Helvind Neel Maria, Andresen Kristoffer, Rosenberg Jacob
Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, 2730, Herlev, Denmark,
Surg Endosc. 2013 Nov;27(11):4184-91. doi: 10.1007/s00464-013-3018-0. Epub 2013 May 30.
Groin hernia repair may be associated with long-term complications such as chronic pain, believed to result from damage to regional nerves by tissue penetrating mesh fixation. Studies have shown that mesh fixation with fibrin sealant reduces the risk of these long-term complications, but data on recurrence and reoperation rates after the use of fibrin sealant compared with tacks are not available. This study aimed to determine whether fibrin sealant is a safe and feasible alternative to tacks with regard to reoperation rates after laparoscopic groin hernia repair.
The current study compared reoperation rates after laparoscopic groin hernia repair between fibrin sealant and tacks used for mesh fixation. The study used data collected prospectively from The National Danish Hernia Database and analyzed 8,314 laparoscopic groin hernia repairs for reoperation rates. Mesh fixation was performed with fibrin sealant (n = 784) or tacks (n = 7,530).
The findings showed a significantly lower reoperation rate for the fibrin sealant than for the tacks (0.89 vs 2.94 %, p = 0.031). The median follow-up period was 17 months (range, 0-44 months) for the fibrin sealant group and 21 months (range, 0-44 months) for the tacks group.
Fibrin sealant was superior to tacks for mesh fixation in laparoscopic groin hernia repair with regard to reoperation rates. The study could not differentiate between different hernia defect sizes, and future studies should therefore explore whether the superior effect of fibrin sealant applies for all hernia types and sizes.
腹股沟疝修补术可能会伴有诸如慢性疼痛等长期并发症，据信这是由于组织穿透性网片固定对局部神经造成损伤所致。研究表明，使用纤维蛋白胶进行网片固定可降低这些长期并发症的风险，但与钉合相比，使用纤维蛋白胶后的复发率和再次手术率的数据尚无可用资料。本研究旨在确定在腹腔镜腹股沟疝修补术后的再次手术率方面，纤维蛋白胶是否是钉合的一种安全可行的替代方法。
本研究比较了在腹腔镜腹股沟疝修补术中使用纤维蛋白胶和钉合进行网片固定后的再次手术率。该研究使用了从丹麦国家疝数据库前瞻性收集的数据，并分析了8314例腹腔镜腹股沟疝修补术的再次手术率。网片固定采用纤维蛋白胶（n = 784）或钉合（n = 7530）。
研究结果显示，纤维蛋白胶组的再次手术率显著低于钉合组（0.89% 对 2.94%，p = 0.031）。纤维蛋白胶组的中位随访期为17个月（范围0 - 44个月），钉合组为21个月（范围0 - 44个月）。
在腹腔镜腹股沟疝修补术中，就再次手术率而言，纤维蛋白胶在网片固定方面优于钉合。本研究无法区分不同的疝缺损大小，因此未来的研究应探讨纤维蛋白胶的优越效果是否适用于所有类型和大小的疝。
