title: Randomized double-blinded prospective trial of fibrin sealant spray versus mechanical stapling in laparoscopic total extraperitoneal hernioplasty.
abstract: 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 expensive. [corrected].
authors.forename: Melissa Shannon
authors.initials: MS
authors.lastname: Chan
authors.affiliation: *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.
authors.forename: Chan Shannon
authors.initials: CS
authors.lastname: Melissa
authors.forename: Anthony Yuen Bun
authors.initials: AY
authors.lastname: Teoh
authors.forename: Teoh Anthony Yuen
authors.initials: TA
authors.lastname: Bun
authors.forename: Kin Wing
authors.initials: KW
authors.lastname: Chan
authors.forename: Chan Kin
authors.initials: CK
authors.lastname: Wing
authors.forename: Yiu Chung
authors.initials: YC
authors.lastname: Tang
authors.forename: Tang Yiu
authors.initials: TY
authors.lastname: Chung
authors.forename: Enders Kwok Wai
authors.initials: EK
authors.lastname: Ng
authors.forename: Ng Enders Kwok
authors.initials: NE
authors.lastname: Wai
authors.forename: Hong Tat
authors.initials: HT
authors.lastname: Leong
authors.forename: Leong Heng
authors.initials: LH
authors.lastname: Tat
mesh_terms: D000287:Administration, Topical; D004311:Double-Blind Method; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000008:administration & dosage*; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000601:surgery; D059685:Herniorrhaphy / Q000379:methods*; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D011446:Prospective Studies; D013526:Surgical Mesh; D017792:Surgical Stapling / Q000295:instrumentation*; D013537:Sutures; D014014:Tissue Adhesives / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives