title: Mesh Fixation with Fibrin Sealant in Totally Extraperitoneal Hernia Repair.
abstract: BACKGROUND
  Repair of inguinal hernia is a common procedure, but there is a lack of consensus as to the optimal repair technique along with the use of mesh and methods of mesh fixation. The objective of this study was to evaluate the efficacy and safety of fibrin sealant for mesh fixation in laparoscopic totally extraperitoneal (TEP) inguinal hernia repair.
  
  
  METHODS
  A study was conducted of the first 200 patients undergoing TEP hernia repair with mesh fixation using fibrin sealant between March 2012 and January 2014. The primary outcome measures were (1) chronic pain (persisting for >3 months), (2) persistence of hernia (recurrence identified within first 2 weeks postoperatively), (3) hernia recurrence, and (4) any additional perioperative complications. The mean follow-up in the series was 34.4 ± 6.1 months (range 22.2-44.1).
  
  
  RESULTS
  Of the 278 hernias repaired in 204 patients (74 bilateral, 130 unilateral), 38 were recurrent and 240 were primary. Three patients (1.5%) had a persistent hernia, including one with a planned return to the operating room the next day due to poor visualization. Three patients (1.5%) had a hernia recurrence. Twelve patients (5.9%) reported experiencing chronic pain. The remaining complications were minor and resolved over time.
  
  
  CONCLUSIONS
  TEP repair of inguinal hernia using mesh secured with fibrin sealant can be effectively used to treat primary, recurrent, unilateral, and bilateral inguinal hernias in adults with minimal recurrence rates and complications during almost 3 years of follow-up.
authors.affiliation: Lankenau Medical Center , General Surgery, Wynnewood, Pennsylvania.
authors.forename: Hank
authors.initials: H
authors.lastname: Hirsch
authors.affiliation: Lankenau Medical Center , General Surgery, Wynnewood, Pennsylvania.
authors.forename: Kei
authors.initials: K
authors.lastname: Nagatomo
authors.affiliation: Lankenau Medical Center , General Surgery, Wynnewood, Pennsylvania.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Gefen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D015718:Fibrin Tissue Adhesive; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013526:Surgical Mesh; D016896:Treatment Outcome
chemical_list: D015718:Fibrin Tissue Adhesive
keywords: TEP; fibrin sealant; inguinal hernia repair; mesh repair; totally extraperitoneal