Schäfer Markus, Vuilleumier Henri, Di Mare Luca, Demartines Nicolas
Department of Visceral Surgery, Centre Hospitalier Universitaire Vaudois, University Hospital, Lausanne, Switzerland.
Surg Laparosc Endosc Percutan Tech. 2010 Aug;20(4):205-12. doi: 10.1097/SLE.0b013e3181ed85b3.
Fibrin sealing has recently evolved as a new technique for mesh fixation in endoscopic inguinal hernia repair. A comprehensive Medline search was carried out evaluating fibrin sealant for mesh fixation, and finally 12 studies were included (3 randomized trials, 3 nonrandomized trials, and 6 case series). The trials were assessed for operative time, seroma formation, recovery time, recurrence rate, and acute and chronic pain.There was a trend toward decreased operative times for fibrin sealing compared with mechanical stapling; however, the results for seroma formation remained contradictory. The most important finding was the reduced postoperative pain. Recovery times were lower after fibrin sealing and the recurrence rates showed no differences.Fibrin sealing for mesh fixation in the endoscopic inguinal hernia surgery is a promising alternative to mechanical stapling, which can be safely applied. As the overall quality of published data remains poor, further well-designed studies are needed until fibrin sealing can replace mechanical stapling as a new standard for mesh fixation.
纤维蛋白封闭术最近已发展成为一种在内镜下腹股沟疝修补术中固定补片的新技术。我们进行了全面的医学文献数据库检索，以评估纤维蛋白密封剂用于补片固定的情况，最终纳入了12项研究（3项随机试验、3项非随机试验和6个病例系列）。对这些试验评估了手术时间、血清肿形成、恢复时间、复发率以及急慢性疼痛情况。与机械吻合器吻合相比，纤维蛋白封闭术有使手术时间缩短的趋势；然而，血清肿形成的结果仍存在矛盾。最重要的发现是术后疼痛减轻。纤维蛋白封闭术后恢复时间更短，复发率无差异。在内镜下腹股沟疝手术中，纤维蛋白封闭术用于补片固定是一种有前景的替代机械吻合器吻合的方法，且可安全应用。由于已发表数据的整体质量仍然较差，在纤维蛋白封闭术能够取代机械吻合器吻合成为补片固定的新标准之前，还需要进一步设计完善的研究。
