayer L, Reda D, Kim L, Anthony T (2004) Repair of ventral incisional hernia: the design of a randomized trial to compare open and laparoscopic surgical techniques. Am J Surg 188(6A Suppl):22S–29S

    Article  PubMed  Google Scholar 

  10. Park A, Birch DW, Lovrics P (1998) Laparoscopic and open incisional hernia repair: a comparison study. Surgery 124(4):816–821

    Article  PubMed  CAS  Google Scholar 

  11. Ramshaw BJ, Esartia P, Schwab J, Mason EM, Wilson RA, Duncan TD, Miller J, Lucas GW, Promes J (1999) Comparison of laparoscopic and open ventral herniorrhaphy. Am Surg 65(9):827–831

    PubMed  CAS  Google Scholar 

  12. Schwab R, Schumacher O, Junge K, Binnebosel M, Klinge U, Schumpelick V (2007) Fibrin sealant for mesh fixation in Lichtenstein repair: biomechanical analysis of different techniques. Hernia 11(2):139–145

    Article  PubMed  CAS  Google Scholar 

  13. Ben-Haim M, Kuriansky J, Tal R, Zmora O, Mintz Y, Rosin D, Ayalon A, Shabtai M (2002) Pitfalls and complications with laparoscopic intraperitoneal expanded polytetrafluoroethylene patch repair of postoperative ventral hernia. Surg Endosc 16(5):785–788

    Article  PubMed  CAS  Google Scholar 

  14. Riet M, Steenwijk PJ, Kleinrensink GJ, Steyerberg EW, Bonjer HJ (2002) Tensile strength of mesh fixation methods in laparoscopic incisional hernia repair. Surg Endosc 16(12):1713–1716

    Article  Google Scholar 

  15. Petter-Puchner AH, Fortelny R, Mittermayr R, Ohlinger W, Redl H (2005) Fibrin sealing versus stapling of hernia meshes in an onlay model in the rat. Hernia 9(4):322–329

    Article  PubMed  Google Scholar 

  16. Novik B, Hagedorn S, Mörk UB, Dahlin K, Skullman S, Dalenback J (2006) Fibrin glue for securing the mesh in laparoscopic totally extraperitoneal inguinal hernia repair: a study with a 40-month prospective follow-up period. Surg Endosc 20(3):462–467

    Article  PubMed  CAS  Google Scholar 

  17. Khajanchee YS, Urbach DR, Swanstrom LL, Hansen PD (2001) Outcomes of laparoscopic herniorrhaphy without fixation of mesh to the abdominal wall. Surg Endosc 15(10):1102–1107

    Article  PubMed  CAS  Google Scholar 

  18. Taylor C, Layani L, Liew V, Ghusn M, Crampton N, White S (2007) Laparoscopic inguinal hernia repair without mesh fixation, early results of a large randomised clinical trial. Surg Endosc 22(3):757–762

    Article  PubMed  Google Scholar 

  19. Morris-Stiff GJ, Hughes LE (1998) The outcomes of nonabsorbable mesh placed within the abdominal cavity: literature review and clinical experience. J Am Coll Surg 186(3):352–367

    Article  PubMed  CAS  Google Scholar 

  20. Novitsky YW, Cobb WS, Kercher KW, Matthews BD, Sing RF, Heniford BT (2006) Laparoscopic ventral hernia repair in obese patients: a new standard of care. Arch Surg 141(1):57–61

    Article  PubMed  Google Scholar 

  21. Schwab R, Willms A, Kröger A, Becker HP (2006) Less chronic pain following mesh fixation using a fibrin sealant in TEP inguinal hernia repair. Hernia 10(3):272–277

    Article  PubMed  CAS  Google Scholar 

  22. Smietański M, Bigda J, Iwan K, Kolodziejczyk M, Krajewski J, Smietanska IA, Gumiela P, Bury K, Bielecki S, Sledzinski Z (2007) Assessment of usefulness exhibited by different tacks in laparoscopic ventral hernia repair. Surg Endosc 21(6):925–928

    Article  PubMed  Google Scholar 

  23. Wassenaar E, Schoenmaeckers E, Raymakers J, van der Palen J, Rakic S (2009) Mesh-fixation method and pain and quality of life after laparoscopic ventral or incisional hernia repair: a randomized trial of three fixation techniques. Surg Endosc. doi:10.1007/s00464-009-0763-1

  24. Eriksen JR, Poornoroozy P, Jorgensen LN, Jacobsen LN, Jacobsen B, Friis-Andersen HU, Rosenberg J (2009) Pain, quality of life and recovery after laparoscopic ventral hernia repair. Hernia 13(1):13–21

    Article  PubMed  CAS  Google Scholar 

  25. Joels CS, Matthews BD, Kercher KW, Austin C, Norton HJ, Williams TC, Heniford BT (2005) Evaluation of adhesion formation, mesh fixation strength, and hydroxyproline content after intraabdominal placement of polytetrafluoroethylene mesh secured using titanium spiral tacks, nitinol anchors, and polypropylene suture or polyglactin 910 suture. Surg Endosc 19(6):780–785

    Article  PubMed  CAS  Google Scholar 

  26. Lau H (2005) Fibrin sealant versus mechanical stapling for mesh fixation during endoscopic extraperitoneal inguinal hernioplasty: a randomized prospective trial. Ann Surg 242(5):670–675

    Article  PubMed  Google Scholar 

  27. Olmi S, Erba L, Bertolini A, Scaini A, Croce E (2006) Fibrin glue for mesh fixation in laparoscopic transabdominal preperitoneal (TAPP) hernia repair: indications, technique, and outcomes. Surg Endosc 20(12):1846–1850

    Article  PubMed  CAS  Google Scholar 

  28. Gaboriau HP, Belafsky PC, Pahlavan N, Amedee RG (1999) Closure of mucosal defects over exposed mandibular plates using fibrin glue. Arch Facial Plast Surg 1(3):191–194

    Article  PubMed  CAS  Google Scholar 

  29. Karaçala N, Çobanoğlub U, Ambarcioğlua O, Kutlua N (2007) The effect of fibrin glue on fat graft survival. J Plastic Recon Aesth Surg 60(3):300–303

    Article  Google Scholar 

  30. Ceccarelli G, Casciola L, Pisanelli MC, Bartoli A, Zitti L, Spaziani A, Biancafarina A, Stefanoni M, Patriti A (2008) Comparing fibrin sealant with staples for mesh fixation in laparoscopic transabdominal hernia repair: a case control-study. Surg Endosc 22(3):668–673

    Article  PubMed  Google Scholar 

  31. Santoro E, Agresta F, Buscaglia F, Mulieri G, Mazzarolo G, Bedin N, Mulieri M (2007) Preliminary experience using fibrin glue for mesh fixation in 250 patients undergoing minilaparoscopic transabdominal preperitoneal hernia repair. J Laparoendosc Adv Surg Tech 17(1):12–15

    Article  Google Scholar 

  32. Canonico S, Santoriello A, Campitiello F, Fattopace A, Corte AD, Sordelli I, Benevento R (2005) Mesh fixation with human fibrin glue (Tissucol) in open tension-free inguinal hernia repair: a preliminary report. Hernia 9(4):330–333

    Article  PubMed  CAS  Google Scholar 

  33. Katkhouda N (2004) A new technique for laparoscopic hernia repair using fibrin sealant. Surg Technol Int 12:120–126

    PubMed  Google Scholar 

  34. Katkhouda N, Mavor E, Friedlander MH, Mason RJ, Kiyabu M, Grant SW, Achanta K, Kirkman EL, Narayanan K, Essani R (2001) Use of fibrin sealant for prosthetic mesh fixation in laparoscopic extraperitoneal inguinal hernia repair. Ann Surg 233(1):18–25

    Article  PubMed  CAS  Google Scholar 

  35. Christoforoni PM, Kim YB, Preys Z, Lay RY, Montz FJ (1996) Adhesion formation after incisional hernia repair: a randomized porcine trial. Am Surg 62(11):935–938

    PubMed  CAS  Google Scholar 

  36. Leblanc KA, Whitaker JM, Bellanger DE, Rhynes VK (2003) Laparoscopic incisional and ventral hernioplasty: Lessons learned from 200 patients. Hernia 7(3):118–124

    Article  PubMed  CAS  Google Scholar 

  37. Olmi S, Scaini A, Erba L, Guaglio M, Croce E (2007) Quantification of pain in laparoscopic transabdominal preperitoneal (TAPP) inguinal hernioplasty identifies marked differences between prosthesis fixation systems. Surgery 142(1):40–46

    Article  PubMed  Google Scholar 

  38. Hidalgo M, Castillo MJ, Eymar JL, Hidalgo A (2005) Lichtenstein inguinal hernioplasty: sutures versus glue. Hernia 9(3):242–244

    Article  PubMed  CAS  Google Scholar 

  39. Topart P, Vandenbroucke F, Lozac’h P (2005) Tisseel versus tack staples as mesh fixation in totally extraperitoneal laparoscopic repair of groin hernias: a retrospective analysis. Surg Endosc 19(5):724–727

    Article  PubMed  CAS  Google Scholar 

  40. Lovisetto F, Zonta S, Rota E, Mazzilli M, Bardone M, Bottero L, Faillace G, Longoni M (2007) Use of human fibrin glue (Tissucol) versus staples for mesh fixation in laparoscopic transabdominal preperitoneal hernioplasty: a prospective, randomized study. Ann Surg 245(2):222–231

    Article  PubMed  Google Scholar 

  41. Eriksen JR, Bech JI, Linnemann D, Rosenberg J (2008) Laparoscopic intraperitoneal mesh fixation with fibrin sealant (Tisseel) vs. titanium tacks: a randomised controlled experimental study in pigs. Hernia 12(5):483–491

    Article  PubMed  CAS  Google Scholar 

  42. Olmi S, Scaini A, Erba L, Croce E (2007) Use of fibrin glue (Tissucol) in laparoscopic repair of abdominal wall defects: preliminary experience. Surg Endosc 21(3):409–413

    Article  PubMed  CAS  Google Scholar 

  43. Cobb WS, Burns JM, Peindl RD, Carbonell AM, Matthews BD, Kercher KW, Heniford BT (2006) Textile analysis of heavy weight, mid-weight, and light weight polypropylene mesh in a porcine ventral hernia model. J Surg Res 136(1):1–7

    Article  PubMed  CAS  Google Scholar 

  44. Cobb WS, Kercher KW, Heniford BT (2005) The argument for lightweight polypropylene mesh in hernia repair. Surg Innov 12(1):63–69

    Article  PubMed  Google Scholar 

  45. Novitsky YW, Harrell AG, Cristiano JA, Paton BL, Norton HJ, Peindl RD, Kercher KW, Heniford BT (2007) Comparative evaluation of adhesion formation, strength of ingrowth, and textile properties of prosthetic meshes after long-term intra-abdominal implantation in a rabbit. J Surg Res 140(1):6–11

    Article  PubMed  CAS  Google Scholar 

  46. Cobb WS, Burns JM, Kercher KW, Matthews BD, Norton HJ, Heniford BT (2005) Normal intraabdominal pressure in healthy adults. J Surg Res 129(2):231–235

    Article  PubMed  Google Scholar 

  47. Gonzalez R, Fugate K, McClusky D III, Ritter M, Lederman A, Dillehay D, Smith CD, Ramshaw BJ (2005) Relationship between tissue ingrowth and mesh contraction. World J Surg 29(8):1038–1043

    Article  PubMed  Google Scholar 

  48. Schug-Pass C, Sommerer F, Tannapfel A, Lippert H, Kockerling F (2009) The use of composite meshes in laparoscopic repair of abdominal wall hernias: are there differences in biocompatibility? Experimental results obtained in a laparoscopic porcine model. Surg Endosc 23(3):487–495

    Article  PubMed  Google Scholar 

  49. Conze J, Krones CJ, Schumpelick V, Klinge U (2007) Incisional hernia: challenge of re-operations after mesh repair. Langenbecks Arch Surg 392(4):453–457

    Article  PubMed  Google Scholar 

  50. Leblanc KA, Whitaker JM (2002) Management of chronic postoperative and following incisional hernia repair with Composix mesh: a report of two cases. Hernia 6(4):194–197

    Article  PubMed  CAS  Google Scholar 

  51. Leblanc KA (2004) Laparoscopic incisional and ventral hernia repair: complications-how to avoid and handle. Hernia 8(4):323–331

    Article  PubMed  CAS  Google Scholar 

  52. Wassenaar EB, Schoenmaeckers EJ, Raymakers JT, Rakic S (2009) Recurrences after laparoscopic repair of ventral and incisional hernia: lessons learned from 505 repairs. Surg Endosc 23(4):825–832

    Article  PubMed  Google Scholar 

  53. Wadström J (1994) Hyaluronic acid modifies and reduces the inflammatory response seen after trauma and treatment with fibrin glue. In: Schlag G, Redl H (eds) Fibrin sealing in surgical and nonsurgical fields: wound healing, vol 1. Springer-Verlag, Berlin, pp 136–143

    Google Scholar 

  54. Dion YM, Laplante R, Charara J, Marois M (1994) The influence of the number of endoclips and of mesh incorporation on the strength of an experimental hernia patch repair. Surg Endosc 8(11):1324–1328

    Article  PubMed  CAS  Google Scholar 

  55. Winslow ER, Diaz S, Desai K, Meininger T, Soper NJ, Klingensmith ME (2004) Laparoscopic incisional hernia repair in a porcine model: what do transfixion sutures add? Surg Endosc 18(3):529–535

    Article  PubMed  CAS  Google Scholar 

  56. Olmi S, Addis A, Domeneghini C, Scaini A, Croce E (2007) Experimental comparison of type of Tissucol dilution and composite mesh (Parietex) for laparoscopic repair of groin and abdominal hernia: observational study conducted in a university laboratory. Hernia 11(3):211–215

    Article  PubMed  Google Scholar 

  57. Lowham AS, Filipi CJ, Fitzgibbons RJ, Stoppa R, Wantz GE, Felix EL, Crafton WB (1997) Mechanisms of hernia recurrence after preperitoneal mesh repair, traditional and laparoscopic. Ann Surg 225(4):422–431

    Article  PubMed  CAS  Google Scholar 

  58. Leber GE, Garb JL, Alexander AI, Reed WP (1998) Long-term complications associated with prosthetic repair of incisional hernias. Arch Surg 133(4):378–382

    Article  PubMed  CAS  Google Scholar 

  59. Kaufman Z, Engelberg M, Zager M (1981) Fecal fistula: a late complication of Marlex mesh repair. Dis Colon Rectum 24(7):543–544

    Article  PubMed  CAS  Google Scholar 

  60. Matthews BD, Pratt BL, Pollinger HS, Backus CL, Kercher KW, Sing RF, Heniford BT (2003) Assessment of adhesion formation to intra-abdominal polypropylene mesh and polytetrafluoroethylene mesh. J Surg Res 114(2):126–132

    Article  PubMed  CAS  Google Scholar 

  61. Karahasanoglu T, Onur E, Baca B, Hamzaoglu I, Pekmezci S, Boler DE, Kilic N, Altug T (2004) Spiral tacks may contribute to intra-abdominal adhesion formation. Surg Today 34(10):860–864

    Article  PubMed  Google Scholar 

  62. Kyzer S, Alis M, Aloni Y, Charuzi I (1999) Laparoscopic repair of postoperation ventral hernia: early postoperation results. Surg Endosc 13(9):928–931

    Article  PubMed  CAS  Google Scholar 

  63. Memisoglu K, Saribeyoglu K, Pekmezci S, Karahasanoglu T, Sen B, Bayrak I, Arbak S, Sirvanci S (2006) Mesh fixation devices and formation of intraperitoneal adhesions. J Laparoendosc Adv Surg Tech A 16:439–444

    Article  PubMed  Google Scholar 

  64. Balique JG, Benchetrit S, Bouillot JL, Flament JB, Gouillat C, Jarsaillon P, Lepere M, Mantion G, Arnaud JP, Magne E, Brunetti F (2005) Intraperitoneal treatment of incisional and umbilical hernias using an innovative composite mesh: four-year results of a prospective multicenter clinical trial. Hernia 9(1):68–74

    Article  PubMed  CAS  Google Scholar 

  65. Moreno-Egea A, Torralba JA, Girela E, Corral M, Bento M, Cartagena J, Vicente JP, Aguayo JL, Canteras M (2004) Immediate, early, and late morbidity with laparoscopic ventral hernia repair and tolerance to composite mesh. Surg Laparosc Endosc Percutan Tech 14(3):130–135

    Article  PubMed  Google Scholar 

  66. Bingener J, Kazantsev GB, Chopra S, Schwesinger WH (2004) Adhesion formation after laparoscopic ventral incisional hernia repair with polypropylene mesh: a study using abdominal ultrasound. JSLS 8(2):127–131

    PubMed  Google Scholar 

  67. Toosie K, Gallego K, Stabile BE, Schaber B, French S, De Virgilio C (2000) Fibrin glue reduces intraabdominal adhesions to synthetic mesh in a rat ventral hernia model. Am Surg 66(1):41–45

    PubMed  CAS  Google Scholar 

  68. De Virgilio C, Dubrow T, Sheppard BB, MacDonald WD, Nelson RJ, Lesavoy MA, Robertson JM (1990) Fibrin glue inhibits intra-abdominal adhesion formation. Arch Surg 125(10):1378–1382

    PubMed  Google Scholar 

  69. Sheppard BB, De Virgilio C, Bleiweis M, Milliken JC, Robertson JM (1993) Inhibition of intra-abdominal adhesions: fibrin glue in a long term model. Am Surg 59(12):786–790

    PubMed  CAS  Google Scholar 

  70. Chmielewski GW, Saxe JM, Dulchavsky SA, Diebel LN, Bailey JK (1992) Fibrin gel limits intra-abdominal adhesion formation. Am Surg 58(9):590–592

    PubMed  CAS  Google Scholar 

  71. Martin-Cartes JA, Morales-Conde S, Suarez-Grau JM, Bustos-Jimenez M, Cadet-Dussort JMH, Lopez-Bernal F, Morcillo-Azcarate J, Tutosaus-Gomez JD, Morales-Mendez S (2008) Role of fibrin glue in the prevention of peritoneal adhesions in ventral hernia repair. Surg Today 38(2):135–140

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

This project and publication was supported by a SAGES grant.

Disclosures

Authors Clarke, Katkhouda, Mason, Algra, Olasky, Moazzez, Sohn, Cheng, and Balouch have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Division of General and Laparoscopic Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, HCC1 514, Los Angeles, CA, 90033, USA

    Tatyan Clarke, Namir Katkhouda, Rodney J. Mason, Bon C. Cheng, Jeffrey Algra, Jaisa Olasky, Helen J. Sohn, Ashkan Moazzez & Maryam Balouch

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  1. Tatyan Clarke
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Correspondence to Namir Katkhouda.

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Clarke, T., Katkhouda, N., Mason, R.J. et al. Fibrin glue for intraperitoneal laparoscopic mesh fixation: a comparative study in a swine model. Surg Endosc 25, 737–748 (2011). https://doi.org/10.1007/s00464-010-1244-2

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