title: Reducing postoperative pain: the use of Tisseel for mesh fixation in inguinal hernia repair.
abstract: BACKGROUND
  The new objective in primary hernia surgery should be the reduction of disabling chronic pain. This article will discuss the safety, efficacy, and reduction of pain of a sutureless glue mesh procedure for primary uncomplicated inguinal hernia repair.
  
  
  METHODS
  We began performing sutureless glue mesh repairs in 2004 for primary uncomplicated inguinal hernias with good results. After reduction of the hernia sac, polypropylene medium-weight preshaped flat mesh is fixed to the posterior inguinal wall with 0.5 mL of fibrin glue on the pubic tubercle; another 1.5 mL is sprayed on the entire mesh surface. The cord is positioned in subcutaneous space. The TI.ME.LI (Tissucol/Tisseel for MEsh fixation in LIchtenstein hernia repair) trial was planned and conducted based on this experience.
  
  
  RESULTS
  In two years, we treated more than 600 primary inguinal hernias with fibrin glue mesh fixation repair. At follow-up (2 to 96 months after surgery), no patients presented with severe pain, 2.7% of patients complained of moderate pain.
  
  
  CONCLUSIONS
  Fibrin sealant for mesh fixation in open repair is well tolerated and it should be considered as a first-line option for mesh fixation in open inguinal hernia repair.
authors.affiliation: Insubria University of Varese, Department of General Surgery, Istituto Clinico Sant'Ambrogio, Milano, Italy.
authors.forename: Giampiero
authors.initials: G
authors.lastname: Campanelli
authors.forename: Cristina
authors.initials: C
authors.lastname: Sfeclan
authors.forename: Marta
authors.initials: M
authors.lastname: Cavalli
authors.forename: Antonio
authors.initials: A
authors.lastname: Biondi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D006552:Hernia, Inguinal / Q000453:epidemiology* / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000453:epidemiology* / Q000517:prevention & control*; D019919:Prosthesis Implantation / Q000379:methods / Q000706:statistics & numerical data; D012307:Risk Factors; D013526:Surgical Mesh / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015718:Fibrin Tissue Adhesive