Post-operative benefits of Tisseel(®)/Tissucol (®) for mesh fixation in patients undergoing Lichtenstein inguinal hernia repair: secondary results from the TIMELI trial.

Abstract

PURPOSE:

The Tisseel/Tissucol for mesh fixation in Lichtenstein hernia repair (TIMELI) study showed that mesh fixation with human fibrin sealant during inguinal hernia repair significantly reduced moderate-severe complications of pain 12 months post-operatively compared with sutures. Further analyses may assist surgeons by investigating predictors of post-surgical complications and identifying patients that may benefit from Tisseel/Tissucol intervention.

METHODS:

Univariate and multivariate analyses identified risk factors for combined pain, numbness and groin discomfort (PND) visual analogue scale (VAS) score 12 months post-operatively. Variables tested were: fixation method, age, employment status, physical activity, nerve handling, PND VAS score at pre-operative visit and 1 week post-operatively. The effect of fixation technique on separate PND outcomes 12 months post-surgery was also assessed. Analyses included the intention-to-treat (ITT) population and a subpopulation with pre-operative PND VAS > 30 mm.

RESULTS:

316 patients were included in the ITT, with 130 patients in the subpopulation with pre-operative PND VAS > 30. Multivariate analysis identified mesh fixation with sutures, worsening pre-operative PND and worsening PND 1 week post-surgery as significant predictors of 12-month PND in the ITT population; mesh fixation with sutures was a significant predictor of 12-month PND in the pre-operative PND VAS > 30 subpopulation (p < 0.05). Mesh fixation with Tisseel/Tissucol resulted in significantly less numbness and a lower intensity of groin discomfort compared with sutures at 12 months; there was no difference in pain between the treatment groups.

CONCLUSIONS:

Pre-operative discomfort may be an important predictor of post-operative pain, numbness and discomfort. Tisseel/Tissucol may improve long-term morbidity over conventional sutures in these patients.

• Authors: G Campanelli, M H Pascual, A Hoeferlin, J Rosenberg, G Champault, A Kingsnorth, M Bagot d'Arc, M Miserez
• Journal: Hernia : the journal of hernias and abdominal wall surgery (Hernia) Vol. 18 Issue 5 Pg. 751-60 (Oct 2014) ISSN: 1248-9204 [Electronic] France
• PMID: 24889273 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Fibrin Tissue Adhesive

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Fibrin Tissue Adhesive (therapeutic use)
• Hernia, Inguinal (surgery)
• Herniorrhaphy (methods)
• Humans
• Hypesthesia (etiology, prevention & control)
• Male
• Middle Aged
• Pain, Postoperative (etiology, prevention & control)
• Postoperative Period
• Risk Factors
• Surgical Mesh
• Sutures (adverse effects)
• Young Adult