• Melissa Shannon Chan, Chan Shannon Melissa, Anthony Yuen Bun Teoh, Teoh Anthony Yuen Bun, Kin Wing Chan, Chan Kin Wing, Yiu Chung Tang, Tang Yiu Chung, Enders Kwok Wai Ng, Ng Enders Kwok Wai, Hong Tat Leong, and Leong Heng Tat.
• *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.
• Ann. Surg.. 2014 Mar 1;259(3):432-7.

ObjectiveThe 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).BackgroundThe most appropriate method of mesh fixation is uncertain.MethodsBetween 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.ResultsDuring 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).ConclusionsFS 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].

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