Laparoscopic incisional hernia repair with fibrin glue in select patients

Abstract

Background and objective: Laparoscopic treatment of incisional hernias can be performed using different types of fixation devices and prosthesis. We present a case series of 19 patients with incisional hernias with a diameter of < 6 cm, who underwent laparoscopic repair using Hi-tex dual-side mesh, positioned intraperitoneally, fixed to the abdominal wall by fibrin glue (Tissucol).

Methods: Nineteen patients with incisional hernias < 6 cm in diameter were enrolled in this study and treated laparoscopically with Hi-tex and Tissucol. Surgical complications and patient outcomes were assessed with a clinical follow-up.

Results: Laparoscopic repair of incisional hernias by using Hi-tex mesh affixed to the parietal wall with fibrin glue was feasible and easy in patients with parietal defects < 6 cm in diameter. Mean operating time was 30 minutes. Mean hospital stay was 1.5 days. Almost no postoperative pain, major surgical complications, seroma formation, relapses, or prosthesis infection occurred during a mean follow-up of 20 months.

Conclusions: In select patients, Hi-tex mesh affixed using fibrin glue allows laparoscopic repair of incisional hernias with very good patient outcomes, especially in terms of postoperative pain and seroma formation.

Figure 1.

Hi-tex mesh fixed to a pig's parietal peritoneum with Tissucol. After 3 weeks, we noted no signs of prosthesis' degradation, a good biocompatibility, and tissular ingrowth associated with isles of new peritoneum (*).

Figure 2.

Microscopic analysis of a part of Hi-tex mesh removed 3 weeks after its fixation to the pig's parietal peritoneum with Tissucol. We noted a low inflammatory reaction and good fibroblast colonization.

Figure 3.

Mean pain scores were ranked according to the Visual Analogue Scale (0 = no pain, to 10 = worst pain) at different times (h = hours, d = days).